Child: Family: Place: Radical Efficiency to Improve Outcomes for Young Children
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Child: Family: Place: Radical efficiency to improve outcomes for young children Croydon 2 contents Foreword..................................................................................................5 Executive.summary..................................................................................7 1. Context............................................................................................13 The public sector needs new models to improve public services .............14 Early Years services are ripe for this type of change ................................15 Background to Croydon ...............................................................................16 2. Our.approach...................................................................................19 Building on our successes ............................................................................20 Background to our approach .......................................................................21 Stage 1: Discover: Creation of new information and insights ..................23 Stage 2: Define: Developing and testing ....................................................27 Stage 3: Develop: Testing, prototyping and refining .................................29 Stage 4: Deliver ............................................................................................29 3. What.we.learned:.from.research......................................................31 4. What.we.learned:.from.listening.to.others.......................................35 Listening to families .....................................................................................36 Listening to practitioners and managers....................................................39 5. What.we.learned:.from.mapping......................................................43 Mapping activity and resources ..................................................................44 Mapping the customer journey ...................................................................48 What we found out ......................................................................................54 6. Conclusions.from.the.evidence.........................................................57 What we have learned .................................................................................58 Leadership of place ......................................................................................60 7. The.way.forward..............................................................................61 Our vision......................................................................................................62 Our propositions ..........................................................................................63 How it all fits together .................................................................................81 8. Projected.costs.and.savings..............................................................83 Our approach to projecting costs and savings ..........................................84 Making savings over time ............................................................................84 9. To.implementation.and.beyond........................................................87 This is just the start of the journey.............................................................88 A new form of organisation? .......................................................................88 Taking the learning forward ........................................................................89 Implications for Whitehall ...........................................................................91 Where next for Croydon? ............................................................................94 . Bibliography.....................................................................................96 . Those.who.supported.our.work........................................................98 contents 3 4 foreword Across the public sector, the imperative to deliver better services for less cost is clear. We face unprecedented budget cuts alongside continuing demands for improvement. In Croydon we feel this acutely, we are the largest London borough, with more young people than any of our peers, and significant social challenges. But in Croydon we are also ambitious. We know that there is potential to improve what we already do by doing it better, together. We are also confident that working together in new ways, across organisations and in partnership with residents, can lead to both radical improvement in outcomes and savings to the taxpayer. We agreed to apply this approach to one of Croydon’s most vital areas: outcomes for our youngest residents. Through the resources provided by Total Place we have – all of us – gone through an eye-opening experience, which has challenged the way we work together, how we think about ‘services’ and ultimately the relationship between the public sector and those we serve. We have learned a lot – more than we anticipated when we started – and are excited about the direction of travel. We take great pride, therefore, in sharing the story of our journey. We hope that it provides insight and inspiration to others who recognise the need to find a new way of thinking about public services transformation; that it exposes the challenges of moving from thinking about services to thinking about systems; and that it adds to the weight of evidence for working with families and citizens, for starting from their experience and their capabilities. We have not yet reached our destination but we are well on our way. We welcome your thoughts, insights and challenges as we continue our journey to become better leaders of our place. Caroline Taylor, CEO NHS Croydon Jon Rouse, CEO Croydon Council foreword 5 I just want a happy child Sarah 30, Upper Norwood 6 I just want a happy child Sarah 30, Upper Norwood executive summary In the end, achieving great performance in the public sector… requires unlocking the initiative, creativity, and motivation of leaders throughout the system, rather than just those at the top. This cannot be done without substantial devolution and/ or providing the freedoms of a quasi-market. In short, you can mandate “awful” to “adequate,” but you cannot mandate greatness, which must be unleashed. Sir Michael Barber, Former Director, Prime Minister’s Delivery Unit one:executive section headingsummary 7 We.are.on.a.journey.to.radical.improvement For at least a decade, the prevailing paradigm for public service improvement has been a top-down model. National targets have been set, delivery chains established, and large amounts of money have been pushed down the resulting command and control structures to achieve change at ground level. In areas where public sector performance was previously very weak, e.g. hospital waiting times, levels of serious violent crime, it is a model that has achieved genuine success. However, this linear model of thought and action around public service transformation is coming to the end of its useful life. Improvements in standards and outcomes in many areas of public service seem to be reaching a plateau, or will not deliver the scale and nature of change that is now needed. In Croydon we are passionately interested in what comes next. Building on a bedrock of trust within our Local Strategic Partnership we have been piloting new solutions for the last few years, in areas as diverse as combating domestic violence, addressing teenage delinquency and aligning services for people with dementia. We have already learned a lot about the benefits of joining up multi-agency teams around the customer, about co-designing services with the citizen and their own support network and about breaking down professional boundaries. We are also learning about how best to balance rights with responsibilities, how to reduce dependency and how to achieve a better balance between State support and individual endeavour. Total Place has given us the chance to stretch our wings. Co-led by NHS Croydon and Croydon Council, and involving all Local Strategic Partnership members including the Police, the local hospital and the Voluntary and Community Sector, we have explored a Total Place approach which considers all the public sector money in a geographical area as one ‘virtual pot’. We have listened deeply to citizens’ needs and experiences, and combined that knowledge with other new perspectives to create new models of place-based leadership which supersede individual organisations and functions. 8 The.earliest.years.are.vital Our focus has been on early years for the simple reason that we believe it matters most when it comes to getting public services right. The evidence is unarguable that a good start in life, in terms of physical, emotional and cognitive development, will result in better individual and social outcomes later in life. An early childhood that is characterised by the deepest attachments to parents or other primary carers who love and care for their child, is likely to result down the line in less dependency on the State, and reduced call on the public purse. The evidence we have gathered through our designed process has been utterly persuasive of the need for system redesign in the early years. We listened directly to families. We heard from mothers who told us - despite our best efforts and well designed strategies - they do not know where to get help and support, from fathers who explained how awful the discontinuities between services can feel. We realised that