The future is already here: on degrees of innovation in public service reform

Ben Hammersley has written an excellent reflection piece for Native, the magazine from the Digital R&D Fund for the Arts. My own main interest is in public service reform, but it doesn’t matter that Ben’s piece is about the possibilities that technology brings to the arts because its arguments extend to any sphere in which there’s a need for progress and development.

The central point of Ben’s argument is as follows:

It’s easy to break out the toys[.] I could be forgiven for pimping out my favourite new thing. But I’d be wrong to do that. Instead, I’ve grown to learn that the greatest innovations are not always with the new ways to tell stories, or the new ways to make a noise. Instead, the truly revolutionary are often somewhat banal. They’re the innovation that disappears as soon as it happens, that arrives and makes us immediately forget what it was like to live without it. Not showy, but subtle and just-so.

Ben goes on to give an example of a banal innovation (an oxymoron?), which is worth quoting at length:

Take ticketing as an example. Many major locations offer online ticket purchases, some of which you can print at home. An online ticket purchase requires a credit card, and that in turn requires your home address. It’s a matter of simple automation to take that address and augment the ticket or email with useful information. Here’s how to get to and from the venue from your address; here’s how long it will take given various public transport routes; here’s some recommended restaurants on the way (and here’s 10% off the bill of the pre-show fixed menu); here’s a local venue you might also like. It’s the day of the show, and the tubes are delayed, so here’s an email in the morning warning you of a slower than usual commute.

The number of places that do this in practice is probably not very many, which is why Ben quotes William Gibson at the start of his piece: “The future is here, it’s just not evenly distributed.”

We know Gibson is right, and can see this by thinking about other things we think are already here but are actually not evenly distributed.

Take the internet itself. It has obviously been revolutionary, but think of the 6.4m adults (13% of the British population, though the number is falling) who have never used the internet[1]. That’s not just people who don’t regularly use it, but people who have never used it. And it’s not just older people who make up these numbers; they disproportionately include people who are disabled or from lower socioeconomic backgrounds.

The internet is relatively recent, though. What about railway travel? Access to railway travel is not evenly distributed either: there is an estimated gap of approximately 100 million passenger journeys between the actual journeys made by disabled train passengers and what proportion of train journeys we would expect disabled people to make[2].

And what of clean drinking water – less something “future” and more “fundamental”? Currently 748 million people in the world don’t have access to safe water, and 2.5 billion people don’t have access to adequate sanitation[3].

So, the future is here, it’s just not evenly distributed, and this is true at quite basic levels. (And by “evenly” we don’t mean just in terms of availability but also in terms of access. Inequality, though, isn’t the focus of this post.)

What I loved most about Ben’s post is the honesty in his starting point, which is to acknowledge that most new-fangled things are already here.

Of course, someone somewhere has to be doing something that is new in the absolute sense of the word. To move from a world in which there was no railway or internet to a world in which there are railways and the internet we had to create something new. But the rate at which these truly new things occur is nowhere near the rate at which people claim to create new things[4].

In the area of public service reform, when people talk of “innovation”, “new” or the need for “new ideas”, my sense is that, more often than not, what they think they’re talking about is what’s new in an absolute sense, i.e. doing something that has never been done before. This typically manifests itself through an organisation or a person offering a new solution, product or way of doing things that will solve a problem heretofore never been solved before.

In reality, though, what people are claiming as “new” is something that actually replicates practice in another area; or they are doing something that is supposed to be done anyway; or perhaps they’re doing something using a different mechanism to what is found in other places.

All of this in and of itself is valuable, but is rarely presented in this more honest way. Instead, developments are often unthinkingly labelled “new”, “innovative” or a “solution”. Such presentations – such pretentions – could be a consequence of the way in which funding is awarded, or indeed the focus on awards themselves, or could be something that is fundamental to the way in which we as humans want recognition.

This, of course, could all just be a question of defining what we mean by “innovation”: should we just stop people calling things “innovative” when they’re anything but? Well, yes, that would help. In this vein, I think there are three things that follow from this often unthinking use of “innovation”.

The first is a direct consequence of public service reforms being presented as “innovative”: it creates an easy target. Situations often arise in which we have strong advocates for change coming up against other forces as a result of the way in which they choose to present what they think is “innovative”. “That’s not new” or “We’ve tried that before” are responses you might typically hear in such a situation. A corollary is that it can then be difficult for strong advocates of the “innovative” to distinguish amongst the “other forces” those who agree with the need for something different and those who defend the status quo. The overall effect is to distract and detract from the first order problem for which a solution is sought.

The second implication is to recognise there are different degress of innovation[5]: it isn’t just about the new, but can also be, for example, the connections between things or the scale at which it happens where innovation lies. So, in Ben’s given example, the automated processes that flow from people providing a postal address when buying a ticket online could be thought of as a degree of innovation. By admitting to the possibility of degrees of innovation, we can start to ask when an “improvement” becomes an “innovation”, and act and present accordingly.

And this concept of degrees of innovation feeds into the third and final point. It’s worth introducing it by repeating a segment from Ben’s article:

[T]he truly revolutionary [innovations] are often somewhat banal. They’re the innovation that disappears as soon as it happens, that arrives and makes us immediately forget what it was like to live without it. Not showy, but subtle and just-so. It’s easy to hand-wave at such new features to an existing ticketing system, of course, but what I just described is genuinely not technically hard. It’s not showstoppingly impressive, but it’s good and thoughtful and useful.

Being “good and thoughtful and useful” strikes me as excellent guides for the sorts of improvements we need at all scales in public service reform. So the final reflection is that innovation doesn’t have to be big and bold and announce itself – it doesn’t have to be a “showstopper”; instead it can be small and subtle.

As such, Ben’s article for me prompted a range of thoughts, centering on a more honest approach to degrees of innovation in public service reform, and so about what it ultimately can deliver and achieve.

I’ll pick up other thoughts on degrees of innovation and being honest about what it can achieve through other posts to follow in due course.

NOTES:

[1] – Internet access quarterly update, Q1 2014, ONS

[2] – 1.5billion train journeys were made in 2012/13 (source, pdf). If these were evenly distributed across the British population we could expect around 11.6% of them to be made by disabled people, or around 174m journeys. In 2012/13, around 72m train journeys were made by disabled passengers (source), resulting in a gap of approximately 100m journeys.

[3] – Progress on Drinking Water and Sanitation, 2014 update, WHO/UNICEF (pdf)

[4] – For those interested in what could be considered “new” in the most absolute sense, Richard Lipsey’s book on General Purpose Technologies – technologies that affect entire economies and societies – is fascinating. Lipsey argues there have only been 24 General Purpose Technologies, including printing, railways, electricity, the internet and nanotechnology.

[5] – Marty Neumeier begins to get at this with his Originality Scale. I think “original” is binary, as is “new”, which is why the language throughout the post above is a bit sloppy when it comes to the use of “new” and “innovative” in a fairly interchangeable way.

On “The Prince” by Nicolo Machiavelli

machiavelli

Image from Jacobin

Anyone interested in change should be interested in Machiavelli.

That many of the observations in The Prince have been cited by leaders with questionable methods in fields such as business and war means the 16th Century Italian adviser has a negative reputation. But investing time in reading the source text on which most of Machiavelli’s reputation is based (i.e. not including The Discourses) will reveal more subtlety, wisdom and honesty than you might expect.

For anyone at any level who is interested in driving or influencing change, it provides plenty of practical advice:

[N]othing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.

From within this setting derives much of Machiavelli’s advice about how to work with different groups of people in the new order. This includes both people who have become “enemies” and, perhaps a harder group to manage, those who were supportive of change. In the latter’s case, Machiavelli recommends you, first, understand the motivations for their support:

[H]e must well consider the reasons which induced those to favour him who did so; and if it be not a natural affection towards him, but only discontent with their government, then he will only keep them friendly with great trouble and difficulty, for it will be impossible to satisfy them.

and then understand the implications:

and you are not able to keep those friends who put you there because of your not being able to satisfy them in the way they expected, and you cannot take strong measures against them, feeling bound to them.

A risk of not addressing either enemies or supporters quickly enough is the emergence of factions, on which Machiavelli has a clear view:

I do not believe that factions can ever be of use; rather it is certain that when the enemy comes upon you in divided cities you are quickly lost, because the weakest party will always assist the outside forces and the other will not be able to resist.

As well as considering external circumstances, there is equally sound advice for the ‘Prince’ or leader of change, especially in how they should carry and prepare themselves:

But to exercise the intellect the prince should read histories, and study there the actions of illustrious men, to see how they have borne themselves[,] to examine the causes of their victories and defeat, so as to avoid the latter and imitate the former; and above all do as an illustrious man did, who took as an exemplar one who had been praised and famous before him, and whose achievements and deeds he always kept in his mind

and

he ought to be a constant inquirer, and afterwards a patient listener concerning the things of which he inquired.

Machiavelli is clear this holds at all times, not just at times of change:

A wise prince ought to observe some such rules, and never in peaceful times stand idle, but increase his resources with industry in such a way that they may be available to him in adversity, so that if fortune changes it may find him prepared to resist her blows.

Such diligence can help prepare for whatever eventuality may arise, which it surely will:

And in examining [great leaders’] actions and lives one cannot see that they owed anything to fortune beyond opportunity, which brought them the material to mould into the form which seemed best to them. Without that opportunity their powers of mind would have been extinguished, and without those powers the opportunity would have come in vain.

Preparation will also allow “evils to be foreseen” and an ability to “distinguish the character of troubles, and for choice to take the lesser evil”. Ultimately, building such foundations will also help with sustainability:

 Nothing can be so uncertain or unstable as fame or power not founded on its own strength.

Of course, all of these insights aimed at ‘princes’ are equally useful for those seeking to influence change: they help provide an insight into the way leaders may be thinking, and therefore an indication of how influencers should accordingly position themselves.

The Prince is only short. Even then, a reasonable proportion is taken up with describing the actions of various leaders drawn from Italian history and beyond that can (unless interested) easily be passed over. Investing time in reading it, and putting to one side what you think Machiavelli might represent, is time well used.

“Somewhere in the world life must be tremendously diverting”

Impressive sounds, some of them, seeming to assure you that somewhere in the world life must be tremendously diverting, exceptionally exciting, and all good clean fun in the meantime… And even, now and then, truth reaches you with the penetrating power of a very quiet voice.

- from “Largo by the Sea (A Prologue)” in Varmints, by Peggy Bennett.

(Thanks to the excellent Neglected Books for uncovering this.)

 

 

 

 

 

Mental health and suicide: the most straightforward reaction was the best

There was an endless stream of responses to Robin Williams’s suicide last week. I found the most dispiriting of these to be from organisations who found the comedian’s death just happened to substantiate everything they’d uniquely been arguing needs to change and, oh by the way, they’re in the best position to lead that change.

These continual offerings from mental health organisations goes a long way to explaining the move of PR agency Edelman (in the US), who noted how they could help such organisations “seize the day” for good press coverage.

As someone who works in and around mental health, I couldn’t help but feel that most of the reactions, what they said and the motivations for publishing them showed why mental health in the UK is in the mess it’s in in the first place.

The best response I saw was from a friend on Twitter who said the following:

I am going to refrain from ranting but all these ‘if you’re depressed seek help’ messages are all well & good. But let’s look at the ‘help': If you live in any kind of city you can wait months for an appointment to talk to a therapist.

Then you’ll get a limited number of sessions. So what help are we urging people to seek exactly? Oh, your GP will happily give you drugs indefinitely. Now piss off.

This was a straightforward response that I found refreshing in its honesty.

That I found it the best reaction possibly says more about me than it does about anything else, but nevertheless I wanted to make sure it was a reaction shared.

When is a policy impact assessment not a policy impact assessment?

Here’s a good question: when is a policy impact assessment not a policy impact assessment?

Answer: when you’re the Prime Minister around 10 months out from a General Election and want something to say about helping families.

This morning, as part of a suite of announcements related to families, the Independent is reporting David Cameron wants:

all government departments will have to assess the impact of policy on “supporting family life”. The assessment will sit alongside similar current tests for cost-effectiveness, equality and the environment, and Mr Cameron stressed that if they failed, they would “not be allowed to proceed”.

All very laudable, of course. But here’s what David Cameron had to say about equality impact assessments in a speech to the Confederation for British Industry in November 2012 (as noted by Neil Crowther):

We have smart people in Whitehall who consider equalities issues while they’re making the policy. We don’t need all this extra tick-box stuff… So I can tell you today we are calling time on equality impact assessments.

Today’s family impact assessment therefore begs at least 2 further questions to the title of this post:

  1. What’s the difference between families and equality?
  2. Are the people in Whitehall dealing with families stuff less smart than the people dealing with equalities stuff?

Murky complications of commissioning

A can of worms in a hornet’s nest and each of the worms is about to open their very own Pandora’s Box.

This was what I thought when the DfE said it would limit outsourcing opportunities for the delivery of children’s services to not-for-profit providers only.

Since then, it’s become clear that the regulations to effect this may be murkier than some people expected:

[R]egulations will not prevent an otherwise profit-making company from setting up a separate non-profit making subsidiary to enable them to undertake such functions.

On the other side of the coin, Labour are saying they will reserve public service contracts for social enterprises using new EU procurement laws and the principles Social Value Act of 2013.

But both of these scenarios are actually the same: the use (and abuse) of commissioning and procurement to reach a desired outcome. (See Toby Blume’s excellent posts on the Big Society Network and the National Citizen Service to see two recent examples.)

I’m afraid that, as commissioning and procurement currently work, anything that’s done to specify a certain type of provider to provide a service can be used (exploited?) to get exactly the opposite type of provider to provide the same service.

If you want a “not-for-profit” company to deliver a service, it’s perfectly possible for a private company to establish appropriate governance arrangements to appear as a “not-for-profit”. Similarly, it’s perfectly possible for a “not-for-profit” organisation to have governance arrangements such that it has a “for-profit” trading arm. These options don’t even include the extra dimensions social enterprises add, with their “for-profit” / social purpose duality. (And, whilst we’re at it, what, actually, is “profit”?)

Commissioning and procurement is a murky business.

For me, there are two real issues raised by all of this.

The first is that the “public is good, private is bad” dichotomy is truly unhelpful when it comes to debating how best to deliver public services. I mean, Julian Le Grand was exploring knights and knaves (pdf) back in 1995, quite aside from the amount of literature that work was built on and which has been written since

The second is that commissioning and procurement are processes that are driven by humans. As soon as you introduce human agency into a process it doesn’t matter how well the rules are written: the pesky human will find a way of using those rules to suit the ends they desire.

The primary issue, therefore, is understanding what is motivating people to act as they are. Questions of public/private providers and commissioning and procurement rules are secondary.

 

 

 

 

“Failure all the way down”

“Fail better,” Samuel Beckett commanded, a phrase that has been taken on by business executives as some kind of ersatz wisdom. They have missed the point completely. Beckett didn’t mean failure-on-the-way-to-delayed-success[.] To fail better, to fail gracefully and with composure, is so essential because there’s no such thing as success. It’s failure all the way down.

- Stephen Marche, writing in the New York Times

Best sources of social care data

Adult Social Care Outcomes Framework steLast week the Department of Health launched the Adult Social Care Efficiency Tool.

It’s “only” a spreadsheet, but

provides a basis for comparing spending and outcomes between councils and helps directors of adult social services and local authority financial leads to find new opportunities for improving adult social care efficiency.

As such, it is well worth checking out.

This means there are now five really useful, easy-to-use tools that help to compare data on a range of issues across local authorities.

The other four are:

  1. HSCIC’s adult social care outcomes tool – interactive map with data about adult social care in local authorities around the country, using outcome measures from the Adult Social Care Outcomes Framework (ASCOF) 2013-14
  2. Mental health intelligence network (MHIN) (incorporating Community Mental Health profiles) – a hub which brings together data already collected around mental health and wellbeing, under themes including common mental health problems, severe mental illness, and children and young people
  3. IHaL’s Learning Disability community profiles – numbers on how many people have learning disabilities in a given area and how health they are, how much health care they get and how well social services are looking out for them
  4. Public Health England’s Public Health profiles – a snapshot overview of health, health inequalities and wellbeing for each local authority in England.

 

 

 

 

 

Mark Twain’s ‘returns of conjecture’ from ‘investment of fact’

One gets such wholesale returns of conjecture out of such a trifling investment of fact.

This was Mark Twain on science in “Life on the Mississippi”, but he could well have been talking about any aspect of the modern world.

It’s a human folly to interpret new information in a way that confirms everything you already think. In danger of repeating this folly, though, the Twain quotation hits home with me for two current reasons.

First, I recently reflected on my relationship with news and decided to make a conscious and proactive choice to opt out of the news, social and other media. This was because:

I’d grown tired of most sources of media. Their focus seemed only to be on trivial, untrue or highly creative interpretations of things to do with politics and policy, or fanning the flames of these things with news stories and opinion pieces. I’d also grown increasingly tired with social media, the majority of which was people sharing either trivial, untrue or highly creative interpretations of things relating to politics and policy, or sharing a news story or opinion column that had fanned the flames of their outrage. On top of this, I found myself frustrated with the never-ending wealth of blogs, reports, videos and so on which offered organisation x’s perspective on the latest thing y or z.

This clearly reflects Twain’s observation. In this case, ‘trifling fact’ was the latest policy idea or something political that had happened, and the torrent of interpretations, opinions and perspectives were the ‘wholesale returns of conjecture’.

The second is on the nature of evidence.

Instead of considering, questioning and reflecting on new evidence – what it might actually tell us, what limitations it has, what our interpretations of it might reveal of our own assumptions – our current policy and political approaches tend to use any new evidence as the jumping off point for any number of other directions. As I intimated before, this is because we don’t live in a rational, evidence-led vacuum that is protected from the whims of politicians and public opinion. This in itself is fine (well, it’s reality); Twain’s observation reinforces to me we should invest more in what is currently ‘trifling fact’ than where most effort is made – on ‘wholesale returns on conjecture’.

Personal Health Budgets and the placebo effect

An idle thought following on from my last post about the evidence base and Personal Health Budgets: what if there’s a placebo effect associated with Personal Health Budgets?

As far as I understand it (as someone who is neither medically trained nor well-versed in the associated literature) there is good evidence that the placebo effect exists: when a patient takes medication or does something they perceive will help their condition to improve, it does (in either their perception or actuality), even if the medication or thing done has no proven effects.

Thus, irrespective of the evidence base of Personal Health Budgets, if people believe having a Personal Health Budget will make them better or contribute to making them better, will the mechanism of a PHB contribute to making them better?

(Note: just to be clear, I find the current evidence base regarding Personal Health Budgets, captured primarily in the PHB Evaluation, persuasive of the benefits of PHBs.)

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