When it is not framed around cost savings, discussion of public service reform these days mostly focuses on technology. This is most obvious in healthcare, where medical science drives change all the time: weight loss drugs, genetic cancer tests, and so on. The benefits and risks of AI are another theme, from education to criminal justice. But some of those involved in trying to improve public services are taking a strikingly different tack. Their work centres not on machines but on relationships.
This might sound like common sense. Pretty well everyone recognises the value of an inspiring teacher or trusted social worker. Wes Streeting has stressed his support for Labour’s policy of “bringing back the family doctor, so patients can see the same doctor for each appointment”.
But despite such pledges, the connections between people are too often overlooked when public services are designed and thought about – and this is one of the problems that a current project, Changing Futures, seeks to address. Like the Tories’ Troubled Families programme, led by Louise Casey, Changing Futures targets help at the crisis-prone households that appear to be least well served by existing services. Its particular focus is a population of up to 400,000 people in England who are regarded as highly vulnerable due to some combination of addiction, homelessness, mental illness, domestic violence and involvement in crime.
Funding runs until next year, so formal evaluations are not due for some time. But one project, in Northumbria, has published descriptions of the “liberated method” through which its practitioners try to break down silos, in order to deliver the kind of person-centred support that is the programme’s guiding principle.
Face-to-face work is central, and an approach its leaders describe as “high support and high challenge”. This is informed by methods from the world of addiction recovery (AA and its offshoots), including the role of peer-group mentors with lived experience. The rationale is that while current services are configured to address discrete issues (housing, employment and so on), the bigger picture also needs to be seen.
Judging from past experience, the prospect of such projects shaping the reform of services nationally is remote – although local leaders might find ways to embed them. Our overcentralised system of government means that most change comes from Whitehall. But the Changing Futures teams are not the only ones banging the drum for relational public services. Ministers made the mistake of undermining their £1bn investment in employment support by linking it to disability benefit cuts. But their Get Britain Working plan does recognise the importance of personalised help – in preference to sanctions. In the words of one adviser at a charity visited by Liz Kendall, the work and pensions secretary, “everything in this business of getting people back into work is about relationships”.
In both the benefits context, and Changing Futures, saving money is a big part of the motive for trying new things. The people being supported by the latter include heavy users of crisis services, such as A&E departments. The underfunding of existing services and chronic lack of affordable homes, which make people vulnerable in the first place, must never be overlooked. But that doesn’t mean nothing creative can come of efforts to reconfigure support. Trying to improve public services is a core duty of government. Innovation is not all about AI.
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