Breaking the cycle: the outcomes model of public service?
Grace Duffy & Mila Lukic, Bridges Outcomes Partnerships
The threads of power and place run through everything we are exploring in UK 2040 Options. Understanding how power and place interact, and how they impact people and communities, is critical to understanding how we might make the UK a fairer place to live. This is part of a series of guest essays that explore how we might use new models of power and place to do just that.
Too many adults in the UK are stuck in a persistent cycle of unemployment, insecure housing and poor health. To break this invidious cycle, we need to think about public services – and invest in people’s skills – in a very different way.
Today, 4.3 million children in the UK live in poverty. In England alone more than 83,000 are looked after by the state, around 100,000 will leave school this year without qualifications and 20% are persistently absent from school. As a society we are facing intergenerational cycles of devastating outcomes cycles which can and must be broken to create a better society for the 2040 generation.
For the most part, the problem is not that the state is failing to reach the individuals behind these statistics. In fact, many of those in the most challenging circumstances have been through multiple public service interventions, at great cost and with good intentions, but without lasting success.
The problem is that we are not reaching the worst affected people early enough, and even when we do, the model for delivering services is fundamentally flawed.
A new paradigm for public services
In the UK, the traditional public services model is to standardise a particular process or intervention and deliver it in the same way, to anyone who needs it, as efficiently (and cheaply) as possible. This model focuses on immediate needs or problems to be fixed, and deals with them individually, in isolation – this is known as the ‘deficit model’.
This works very well for single issues with a ‘one-size-fits-all’ solution, such as mass vaccination or pension payments. However, it demonstrably fails to effectively address our society’s so-called ‘wicked problems’ – complex social problems without clear solutions, including multifaceted challenges such as family breakdown, long-term health conditions and homelessness.
This standardised deficit model has three key drawbacks. Firstly, by only focussing on ‘needs’ or ‘weaknesses’ (real or perceived) it can reinforce rather than break down the psychological barriers many people face when pursuing education and employment. Secondly, by focusing on isolated issues rather than trying to understand an individual’s situation more holistically, we often end up treating the symptoms rather than the underlying cause. And thirdly, it prohibits the personalisation needed to effectively address multifaceted challenges with complex interactions and instead takes a one-size-fits-all approach, treating everyone the same instead of treating them as individuals.
Fortunately, over the last decade, a new model of public services has started to emerge. This new paradigm recognises that what it takes to achieve positive outcomes is going to be different for everyone. It recognises that different places have different assets and priorities. It recognises that building on people’s strengths rather than focusing on weaknesses provides a better basis for sustained change. And it recognises that relationships are fundamental for thriving lives and communities.
At Bridges Outcomes Partnerships (BOP), we believe there are 12 essential ingredients when designing delivery to deal with these wicked problems.
Collaborative design
From programmes designed by a central department, often in isolation from other departments and implemented in a top-down way, to projects that:
- Bring community organisations together around a shared vision of success
- Co-create with real experts – frontline teams and participants themselves
- Join up with other local services via cross-government co-payment funds
- Operate as dynamic, actively managed partnerships by changing the nature of the contractual relationship between governments and delivery organisations.
Flexible delivery
From fixed-specification contracts that are delivered to rigid budgets for groups of people with identical needs to flexible, personalised services that:
- Tailor to peoples’ strengths by giving front-line teams the freedom to shape their services around individuals
- Invest properly in delivery teams by taking a more flexible approach to resourcing costs
- Embrace continuous improvement and allowing the service to be redesigned and ‘relaunched’ regularly
- Tackle systemic barriers to progress.
Clear accountability
From arms-length contracts with limited visibility on progress, success and key learnings to supportive partnerships which:
- Are transparent on progress by sharing regular updates against objective, clearly defined milestones
- Are accountable to those who access services
- Consider the longer-term impact of the service by finding light-touch ways to link into or compare with other government data
- Access and share learnings to benefit future services by investing in more sophisticated evaluations that tease out relative benefits of project features.
Since 2012, BOP has deployed these lessons through ‘outcomes partnerships’. These bring together multiple stakeholders to achieve meaningful change for people facing wicked problems, while helping create environments where delivery teams have more flexibility to personalise their delivery. By switching the focus to the desired goals rather than a specific delivery model, it allows for more personalised, localised programmes. The model also breaks down silos between systems to create more holistic – and therefore more effective – delivery of public services.
For example, in Kirklees, West Yorkshire, the local council recognised that its existing top-down, deficit-based model – using rigid service specifications focused on short-term needs – was consistently failing to achieve lasting change in people’s lives. So, together with the council, we created the Kirklees Better Outcomes Partnership (KBOP). Its strengths-based, outcomes-focused approach to tackling persistent homelessness, drawing on community assets, has been much more successful.
Of the 6,379 people KBOP supported since September 2019, 73% of people have been able to keep their accommodation while 49% have entered education or employment compared to 43% of people sustaining accommodation and only 15% entering education or employment in the initial year. These outcomes demonstrate ongoing innovation in delivery and are outcomes with long-term impact:
- KBOP has reduced the need for repeat support by over 70%
- has been able to support more than twice as many people than predicted
- at an average cost-per-participant which is 39% lower to the commissioner than under the previous service.
Moving to a holistic, strengths-based approach to delivery through outcomes partnerships has not only transformed lives, it has resulted in much better value for taxpayers’ money.
Breaking the cycle: skills and education
This emerging model has important implications for our approach to skills and education – an essential foundation of fulfilling, stable lives. Our work supporting adults who are homeless or at risk of homelessness demonstrates how this more personalised, strengths-based approach has helped practitioners approach skills in a different way and help people achieve sustained, positive changes in their lives.
Take the Greater Manchester Better Outcomes Partnership (GMBOP), a collaboration between mission-led organisations commissioned by Greater Manchester Combined Authority. This project supports young people at risk of homelessness. A lack of educational attainment was one of the biggest barriers to accessing stable employment and therefore housing. Many young people with highly transferable practical, creative and interpersonal skills are held back from jobs and apprenticeships because they don’t have a grade 4 GCSE in Maths or English.
By helping young people get qualified, GMBOP’s link workers have a huge impact, enabling them to access and sustain employment and accommodation. But first, they need to overcome the barriers that have stopped them in the past and lay the foundations for transformational change. This means taking a relational approach to improve resilience and confidence. And conceiving of skills in a wider sense to embrace essential soft skills such as communication, building relationships, setting goals and practical skills such as budgeting. Taking the time to develop foundational skills and focus on long-term outcomes helps these young people break their cycle of dependence on public services.
It follows then, that if we really want to tackle these problems we need to start early and prevent young people from getting trapped in these negative cycles in the first place.
That’s the key idea behind AllChild (formerly West London Zone), an outcomes-focused organisation that supports children and young people with an average of four risk factors across emotional, social and academic areas. None of these risk factors are, in isolation, bad enough to trigger statutory thresholds for children’s services. But taken together, they put the young person at high risk of negative outcomes, such as mental health challenges, being excluded from school, and/or falling into the ‘not in education, employment or training’ category.
AllChild’s two-year Impact Programme puts the child at the centre and personalises support around them, working with schools, early help, social care and local voluntary organisations to provide the tailored, holistic support they need. And it works. AllChild has supported more than 4,500 children across over 50 schools in West London. Three-quarters are no longer assessed as at risk in terms of their emotional and mental wellbeing, while two-thirds improved their grades.
A crucial factor in AllChild’s success is that it is deeply place-based. Extensive community co-design ensures interventions and services work in the local context, capitalising on local strengths. Indeed, building on its success in West London, this year AllChild has launched a new model in Wigan, Greater Manchester.
We need to change the system
These strengths-based, outcomes-focused programmes are hugely promising. But they remain the exception rather than the norm and there are systemic barriers to them realising their full potential. Most services designed to tackle ‘wicked’ problems are delivered with rigid service specifications that don’t allow for the personalisation possible under outcomes contracts – procurement processes and limited resources tend towards inflexibility, short-term budget cycles lead to short-term decisions and funding pressures result in prioritisation of crisis cases rather than prevention.
While this is understandable, it’s a false economy. Independent analysis (which has yet to be published) has found that outcomes partnerships such as AllChild deliver average total savings and wider economic benefits of £81,000 per child. This includes money saved by the state through the avoidance of negative outcomes, such as requiring child protection, and increased value from improved educational attainment and reduced exclusion. We must escape this ‘firefighting’ funding trap.
AllChild offers one potential solution. Partly because of its focus on place, it has been able to develop an innovative co-payment funding model. This brings together central and local government, local schools, local businesses and philanthropists to jointly pay for the positive outcomes the programme achieves, recognising that improving outcomes for children has benefits for the whole community. The model will soon be launched in Wigan – and can and should be replicated nationally.
Another crucial challenge is to target the right support, at the right time, to those most at risk of spiralling into negative outcomes.
In delivery, we see time and again the common factors trapping people in cycles of negative outcomes. And we see the enormous value of early intervention and prevention.
Where it’s been possible to securely link data sources, for example through Ways to Wellness, an asset-based social prescribing service, we have seen dramatic improvements in collective ability to understand what works and for whom leading to much improved outcomes for participants and cost savings to the NHS. With the advent of big data and AI, we have an opportunity to much more effectively target and tailor support for those who need it most.
The voluntary, community or social enterprise sector working on the frontline has a vital role to play in identifying those in need of help. Critically, the front line is the source of innovation and can also build the evidence base around how best to help people develop the skills they need to break negative cycles and improve their lives. We at Bridges Outcomes Partnerships would love to join forces with others who see the potential impact of truly holistic, place-based data and learning partnerships to get the right support to the right people at the right time. Given the likely state of the public finances over the next five years, improved targeting and investment in early intervention is clearly essential.
Solving these problems won’t be easy. Embracing this new approach to public services – more preventative, holistic and localised services and a strengths-based approach focused on improving individual outcomes – requires a change in mindset from commissioners and policy-makers. Breaking the cycle requires boldness and innovation. And if we get it right, the potential prize is huge.