Total place: dig for victory
Author: The Guardian - Dec 3, 2009
If Total Place achieves nothing else, it will at least have brought the phrases "local government reorganisation" and "quick and dirty" together for the first time.
That is, at least, if you believe John Atkinson, the head of the Leadership Centre for Local Government, the agency running the pilots.
The "quick and dirty" work created the initial maps of how public money is spent in each of the 13 pilot areas, which were submitted in October. The next milestone for the programme December 9 and the pre-budget, but that is likely to do little more than spell out the lines of inquiry already established.
The final reports are, after all, due in a couple of months' time in February – "a tight timetable", Atkinson acknowledges. "Although there's not a high-profile reporting piece going on [at the moment], there's lots of activity, people doing spadework. It's an interesting time."
It is that spadework that is starting to unearth new ways to solve relatively old problems, according to people involved in the pilots.
Bournemouth, Poole and Dorset's attempts to improve services for older people is one such case. The basic principle behind their reform plans is well known: older people would get better care, and local bodies could save money, if more time and effort was devoted to preventative services.
Many elderly patients needlessly end up in hospital with complaints such as urinary tract infections and other things "that make older people confused" says Chris Kippax, Dorset county council's project manager.
"The default is that those admissions will take place because they [hospitals] are the most safe and secure place available – but in terms of medical interventions they are not [what's] required."
At least 10% of those admissions, and probably "significantly" more, could be avoided, through more preventative care and better services delivered at home, Kippax says. So far, so familiar.
What's new about the thinking coming out of the Total Place pilots is that it draws on so many local bodies: the Bournemouth pilot involves not just county and district councils and NHS trusts but also the fire service and the police. It's also the way in which looming budget cuts are concentrating minds.
Kippax says his pilot team has come up with "a whole menu of options" including so-called virtual wards, which use the systems, staffing and daily routine of a hospital ward to provide care in people's homes; multi-agency teams providing older people's care; and intensive programmes to give older people back skills they may have lost after a stroke or severe illness.
The problem with that, of course, is that it will involve some organisations spending more money, rather than less, upfront. Others, probably the acute hospital trusts, may have little incentive to participate in a programme that will leave them with less income (under payment by results) and expensive hospital beds sitting empty.
Bournemouth hasn't solved these conundrums yet. Providing better services will require "a different approach between [agencies] to agree on how they fund this, and that may challenge the existing patterns of spending," Kippax says. That, in turn, will mean "some hard-edged decisions ... we're working on this at the moment."
Atkinson insists that these problems can be solved — and that the pilot schemes are even taking collaboration to a higher level. Those looking at similar themes, such as the drugs and alcohol addiction-focussed pilots in South Tyneside, Birmingham and Leicester, are now themselves coming together to share ideas, along with representatives from central government departments such as the Home Office, he says.
"They all come together to say, 'What are really trying to achieve, what's the route we are going to take, and how do we collectively ensure we get as good a response to this as we can?'"
The way that public bodies are assessed remains a major stumbling block, Atkinson adds. The separate – and sometimes conflicting -targets and inspections "keep people apart. If we can find a way through that, it will be a way forward."
But, he admits: "It's this complicated mess for a reason, and resolving that takes some time."
The most "encouraging" sign is that Whitehall departments are getting involved, he says, sitting in on workshops and in some cases hosting them. That is vital, because changing spending habits among government departments is going to be at least as important as those of the organisations further down the food chain.
"Those questions are very much the questions they [the pilots] are trying to resolve now, because they are not necessarily straightforward," Atkinson says, adding: "The Treasury hold the key to a lot of that."
As in Bournemouth, so it is nationally: old problems – in need of new solutions. Whether Total Place can deliver those solutions is another question.
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