Appendix 1: Case Studies

Changes in the delivery of public services.

Case Study 1: Whole Place Community Budgets

What happened?

Reflecting the need to explore and test new ways of designing and providing local public services, local authorities and other local bodies in England were invited to participate in an area-based pilot to test how Community Budgets comprising all funding on local public services could be implemented. Through a competitive process four areas were selected as local pilots: West Cheshire; Whole Essex; Greater Manchester; and the West London Tri-borough area. The focus of these pilots was to wrap services around people and place, drawing in partners from public, private and community sectors.

All four areas worked with central government to develop and evaluate each pilot. They adopted a pragmatic approach to defining, developing and appraising their proposals. They focused on specific, measurable outcomes such as reducing reoffending, preventing avoidable hospital admissions and developing a more integrated approach to employment and growth. Each local area identified potential for net savings from its projects within five years, reflecting the proposed activities, and the priorities and scale of spending in the local areas.

Local areas also identified a number of conditions that contributed to this success, including:

  • encouraging data-sharing between local and national partners;
  • continued collaboration and clear leadership both locally and nationally in designing and implementing new services, including continuing technical cooperation; and
  • dialogue around potential longer-term and systemic reforms to the way local services are funded, including financial incentives or funding arrangements that encourage partners to invest across organisational boundaries, particularly where reform takes longer to be financially sustainable.

Key lessons

The Whole Place Community Budgets initiative demonstrates:

  • the importance of leadership to bring cultural changes in both local and central government with pilots drawing on seconded officials
  • that progress can be made towards joint working, embedding collaboration is not immediate
  • co-production requires a change in the way departments operate and behave, including releasing some control over service delivery, and contributing expertise – e.g. through seconding senior staff from central government to be part of the project team at the local level
  • the potential to achieve significant cost savings without driving out other objectives
  • the value of using robust cost-benefit analysis to align resources with potential benefits. 

Sources: House of Commons Communities and Local Government Committee, 2013; National Audit Office, 2013

Case Study 2: Co-design at the Australian Department of Human Services

What happened?

The Australian Department of Human Services (DHS) is responsible for delivering the majority of the social, health and welfare programs in Australia. DHS delivers services to approximately 99 per cent of Australians and undertakes 8.5 billion customer transactions every year.

DHS undertook a series of community fora to better understand the needs and wants of their clients, to inform the development of new service offers under the Australian Government’s Service Delivery Reform agenda. DHS introduced eServices to further improve customer access, and to inform the development of products that meet customer needs. Co-design is an important feature of their contemporary service delivery model. The result was more streamlined and more tailored services, that responded to the clients:

  • Providing more or less intensive support as required by the individual,
  • Offering easier and more convenient ways to do business with DHS, including online,
  • Streamlining processes and information sharing, and
  • Automating systems wherever possible.

What does it demonstrate?

Co-design at DHS demonstrates:

  • co-production allows an ‘outside in’ perspective that can lead to revealing insights and a wider and richer set of choices to try out
  • co-production and technology are key for more personalised services, delivered in a way that is most convenient to clients, and that tackle problems that users care most about
  • there is a risk of raising expectations that might not be met
  • social media can be powerful, exceeding expectations for the richness and quality of response from the community
  • moving services online can improve customer access but care must be taken to make the services relevant to what clients are looking for.

Source: Bridge, 2012

Case Study 3: HealthOne (Shared Care Record View)

What happened?

HealthOne (formerly eSCRV Shared Care Record View) is a secure on-line system for sharing health information in use across the Canterbury Health System. Faster and more informed treatment, shorter waiting times and better outcomes for patients are all benefits of the new system that evolved out of lessons learnt during the earthquakes. HealthOne makes routine health information (such as allergies, prescribed medications, medical diagnoses and test results) available to all health professionals involved in their care.

Following the Canterbury earthquakes, health providers shifted to a secure on-line system for sharing patent information between health professionals (hospitals, pharmacies, GPs, laboratories and nursing services) to achieve:

  • faster treatment, shorter waiting times
  • reduction in acute admissions
  • avoiding duplication of procedures
  • reducing vulnerability to disaster (paperless records)
  • information sharing to allow for a more integrated approach to case management in the future.

The initial need for a different approach was driven by the damage to buildings and infrastructure that meant patient records were inaccessible making it difficult to check the medical history of people presenting for treatment. The online shared healthcare record view was initially piloted, with medical practititioners (including DHB staff, GPs, pharmacies and community nurses) invited to the trial. Their feedback and the wider response enabled the system to be fine-tuned (e.g. building in additional protections to respond to public concerns about privacy of personal information) in advance of its wider roll-out.

HealthOne has been available in all Canterbury DHB hospitals, community pharmacies and general practices, since the end of 2012. There has been international interest in the system, including for the UK’s National Health Service.

What does it demonstrate?

  • HealthOne demonstrates:
  • the potential to use technology to enable information sharing and more personalised and responsive services for clients
  • the value of piloting an approach to explore the risks and challenges
  • the ability to innovate under pressure, in response to an external shift in the context for public services.

Source: SSC, 2012

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