What are the main challenges to improving public services across adults and children?
For over 30 years, most of my career, I’ve asked, ‘How do we make public services better?’ As a naive and idealistic youth worker in the 1990s, I’d be frustrated at statutory services who’d breach, arrest & exclude the same young people who’d walk to the ends of the earth for us youth workers. I believed our ability and commitment to building strong & progressive relationships with young people lay at the heart of our success and that statutory workers lacked interest in putting young people first.
I moved into youth crime prevention and worked more closely with social workers, teachers, clinicians and the police, and realised the systemic and structural constraints statutory workers operated in. Moving into senior leadership roles in children’s services, I was fortunate to help build a truly transformative integrated service model, bringing disparate services across local authority, community, police physical and mental health, into one unified model. I went freelance and moved into NHS transformation spaces, and again saw the systemic and structural challenges preventing meaningful service and workforce transformation - transformations explicitly sought but seemingly out of reach. At times and in moments of disarming honesty, senior leads would confide they felt they’d taken systems as far as they could but didn’t know how to make the leap into more flexible, responsive and accessible care.
There’ve always been small pockets of success, but the whole-system transformations sought through structures such as ICSs and the sustained improvements in casework sought across children’s services continue to elude us. Every tragic child death reminds us that structures create and enforce fragmentation and silos. Similarly, in health settings, patients find themselves navigating silos rather than person-centred care.
I was fortunate to spend the 2nd half of 2024 speaking to Chief Execs, Directors and other senior leads across health, local authorities and research spaces, sharing my thinking and gaining valuable insights. These discussions built on my academic research conducted back in 2022 as well as models I’ve tested since.
The outcomes of this research have been peer-reviewed and now published in the aptly named Journal of Integrated Care.
The headline findings are we spend too much time investing in rigid & constraining structural responses to service delivery and change, and these structures limit the spaces for the emergent responses required. These structures alienate the people delivering and accessing services and trap services in a limiting cycle of inertia - in spite of the small pockets of progress. These structures dictate the culture of care, making the ground less fertile for widespread and sustained innovations.
My solution is to create professional social spaces I call collaborative knowledge networks - because, for me, the solution lies in recognising and releasing the depths of knowledge and experience amongst the people accessing & delivering services.
Yes, we need structures, but these need to be enabling of these social interactions and knowledge transfers. Structures need to enable that leap of faith out of safe but constraining spaces into less certain but more progressive spaces where human interaction lives and thrives.
But that’s my thinking.
What do others feel is the handbrake to progress, and what do you think is the solution to delivering the public service transformations we’ve all aspired to for so long?
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