Louise Downe discusses the challenges of designing government services and five things being done to scale service design. Government spends 80% of its costs on services, with 60% spent on calls and casework. Services were not designed for the internet and need to be rebuilt from the ground up. The five things being done are: 1) Reducing complexity by simplifying processes. 2) Building services around verbs rather than nouns to help people understand what to do. 3) Collaborating openly across departments as most services involve multiple teams. 4) Building standards and patterns together openly to improve services. 5) Growing internal service design teams to better design services.