report_shaping_services_around_individuals_needs_274

A personal approach
to public services
Shaping
services
around
individuals’
needs

Contents
3 About Turning Point,
about Dr Foster
4 Foreword: Lord Victor
Adebowale and Tim Kelsey
5 Introduction
6 Executive Summary
8 The intelligent route
to customer insight
13 Designing services with
people, not for them
16 Personalisation in practice
19 Mainstreaming prevention
21 Making partnerships work
24 Conclusion: world class
commissioning pioneers
26 References, credits
and acknowledgements

A personal approach to public services
We turn lives around every day, by putting
the individual at the heart of what we do.
Inspired by those we work with, together
we help people build a better life.
Turning Point is the UK’s leading social care
organisation. We provide services for people
with complex needs, including those affected
by drug and alcohol misuse, mental health
problems and those with a learning disability.
We provide services in over 200 locations and
have contact with over 100,000 people a year.
Turning Point has particular expertise in working
with people who have complex needs and face
multiple social challenges. As a result, Turning
Point has set up the Centre for Excellence
in Connected Care to champion Connected
Care, our blueprint for community led and fully
integrated health, social care and housing services.
...Turning Point
...Dr Foster
About
Dr Foster Intelligence is a public/private
partnership that aims to improve the quality
and efficiency of health and social care through
better use of information. We make it easier for
professionals and the public to access information
about health and social care through a range of
innovative products and services.
The partnership is a 50/50 joint venture between
The Information Centre for Health and Social Care
(a special authority of the NHS) and Dr Foster,
a commercial provider of healthcare information.
Dr Foster Intelligence was launched operationally on
13th February 2006. In 2007, Dr Foster Intelligence
won the Innovation award in Laing Buisson’s 2007
Independent Healthcare Awards.
The Dr Foster Unit at Imperial College of Science
Technology and Medicine has developed
pioneering methodologies that enable fast,
accurate identification of potential problems
in clinical performance – and areas of high
achievement.
Dr Foster Research is the UK’s leading independent
supplier of research, analysis and communication
products for and about UK health and social care
and for the international development of health
informatics. Dr Foster Research is a sister company
to Dr Foster Intelligence.
Dr Foster works to a code of conduct that
prohibits political bias and requires it to act in
the public interest. The code is monitored by the
Ethics Committee, an independent body chaired
by Dr Jack Tinker, emeritus dean of The Royal
Society of Medicine.

Putting people first is the mantra of public
services policy. All agree that modern public
services should be just that – services for the
public. They should be there for those with the
most complex needs, who tend to be those who
get help the least. Talking about the concept of
a 21st century public service is one thing, but
doing it is another.
This report is a call to action. We are challenging
you – policy-makers and those responsible for
public services at a local level, especially local
authorities and primary care trusts – to consider
whether you are developing a modern, user-
oriented service that tackles inequalities and
delivers good value for public money. This
report is, we hope, a practical guide to what
can be done and a checklist against which to
demonstrate progress.
We are delighted to have joined forces to support
this project, having discovered common cause
between Dr Foster and Turning Point from our
experiences of working both at national and local
level in the health and social care arenas. Turning
Point works at the sharp end, delivering services
to over 100,000 people with complex needs.
We aim to be at the forefront of thinking and
practice when it comes to helping commissioners
to see new ways of engaging more directly with
communities, and finding ways of connecting
services to turn more people’s lives around.
Dr Foster is in business to harness the power
of information to improve services and people’s
health and wellbeing. We are increasingly
working with commissioners on how to use
data better to assess the diverse needs of local
communities, track patients’ experiences, address
inequality and manage provider performance
– in short, to help them commission services that
respond to the needs of individuals, delivering
better health, better care, and better value.
From our distinct perspectives, we share a
common and positive sense of what is possible.
This report is not just based on our own views
and experiences. We are grateful to all those
who took the time to contribute their views
and on-the-ground experiences as part of this
project. The public expect services to be value
for money, but they also expect them to be
value for people. That means services that are
personalised to the individual and bespoke to
the community. We hope that this report will
start a range of conversations – please feel free
to start one yourself by going to www.turning-
point.co.uk/personalapproach. We look forward
to your response.
Foreword
Tim Kelsey. Chair, Executive Board,
Dr Foster Intelligence
Lord Victor Adebowale.
Chief Executive, Turning Point

The Advisory Group
Introduction
Across the political spectrum there is broad
agreement around the direction of travel in
public service reform, with the emphasis being on
localism, citizen engagement, plurality of provision,
personalisation, and choice. The ultimate prize is
public services that are targeted at the greatest
need, delivered in a coherent way, and responsive
to users’ views and experiences.
Significant structural reforms have been
implemented – the question now is how to make
a reality of world class public services. There are
successful innovations in place in many localities,
yet they are not widely replicated. There are good
ideas, which could make a positive difference but
have yet to find purchase. Our focus is on these
kinds of pragmatic approaches.
Above all, our aim has been to produce
something of immediate practical use to those
leading primary care trusts and local authorities,
and to those (of whatever political persuasion)
who are in the process of formulating policy.
We have therefore sought to build on existing
policy directions, including in particular the
debate about world class commissioning.
We have also limited ourselves to techniques,
ideas, and initiatives that can be replicated now,
from locality to locality:
n Without further structural reform
or legislative change
n Without substantial new resources – but
leveraging extra value and efficiencies from
existing infrastructure, resources, and data
This report is not an exhaustive analysis of
public policy challenges. It picks out a series of
common themes from the ongoing debate about
strengthening commissioning and improving
public services, and provides a practical agenda
for each, informed by real examples and insights.
It focuses on a range of ideas, techniques, and
examples, which we believe are practical and
achievable now in meeting some of the immediate
challenges facing PCTs and local authorities. We
want to see these ideas and approaches adopted
more widely to help commissioners and providers
of local public services to work with each other
and other sectors to better target resources at
the right people. We believe these ideas will help
make a reality of public services that truly serve
the public.
The project has been supported by Turning Point
and Dr Foster and informed by an advisory group:
Joint-Chairs
Lord Victor Adebowale. Chief Executive,
Turning Point
Tim Kelsey. Chair, Executive Board,
Dr Foster Intelligence
Members acting in a personal capacity
Hilary Cottam. Director, Participle
Andrew Cozens CBE. Strategic Adviser for
Children, Adults and Health Services, IDeA
Professor Julian Le Grand. Richard Titmuss
Professor of Social Policy, LSE
Dr Nicolaus Henke. Director, McKinsey
Nigel Kershaw. Chief Executive, Big Issue Invest
Henry Pitman. Non-Executive Director,
Tribal Group

Executive Summary
This report is a call to action aimed at policy-
makers, the boards of primary care trusts, and the
political and executive leaders of local authorities.
We have selected five domains in which to
describe what we believe should – and can – be
done to better target need and integrate services.
We aim to point the way to practical innovation
by illustrating each with real local examples of
best practice.
A practical agenda…
Take the intelligent route to customer insight
The effective use of data is a core commissioning
skill. This chapter explores a number of different
practical perspectives on the role and use of data
to gain insight into the needs of local populations,
with particular reference to the advent of joint
strategic needs assessments. Key points include:
n How to use segmentation to gain deeper
insights into the diversity of your population’s
needs, i.e. using data to identify groups
of people within your local population
that are distinct in their needs, lifestyles,
and preferences.
n Promoting greater consistency in the use of
data across departments and agencies, from
simply using the same population forecasts
to adopting a common protocol for recording
and storing survey data.
n Linking up data to plan and target services
better, and how to address the concerns often
raised by the idea of data-sharing.
This section also highlights the need to improve
routine, regularly collected information about users’
experiences, and one hospital trust’s solution.
Designing services with people, not for them
Effective engagement with local communities
and individuals is a requirement of joint strategic
The practical agenda for local leaders
We are asking local leaders to consider how they match
up to this practical agenda:
Intelligent customer insight: What are you doing to
ensure that you are making effective and consistent use of
all the data available to profile the diversity of local needs?
How detailed is your approach to segmenting the needs
of different communities and understanding inequalities?
Are all of your departments and partners using data in a
consistent way? Are you linking up different data sources
to enrich this picture of local need?
Service design: What are you doing to involve local people
in ensuring that services are configured around their needs?
How does this include the so-called hard to reach?
Personalisation: What steps are you taking to personalise
services? Are you making progress towards individual
budgets? Have you considered creating new navigator roles
to help ensure people get the services they need? How are
you connecting up services to meet complex needs and
tackle inequalities?
Prevention: Are you making prevention a mainstream
activity, putting it at the heart of commissioning?
How closely are you targeting prevention activity at specific
issues and specific groups of people?
Partnerships: Are local partnerships changing the way
you do business? What risks are you taking together to
improve services?
World class commissioners will have good answers to each
of these questions. We would like to see these questions
firmly on the agenda of PCT boards and local authority
cabinet meetings.

needs assessments. It is expected to inform
local area agreements, and will be looked at
through comprehensive area assessments. More
importantly, PCTs and local authorities will not
be able to solve the problem of the inverse care
law without involving people in the process of
designing services and dispensing with top-down
solutions. Building on the first section and its
tips on using population analysis to better target
efforts, this chapter highlights how to:
n Involve individuals and communities
in designing services
n Reach the “hard to reach”
Personalisation in practice
Personalisation is not just about responding to a
more demanding public; it is the key to addressing
the needs of the estimated 3.7m people who are
living with multiple disadvantages. Having assessed
and prioritised the needs of local communities, the
next step is to find new ways of delivering services
to individuals. This chapter picks out three
key opportunities:
n Prepare for individual budgets
n Consider creating new ‘navigator’ roles
to connect care
n Take opportunities to tackle multiple needs in
one service, thus breaking down the traditional
silos, which label people and get in the way
of integrated services
Mainstreaming prevention
Mainstreaming prevention means creating services
and projects that can be commissioned and held to
account in delivering results. Too often, prevention
has been an add-on, an activity separate from
the core operations of local authorities and PCTs.
The innovation of social enterprises and the ideas
of social marketing are putting prevention at the
heart of commissioning. The messages of this
chapter are:
n Targeted prevention. With funding for
prevention in limited supply, a targeted
approach minimises the risk of wasted effort.
n Learnfrom the pioneers. Effective prevention
requires a pioneering spirit and a willingness
to take risks with new models and new
techniques.
Making partnerships work
The unavoidable and unsurprising fact is that
the defining quality of any successful partnership
is leadership. The lessons of local strategic
partnerships and the demands of local area
agreements are that leaders need to do their jobs
differently to succeed. This chapter poses some
questions to chief executives about how they
approach their roles.
World class commissioning?
World class commissioning is going to depend
on a step change in the culture of public services.
This report concludes with our reflections on the
values and skills that we believe will characterise
world class commissioners.
This report has four key recommendations
which demand national action
n Initiate a cross-Whitehall strategy to make key
national datasets available to local commissioners,
with appropriate safeguards, to enable them to better
understand how different communities use different
public services, to enable benchmarking, and to
inform commissioning strategies.
n Establish commissioning standards which require local
service providers to collect and publish routine, timely
information on customers’ experiences of services.
n Encourage the creation of public service navigators to
link up local services for people with complex needs.
n Train commissioners in how to get the most from
partnerships with the private sector and social
enterprises. Support this by commissioning a piece
of work to investigate and make recommendations
to enhance incentives for establishing mutually
beneficial cross-sectoral partnerships.
Have your say – visit www.turning-point.co.uk/personalapproach

Targeted services through segmentation in Hammersmith
Hammersmith and Fulham council are pioneers of customer
segmentation. They identified 12 distinct segments or
groupings within their population, having created a bespoke
segmentation model based on Experian’s Mosaic™ lifestyle
data1
and taking into account census data, information
on service usage, and individual preferences. Using this
segmentation, they found evidence that existing processes
and channels for delivering the council’s services were not
meeting basic customer needs and preferences. A distinct and
significant proportion of the borough’s population (including
‘Prosperous Mobile Young Professionals’) – whose needs
were generally restricted to “quick” transactional services like
council tax and parking – preferred to interact with the council
online or by phone. Another distinct cluster of segments
(e.g. ‘Mixed Inner City Urban – Modest Means’ and ‘Deprived
Families in Public Housing’) had greater social care needs and
wanted more face-to-face interaction. The result was enhanced
service delivery on web and phone channels for services and
customer groups that do not require face-to-face support, and
multi-skilling staff to deal with customer queries within a single
contact, as well as investing in community-based face-to-face
reception points that target customers in need.
The intelligent route
to customer insight

Local authorities and PCTs are beginning to
address the task of developing joint strategic needs
assessments to underpin the commissioning of
local public services. The message from this research
is that there is scope for local partners to use data
more intelligently to facilitate this challenge.
Use segmentation to gain deeper insights
into the diversity of your population’s needs
Personalisation is the mantra of the new breed
of commissioners. Yet personalisation is no small
task. It depends on developing and maintaining in-
depth knowledge of the diverse communities being
served – their needs (whether met or not), lifestyles,
preferences, and patterns of service usage. It’s an
ugly word, but segmentation is an essential first
step. Commissioners have always adopted some
level of segmentation according to age, ethnicity,
level of deprivation, and ward of residence.
However, the characteristics of local populations
vary dramatically from city to city and from street to
street. Segmentation that is too broad-brush limits
the ability of commissioners to efficiently target
resources and effectively respond to inequalities and
disadvantage. World-class commissioners therefore
go deeper than this and they use a range of data
and techniques to assist them.
In the private sector, segmentation is a standard
marketing technique, enabling companies to
understand, anticipate, and respond to customers’
needs. This language causes discomfort in some
public sector circles; in extremis it conjures up visions
of manipulation and exploitation of the vulnerable.
However, the purpose of segmentation for a PCT
or a local authority is to shed greater light on need
and vulnerability precisely so it can be addressed.
Segmentation has, if anything, a greater part to play
in the public sector because identifying different
Key messages in this chapter
1. Use segmentation to gain deeper insights into
the diversity of your population’s needs.
2. Be more consistent in how you use data across
departments and agencies.
3. Link up data to plan and target services better.
“What is needed is a strategic needs
assessment for the whole population.”
Andrew Cozens, CBE. Strategic Adviser for Children,
Adults and Health Services, IDeA

groups of people with different needs can influence
not only the range of services offered, but also the
level of services commissioned for different groups
of people. It allows commissioners to make sure
they are putting resources where they are needed
most, avoiding waste and promoting better value.
Be more consistent in how you use data
across departments and agencies
Adopt a common view on the size and nature
of your local population, now and in the future
There are challenges in producing the data needed
to measure populations and their needs. One of the
first challenges is simply counting the number of
people within a given area or population segment.
It is not unusual for public sector organisations
within one area, or even departments within
the same authority, to be working with different
models of the population. For example, some
departments may use ONS population estimates.
Others may have rejected these and use other data
sources such as GP lists. Yet others may have their
own local estimates, related to recent or planned
housing developments, for example.
Having a common view on the size and nature of
the current and future local population is an essential
precursor to effective commissioning. You should
ensure that local agencies and departments agree on
how they go about estimating the size of the current
and future population, as well as key characteristics
such as age, gender, ethnicity, employment status,
health status, and income.
Record information about people in
a consistent manner
When conducting surveys, or during other
data collections, local agencies tend to record
information about people in a variety of ways,
and then store the data in a variety of formats
and locations. This makes it nearly impossible
to reuse the data to support commissioning
and limits its value considerably.
“Health and social care have never done
marketing well. Choice isn’t an issue for
Amazon or Apple because they make really
good use of data to ensure they already
know what their customers want, and then
they just make it easy to access.”
Julie Dent. Consultant, Social Enterprise Coalition
The Local Government Association’s
Customer Insight Protocol
The Customer Insight Protocol suggests some rules of
consistency that local authorities could adopt for collecting
and storing customer survey data. It recommends that
authorities retain the following information for individual
respondents to enable segmentation:
Minimum requirements
n Geographical reference – postcode
n Date of birth
n Sex
n Ethnic group
Recommended collection
n Carer status
n Disability status
n National Statistics Socio-Economic Classification (NS-SEC)
n Employment status
n Rural/Urban (not collected but defined from
geographical reference)
Sensitive discretionary variables
n Household income
n Religion
n Sexual orientation

10 A personal approach to public services
National action required
Government should make national routine datasets available,
in formats that do not compromise confidentiality, to local
commissioners as soon as possible. Many key datasets
that could be used to better understand population needs
are held nationally but are not made available to local
government in ways that would allow them to use the
information effectively. Local commissioners need access
to understand patterns of behaviour among different
communities so that services can be more effective.
They also need to be able to compare policy, practice,
and performance between local authorities serving
similar populations.
Some examples, of how these data sources could be
used, include:
n Enabling schools data, benefits data, crime data, and
GP lists data to be used by commissioners, again on
an anonymised basis, to:
– estimate population sizes,
– identify what specific groups are at high risk of a
range of avoidable adverse outcomes from ill health,
to worklessness, to crime, and
– understand how local service provision and national
policies are affecting their local populations and sub-
groups within that population.
n Allowing Hospital Episode Statistics (routine data which
describes every inpatient and outpatient episode that
occurs in the NHS) to be linked on an anonymised basis
with data held on Incapacity Benefits by the Department of
Work and Pensions. In this way, local service commissioners
could understand how best to engage communities who
are at high risk of not being able to work through illness.
n Linking health and schools data to track the impact
of children’s health on educational attainment.
n Linking data on attendance allowance and health to
understand how well-targeted benefits are, and their
impact on the use of health services.
We are not arguing for the release of personal data, nor
for it to be used to target individuals. We are arguing
that there is much data held by government, which could
be enormously valuable in improving the planning and
commissioning of local public services and in ensuring
resources are aligned more closely with real need.
Consistency in the way that information is
collected and stored is a particularly powerful
way of increasing the usefulness of survey data.
The Local Government Association is promoting
the advantages of consistent segmentation and
customer insight. It has developed a practical
tool to help local authorities: Customer Insight
Protocol2
available from: www.lga.gov.uk
The potential benefits of better segmentation
and more consistent use of data to PCTs, local
authorities, and other local agencies include
the ability to:
n Develop a richer understanding of how
‘similar’ people experience different services,
and the extent to which their needs are
– or are not – being met over time.
n Share your understanding of different
communities and pool data to better assess
the needs of smaller, less visible communities.
n Use this understanding to target user surveys
and engagement more closely, and to design
services that meet particular needs better.
n Share best practice when it comes to meeting
the needs of specific communities.
n Benchmark performance in meeting the needs
of particular communities, creating a competitive
incentive for improvement.
Link up data to plan and target services better
Joint strategic needs assessments will become truly
joint – and truly insightful – only when PCTs, local
authorities and other agencies put together all
the data about their communities that is at their
disposal: their needs and how they use services
– not just health and social care data, but lifestyle
data, education, and criminal justice data to develop
real population intelligence. It has become a truism
that the frontline staff of every local agency can name
“Surveys are often carried out for one-off
purposes and are then thrown out. The data
is expensive to collect. It should be done
in a way that allows a picture to build up
over time and compare outcomes with
other surveys.”
Roger Taylor. Research Director, Dr Foster Research

A personal approach to public services 11
“There needs to be better data around the
client and user and shared information
systems. Having good information is simply
good business practice.”
Paul Coen. Chief Executive, Local Government Association
the ten local families who place the greatest demands
on their services, yet it can feel like a struggle to
get agencies to help link those services up. To create
integrated services targeted at those most in need,
commissioners should link up the data they each hold,
and adopt the sort of detailed segmentation and
consistent recording discussed earlier in this chapter.
But there is another challenge the world-class
commissioner will need to face up to. In order to
secure the benefits of actively managing the health
and wellbeing of your population in this way, you
will have to deal with the sense of anxiety created by
the concepts of sharing data and targeting services.
Personal data should always be used proportionately
and only when necessary. As long as the original
full datasets are saved securely, only pseudonymised
versions are needed for more routine use. It is
important to be clear that the law does not prevent
you from:
n Holding personal details in connection with survey
results (e.g. the date of birth of the respondent)
n Holding data for long periods of time
n Using data for a number of purposes
n Sharing data between agencies
Data protection laws are, in fact, designed to enable
all of the above, so long as respondents understand
how data will be used, and consent to this use.
All commissioned research should carry text that covers
how the data should be used and make clear that:
n It will be used solely for measuring the performance
of local services and planning future services
n It will be used by the local authority and
partner organisations involved in delivery
of local services
n It will be used anonymously
If these principles are rigidly adhered to, and the
public is made aware of the benefits, then the
evidence suggests that they support data linking.
Indeed, the public often fail to understand why
they have to provide the same information over
and over again to all the different agencies they
come into contact with.
Joint strategic needs assessment
– Isle of Wight
Dr Foster Research is currently working with the Isle of Wight
local authority in preparation for their local joint strategic needs
assessment. The project is putting into operation all three of
the key messages of this chapter. Specific activity includes:
n Pulling together different sets of data sources from
across the agencies in the area
n Using these data to segment the population
n Identifying peer group local authorities
n Comparing service levels with peer group local authorities
n Comparing service usage by different communities
n Calculating population projections and forecasting
future levels of service usage
This will allow the Isle of Wight to produce an effective
analysis of the local population and identify the needs of
different communities. Such a foundation will allow it to
design services that meet those needs and improve the
provision of services for everyone in the community.
Practical agenda
1. Explore the potential for identifying more meaningful
groupings within your local population.
2. Adopt a consistent model of the population between
commissioning partners.
3. Ensure wherever possible that routine data and
survey data is coded and stored to improve analysis
by different population groupings.
4. Support data linking through consent
and pseudonymisation.
“It’s mad if we can’t get to grips with the
issues around sharing data. If we don’t,
people’s lives are going to be a lot worse
off than they need to be.”
Professor Paul Corrigan. Director of Strategy and Commissioning,
NHS London

Improving information about users’ experiences
“Surveys must be linked to reality and allow
managers to make operational decisions.”
Nicolaus Henke. Director, McKinsey
Most local services conduct a range of user surveys, from one-
off surveys on a particular topic or service, to standard surveys
to meet regulatory or other requirements. There is no doubt that
these all serve a purpose, yet that purpose is too often a one-off
and the data collected is often used only once, then discarded.
Moreover, there is a tendency, particularly with local ad hoc
surveys, to ask general questions about people’s satisfaction
rather than their specific experiences of specific services.
Providers of health and social care services need far better
information on how people experience services if they are to
improve their efficacy and value. Relying on annual, mandated
surveys covering a limited sample of users will not deliver the
quality and depth of information required. We also expect
commissioners to set far higher expectations of providers to
seek and use customer feedback to demonstrate the quality
of their services.
Tracking patients’ experiences
Since early 2007, Homerton University Hospital NHS
Foundation Trust has been gathering instant on-site feedback
from patients in ten of their wards, using Dr Foster Intelligence
Patient Experience Trackers (PET). These digital keypads pose
five questions, which can be varied to suit the particular
priorities of each ward, or coordinated to allow comparisons
across wards. Analyses are automatically generated on-line
and the results e-mailed to staff. Between January and June,
over 3,300 patients answered questions compared to just
325 completed surveys for the annual national survey.
Deputy director of nursing at the Homerton, Jennie Negus,
said hospital cleanliness and general patient care had
improved after the system was introduced. “The high volume
of responses, compared to paper questionnaires, along with
a recognition from staff that this is what patients are saying
about care in their own areas, has encouraged ownership
of that data and quick changes”, she said. “It is not just
how you collect information that is important. It is what
you do with it that counts”, said Negus. “We are open with
the information we collect and present it in such a way that
patients can see we are improving. If we are not, then they
know our plan of action”.
The Trust displays its feedback results on posters around
the organisation and includes a timeline for improvement
plans being put into place. The displays have spurred on
internal competition as participating departments strive
to get the best scores.
The Trust was recently awarded the BT e-health Insider
Excellence in Health Information Management award.
National action required:
Establish commissioning standards that require local
service providers to collect and publish routine, timely
information on customers’ experiences of services

Designing services with
people, not for them
Using data intelligently is necessary but not
sufficient for the world-class commissioner – or
indeed the world-class service provider. The next
step is to build far more direct relationships with
your local communities, involving them in planning
and designing services that meet their needs. The
meaning of the term ‘engagement’ is too often
being eroded by being used to describe general
consultation and unfocused involvement activities.
Good analysis of available data is the jumping-off
point for real engagement to be properly planned
and targeted at ensuring public services are fit for
purpose. Without this kind of direct and targeted
engagement, PCTs and local authorities can too
often waste valuable time and resources (your own
as well as those of local people) and fail to close
the gap between commissioners’ decisions and the
priorities of the people you serve.
Perhaps even more importantly, real engagement
is essential if commissioners are to get anywhere
in the task of reducing inequalities (and achieving
your targets). The inverse care law is a reality: the
people who need help the most are accessing it
the least. For example, the ten most under-funded
health trusts in England and Wales cover some
of the poorest areas in the country with above
average levels of ill health.
People who have multiple problems, such as
mental health issues and a drug problem, are
often turned away because services do not know
how to deal with them. Others with complex
needs never make it near the services that could
help them – and are somewhat glibly referred
to as ‘hard to reach’. These people are not being
served by agencies in their current structure and
hence are not getting the help they need. This
is not just a matter of social (in)justice, it is also
not cost-effective. Those so-called ‘hard to reach’
people will all too often be those who create
repeated emergency admissions, who cannot
sustain tenancies, who require crisis interventions,
or who commit or are the victims of crime.
Designing with communities
Services should be designed from the specific to
the general. They should not be designed by taking
a general blueprint from a central government
department and trying to fit that to a specific local
situation – that would be like trying to build a house
from the roof down. Instead, you should first target
the specific; that is, the situation within the local
community, with a particular focus on those with
greatest need or hard to reach groups. Those people
should be engaged in designing solutions before
policymakers finally work up to general principles.
1. Ensure services are configured around people’s
needs by involving individuals and communities
in designing services.
2. You can reach the ‘hard to reach‘.
“Engagement is very important when
commissioning services because you will
often get surprises, learning that what people
want is the thing you hadn’t thought about.
And it’s not always the big stuff that will
make a difference to people’s lives.”
Anne Williams. President, Association of Directors of Adult Social Services
“There is no such thing as hard to reach
groups – there are services that are hard
for some people to access. Unless people
with complex needs are involved in the
design and delivery of public services,
those services will not meet their needs.”
Victor Adebowale. Chief Executive, Turning Point

This is not traditional consultation. Consultation
is too late – real involvement can only truly
happen if it is built into the beginning of the
process – when the need for change is identified.
This is one of the reasons people so dislike
meaningless consultations. In fact, 55% of people
want to get involved in shaping how their local
public services are provided, yet only 2% actually
do so. Moreover, two-thirds of people currently
feel that public services neither listen, nor respond
to them3
. Traditional consultation processes seek
feedback from members of the local community
on proposed projects or services, which they have
already envisaged. Forward-thinking professionals
in this field use the time and effort they put into
‘engaging’ communities to work with them to
find solutions together, rather than to test their
own ideas for service provision.
“The mistake is often to develop some ideas
then go and test them with the community;
you have to create solutions with the people
themselves, taking into account their whole
lives, motivations and behaviours.”
Connected Care
Connected Care is Turning Point’s vision for bringing
services together to meet all the needs of the community.
It integrates health, housing, and social care in the most
deprived communities, with the community playing a central
role in the design and delivery of those services.
Connected Care has been designed to help commissioners:
n Develop new ways of engaging with their community.
n Design intelligent and innovative new models for
integrated health, social care, and housing provision.
n Promote choice and engage hard-to-reach groups who
are rarely consulted and often marginalised.
A new model of community engagement, the Connected
Care audit, enables the community to have a direct say in
what health and social care services need to be commissioned
in their area. This is a requirement of joint strategic needs
assessments, and also delivers what is likely to be a
requirement of Comprehensive Area Assessments: evidence
that commissioning plans have been designed in partnership
with the community. The audit assesses how individuals and
the community perceive existing services, and what they
would like to see in the future. This creates a specification
that ensures that each community has its own bespoke range
of services. Local people are trained and supported to do the
audits, thus building skills and local capacity.
Turning Point then works alongside commissioners and
communities to explore ‘whole systems’ funding and
support to integrate health, housing, and social care
provision and bring in the wider support of other services
such as community safety and employment. Modelling
the cost/benefit consequences is an integral part of the
process, and clear outcomes are defined from the outset,
allowing benefits to be measured and effectiveness to be
demonstrated both to communities and commissioners.
Connected Care is being piloted in Bolton and Hartlepool.
In Hartlepool, the ward of Owton is within the 5% of most
deprived neighbourhoods nationally, ranked according to the
Index of Multiple Deprivation (IMD). However, the ward has a
well-developed community and voluntary sector and the pilot
service is delivered through a social enterprise managed by
residents and local community organisations. The development
of a social enterprise is seen as central to the service, helping
to ensure it remains focused on the needs of local people.
In Bolton, Connected Care focuses on three specific areas
of the borough:
“The Connected Care pilot will provide a
fantastic opportunity to work with other
service providers to best meet the needs
of the local population. Our partnership
with Turning Point will allow us to bring
in the support of health and social care
to sit alongside housing advice,
community safety, and adult learning
to provide tailored support to adults
with complex needs.”
John Rutherford. Director of Adult Services, Bolton
“Connected Care is not a consultation
or information exercise. It is a capacity-
building tool, an approach done with
the community, not to it.”
Richard Kramer. Director, Turning Point Centre for Excellence
in Connected Care

Designing with individuals
Service redesign does not always need to be a
major exercise. Empowering local staff to work
with service users to redesign services themselves
can generate apparently small changes; these
can make a significant difference to quality of
services and customer experiences. It is not
always a question of investing substantial sums
into service redesign.
“We have become hopelessly
government centric… We need devolution
of responsibility for delivery to the person
who is actually giving the frontline service
to the customer. This is where the service
exists, so to improve the service you have
to improve this relationship. Giving power
to the frontline worker allows for a
meaningful dialogue between them and
the user because change can occur as a
result of their input.”
Diabetes care in Bolton
Bolton has one of the best diabetes services in the country,
yet, despite this, the Bolton Diabetes Network estimate that
80% of those diagnosed with diabetes do not manage their
condition correctly, leading to further complications.
The Design Council’s RED project worked with the local
services to redesign consultations with diabetes nurses and
put service users in control. The Design Council worked
closely with families to understand not only their illness
but also their personalities and lifestyles. Together with the
nurses, they developed a pack of playing cards about positive
changes people with diabetes can make to improve or
maintain their health. Before a consultation with the nurse,
a patient chooses four of these cards to represent areas they
feel they can work on to change their lifestyle. They might
for instance feel able to stop eating cake, but not smoking.
So the change is incremental, not all in one go. The nurses’
behaviour has changed as they have to actively engage
with the choices made by the patient, providing space for
real interaction and support. The cards potentially save up
to 80% of frontline workers’ time, opening up resources for
the service where people with diabetes can access personal
coaches to work with them on sustaining lifestyle changes.
“A process of deep engagement with users
provided the insight to design system level
changes that had the support of service
users, frontline workers and professionals.”

Personalisation in practice
Personalisation is not just about responding
to a more demanding public; it is the key to
addressing inequalities. An estimated 3.7m
people are living with multiple disadvantages4
.
These are the people with complex needs, living
in deprived circumstances, perhaps needing help
with a mental health problem, with getting a job
and having stable accommodation. These are
the people who are forced to knock on several
different doors and tell their story over and
over again, and are then at the receiving end
of services that don’t seem to link up with each
other. Having assessed and prioritised the needs
of local communities, the next step is to find
new ways of delivering services to individuals.
This chapter picks out just three opportunities
to create services that are organised around
people’s lives, giving them sustained support
for the long term.
Show me the money
In social care, it is becoming clear that self-
directed support and individual budgets are
the way forward in driving personalisation.
These innovations are in effect re-engineering
the system, and they are working:
n An evaluation by Lancaster University of
self-directed support in six local authorities
found that, once people took charge of
their individual budgets and support, their
satisfaction with the level of control in their
lives rose from 42% to 97%5
.
n When people direct their own support, the
study found that they were more satisfied with
their support (satisfaction rose from 48% to
100%) even though, in some cases, costs were
reduced. Savings ranged from 12% in one
local authority to 33% in another.
n Positive views of the potential for individual
budgets to improve long term quality of
life, by offering more choice and control,
1. Prepare for individual budgets.
2. Consider creating new navigator roles.
3. Take opportunities to tackle multiple needs in one service.
“…excellent personal experiences for all
– meeting rising expectations by matching
the standards offered by the best of the
private sector, with flexible, personalised,
tailored public services that treat people
with care, respect personal preferences,
and appreciate the value of people’s time.”
Comprehensive Spending Review 2007
“The source of money often determines
what services people will get.”
Lord Warner. Chair, NHS London Provider Development Agency
in Control, Wigan
In Wigan, families of children with special needs have been
given their own social care budgets, and help to manage
these budgets. For instance, one mother was having to
use a large part of her budget on expensive taxis to get her
son to school. Instead, she arranged with six formers doing
an NVQ in social care to take him to school, giving them
a small stipend. She then had a lot more money to spend
on his care. This is an example of where families are being
encouraged not only to spend and manage, but to create
new individualised services to meet their particular needs.
Indeed, in many cases they have saved money compared
to the council services. According to in Control, there are
now 2,240 people across the country holding individual
budgets amounting to £20m.

have emerged from the evaluation of the
Government’s 13 Individual Budget pilots.6
n The 12-month evaluation of the control pilots
highlighted a case where a person, who
previously had funding of £114,000 for an
“unsatisfactory” placement, moved to self-
directed support with an allocation of £60,000.7
Navigating the maze
Whilst examples exist only in pockets, there
is a growing view that a new breed of support
worker is needed: a navigator. The navigator
would have generic skills and deep knowledge
and understanding of the system across health,
care, benefits, housing, and criminal justice.
They would help an individual negotiate a route
through this complex maze of services and hold
onto them until their needs are being addressed.
“The goal of social care is to allow people
to lead independent lives. If a service
creates dependency, then it has failed. Too
frequently, the traditional model – unlike
direct payments – has tended to do this.”
Lucy at Support Link
Lucy has an emotionally unstable borderline personality
disorder. When she used alcohol and drugs, overdosed or
self-harmed, she was deemed by her mental health service
as “acting out” or being manipulative, or attention-seeking.
She however felt she was drinking to cope.
Lucy has now been with Turning Point’s Support Link service
for some years and, with consistency and over time, her
quality of life has improved dramatically. Support Link is an
outreach project providing support for people with a dual
diagnosis living in the community. The philosophy of the
service is to build trust by focusing on issues that service
users feel are important, before going on to address some
of the deeper issues associated with their mental health and
substance use. Services offered include practical support
such as securing and keeping tenancies, benefits advice,
long term emotional support, computer skills training, and
work experience. Staff work closely with service users and
other agencies to develop individually tailored support plans.
Lucy now has a firm care plan with appropriate services.
She says “I am one of the lucky ones. I have survived a crazy
system that crushes your spirit and stigmatises you. I am also
lucky that I have an excellent keyworker, and a wonderful
counsellor. I am now on the road to recovery. People need
to be treated as individuals, not packed in a box, which is
just convenient for mental health services.”

progress2work is a voluntary scheme that is specifically
designed to:
n Help people get over a drug problem and gain jobs
or training.
n Support people through treatment and into work, and
offer drug users employment advice and full access to
Jobcentre Plus services.
A progress2work project worker helps the client prepare
for work and provide support and practical advice. They
meet with the client to talk about jobs and training, and
will create a personal action plan to help them move
towards work and lead a more stable life. The project
worker can also help a person to sort out problems
that may be making it harder to find work – like health,
housing, or debt.
The project worker also works closely with local agencies
to make sure that a client’s drug treatment, rehabilitation,
and employment services are effectively linked. Once the
service user moves into work or training, the project worker
will still be there to provide support and help deal with any
problems that may crop up.
Connected Care Part Two: The Connected Care worker
Turning Point is putting the navigator concept into practice
as part of Connected Care. Connected Care workers are
highly skilled and highly trained generalists, flexible enough
to provide low level interventions or more specialised
support, and make the links between services. They ensure
that an individual with complex needs will need to tell their
story only once, in a single needs assessment.
They can then put together multi-disciplinary teams across
health and social care. All relevant professionals will have
access to the person’s information (after permission has
been given), and the generalist can bring in the specialist
help required, as well as acting as a point of engagement
for practical issues such as housing and benefits.
This cohesive joined up approach to service delivery,
combined with long term, low level, individual support,
will turn people’s lives around, with associated benefits both
to local communities and commissioners.
The Connected Care service has now been set up in Owton,
Hartlepool. It is made up of the following elements:
n Navigators, working to improve access, promote early
interventions, support choice, ensure a holistic approach,
and integrate universal and long term support.
n A complex care team, integrating specialist health, social
care, and housing support.
n A transformational co-ordinator, to manage the service
and promote change in the wider service system.
n The development of a range of low level support services
that focus on maintaining independence.
Encourage the creation of public service
navigators to link up local services for
people with complex needs
Silos and labels
What is stopping services being wrapped around
people’s lives? Services are organised in silos and
people are labelled according to which silo they
end up in. Here are two very different examples
of services that break down those silos to positive
effect (see boxes).
41% of the 2.4m receiving incapacity benefit
in 2007 were unable to work because of mental
illness.8
Around 270,000 drug users are in receipt
of benefit.9
Too often, services are addressing one
issue, such as mental health, but failing to follow
up with services that help people to turn their
lives around. Too often, services lack awareness
or incentive to address people’s wider needs.
“The people with the most complex needs
are the ones that end up in a ‘cul de sac’.
The police know them, the schools know
them, the GP knows them, a social worker
knows them – but each of them only knows
part of the story. What they need is a skilled
navigator to make sure they get what they
need from across the range of services.”
Sir Mike Pitt. Chair, NHS South West

Social justice through enterprise
TREES is a regeneration-focused social enterprise
addressing both the physical needs of disadvantaged
areas through its construction expertise, and also the
social needs through its commitment to training and
job creation in disadvantaged areas.
TREES started out refurbishing and maintaining gas boilers
and heaters for Leicester Housing Association. It now
describes itself as the “largest multi-disciplinary social
enterprise in the East Midlands” and runs gas services,
a construction company, a landscaping and maintenance
firm, conference and training centres and even a chip shop.
The local service employs 75% of its workforce from people
coming out of the poorest estates – breaking a generation
of dependency and creating role models.
The group has turned a profit every year since its inception
and these funds are loaned to subsidiary companies serving
the needs of the community and creating opportunities for
local people.
Mainstreaming
prevention
Rehearsing the arguments for prevention hardly seems
necessary, the facts are well known. For example:
n Admissions to hospital for the kind of conditions
which can be better treated in community
settings cost the NHS £1.4bn in 2006/07.10
n The Audit Commission11
looked at the case of
a boy called James who, had he been provided
with preventive support in early years, would
have cost the state £42,000 up to the age of 16.
However, due to the lack of such support at an
early age, the actual cost of handling James’
case, including court appearances and custody,
came to £154,000. In this case, more integrated
support would have saved over £112,000.
n It is estimated that efforts by the Government
to get 2.5 million extra people into work
have released around £5 billion per annum
of public spending.12
n Every £1 spent on drug treatment saves £9
in criminal justice costs.13
The challenge, as ever, is for commissioners to
break old habits, take risks, and work the system to
enable them to invest in prevention. A shift needs
to be made from describing the problems towards
better managing the “delivery chain”, particularly
the way in which local authorities and PCTs work
together to integrate public health with social care.
Where do you start?
We have already discussed in this report the
essential starting points for effective prevention:
n Using data intelligently to analyse your local
community (see pages 8 to 11).
1. Target prevention.
2. Learn from the pioneers.
“I was once asked what I would change if
I could be Prime Minister for one week. I’d
get every Government department to think
about prevention for that whole week and
nothing else.”
Nigel Kershaw. Chief Executive, Big Issue Invest.
“If we shift resources from the acute end of
the health service to social care, we would be
investing far more of the state’s resources on
preventative services rather than spending large
amounts of resources when their condition is
worse and their needs greater. Social care is
also potentially a great economic policy too.”14
Ivan Lewis. Parliamentary Under Secretary of State for Care Services

Changing behaviour through social marketing
“The campaign has driven people towards
local services but the more significant
element of the work has been the opportunity
to develop services in relation to hard-to-
reach communities.”
Will Blandamer. Director for Health Improvement, Association
of Greater Manchester PCTs
The North West has the highest number of smokers in
England. More than 3,000 people in the region die each year
before the age of 64 because of diseases caused by smoking.
In Greater Manchester alone, 14 people are buried every day
as a direct result of smoking-related illnesses.
In 2007, all ten PCTs in Greater Manchester took the
unprecedented step to collaborate on a major social
marketing initiative: the Greater Manchester Quit-It
campaign. The aim was to drive traffic to local stop smoking
services, particularly amongst smokers from more deprived
communities and the so-called hard to reach.
Informed by population analysis, Dr Foster Intelligence has
worked alongside the NHS in Greater Manchester to use
social marketing techniques to reposition the stop smoking
services to make them as relevant as possible to those
who need these services most. Campaigning has been one
element of this, which has seen a double-decker Quit-it bus
touring the conurbation offering help, support, and advice to
smokers wanting to quit. The campaign also employed other
techniques – for example, text messaging and telemarketing.
A total of 4,512 referrals have so far been generated.
The campaign, however, is only one element of what has
been happening across Greater Manchester. Dr Foster
Intelligence has been working with PCTs, stop smoking
professionals and, most importantly, smokers themselves
in reviewing the services and products currently on offer
and making recommendations that will make them fit
for purpose into the future. The Association of Greater
Manchester PCTs are committed to ensuring that the
services they offer are targeted at those who need them,
in a way that makes them relevant to potential users and
the communities of those they serve.
We know from previous campaigns that such results can be
sustained. In Lambeth, we have run two successful New Year
smoking cessations campaigns. Lambeth saw a 75% increase
in people setting a date to quit smoking and a 110% increase
in the number of people who had still quit after four weeks.
An evaluation showed that an investment of £60,000 secured
a minimum return of £155,266 in costs to the NHS.
YOU DON’T HAVE TO BE AN ADDICT ANYMORE
A Greater Manchester Initiative
You’re 4 times more likely to beat your addiction by using your local NHS Stop
Smoking Service.Call now or text‘quit-it’ with your name and postcode to 81066.
www.quit-it.org.uk
n Engaging purposefully with key communities
(see pages 13 to 15).
Both of these enable commissioners to prioritise
the health and wellbeing challenges they face,
and provide them with the knowledge required
to target early interventions and prevention
initiatives. With funding for prevention in limited
supply, this targeted approach minimises the risk
of wasted effort.
Pioneering spirit
Effective prevention requires a pioneering spirit
and a willingness to take risks with new models
and new techniques. On the previous page is
just one example of a social enterprise combining
integration of services around the individual
with creative methods of prevention; below is
an example of social marketing on a grand scale.
What these examples illustrate is the mainstreaming
of prevention – the creation of services and projects
which can be commissioned and held to account in
delivering results. Too often prevention has been an
add-on, an activity separate from core operations of
local authorities and PCTs. The innovation of social
enterprises and the ideas of social marketing are
putting prevention at the heart of commissioning.

Making partnerships work
The question for most chief executives is not
whether partnerships are important but how you
make them work. The best partnerships deliver
cohesive plans and coordinated services. They are
inspiring for frontline staff, they get points from the
regulatory authorities, and are unnoticeable to the
end user. They get results. The worst partnerships
become talking shops mired in bureaucracy and
countless meetings.
The sharing of budgets and pooling of staff is
one of the most effective drivers of partnerships.
Leaders must ensure that, where possible, this
is not being held back.
Some have gone as far as fully integrating health
and social care into the same organisation – for
example, Torbay Council in December 2005
transferred its entire adult social services staff
into the PCT creating Torbay Care Trust. There
is a large elderly population in Torbay, and the
full integration of health and adult social care
– including staff, facilities, and budgets – was
agreed by the council and the PCT as the most
appropriate way to meet the community’s needs.
“The same old arguments about boundaries
between health and social care are still taking
place. We must move beyond them to produce
effective service delivery coordination that
will be best for the community.”
Lord Warner of Brockley. Chair, NHS London Provider
Development Agency
“I met some commissioners recently
who said the auditors wouldn’t let them
have joint budgets. This is nonsense
– they just lack the will and desire to
make the change.”

The Care Trust works very closely with
the council and is a key player in the local
strategic partnership.
This sort of full integration is not the solution
in all areas, but local strategic partnerships are
a reality everywhere. Here are just two London-
based success stories.
“Bringing health and social care staff
together into a single organisation means
better care for some of the most vulnerable
people in Torbay, particularly the elderly
and those with long-term conditions. This
is our chance to bring a fresh, integrated
approach to solving problems.”
Peter Colclough. Chief Executive, Torbay Primary Care Trust
Successful partnerships
“Westminster LSP brings together a diverse
range of partners with a shared motivation
to make the ‘capital of the capital’ a better
place. The reduction in crime and anti-
social behaviour is just one example of
its achievements.”
Chief Superintendent David Morgan. Metropolitan Police
Westminster City Partnership
Westminster City Partnership has been highly successful at
adopting a coordinated and targeted approach to meeting
the specific needs of its community. One example is the
Church Street Neighbourhood Management scheme, which
focuses on Westminster’s most deprived ward: 12,000 people
living in under half a square mile, over 80% of whom in
social housing; only one in two working (officially) and life
expectancy eight years lower than the borough average.
The partnership has seen a specialist Neighbourhood
Management team set up working alongside officers from
the council, the Metropolitan Police, the PCT, the community
and voluntary sector, and elected resident representatives to
ensure more effective delivery of services. Major successes
include a street improvement scheme (known as the Red Dot
Initiative), where residents are working alongside the council
to identify and resolve problems with streets and pavements,
significant reductions in dog fouling in the neighbourhood,
a “local lettings” scheme (new social housing was earmarked
for people with acute housing need who had lived in the
neighbourhood for more than two years), and a halving
of thefts from vehicles. As a result, only 1% of people
interviewed in a recent NOP/MORI household survey cited
the Council/Council services as being amongst the priorities
most in need of improvement, compared with 10% in 2004.
“Effective service delivery in Tower
Hamlets demands partnership working,
both to meet the complex and wide-
ranging needs of our different local
communities, and to contribute to a
coherent local identity and promote
community cohesion.”
Jeremy Burden. Director of Strategic Commissioning,
Tower Hamlets PCT
Tower Hamlets Partnership
Tower Hamlets has successfully involved the private sector in
a partnership. Just one example is the council’s job brokerage
service, Skillsmatch. Canary Wharf Group plc have supported
Skillsmatch since its inception through introductions to tenants
and support for recruiting locally. Recently, Canary Wharf
Group offered a building that now serves as a Recruitment
and Training Centre, working within the LSP partnership
with key strategic delivery partners such as Tower Hamlets
College and Jobcentre Plus, to equip local people with the
appropriate skills to find work within the borough’s growing
employment base. Skillsmatch assisted 524 local people into
work last year, 77% of whom were from black and minority
ethnic communities; the wider delivery partnership, through
Neighbourhood Renewal programmes, increases this figure to
just under 1,000. A number of private sector companies now
regularly recruit from the partnership and offer essential work
placements for local job seekers. Negotiations are ongoing
for the private sector to assist in developing a construction
training centre on one of the major developments in
Canary Wharf.

A practical agenda for leaders
“The modern local authority CEO should
be turning their roles inside out – spending
the vast majority of their time out with
partners and in the community. If I was a
CEO again I would stop asking permission
and start taking more risks.”
The defining quality of any successful partnership is leadership.
The lessons of local strategic partnerships and the demands
of local area agreements are that leaders need to do their jobs
differently to succeed.
Chief Executives should ask themselves:
n Do you attend partnership meetings yourself?
n How much of your time is spent with your partners
and with community leaders?
n Do you and your partners have a shared picture
of communities’ needs?
n Do the local public services in your patch have shared
priorities and outcome targets?
n Do you provide opportunities for staff from different
partners and services to work together to solve problems?
n Are you ensuring that budgets and staff are being pooled
wherever they can be?
n When did you last break the rules in order to
improve services?
It is possible to imagine how local
authorities, for example, might wish to
invest in local businesses in order to
enhance service delivery. The private
sector should be seen as both a source
of capital and entrepreneurial discipline.”
Tim Kelsey. Chair, Executive Board, Dr Foster Intelligence
What are the incentives?
There are success stories, as these examples show,
but the fact remains that working in partnership
is not straightforward – it demands the right skills
and the right mindset, not just the right structures.
One of the issues to become clear in the research
underpinning this project is that there is a need
to investigate what incentives exist, or should
exist, to make partnership working easier and
more productive. In particular, there is a need to
facilitate greater understanding and skills transfer
between sectors – the private sector, the third
sector, and the public sector.
To take just one example, large employers have
a vested interest in promoting the health and
wellbeing of their workforce – an objective
undoubtedly shared by the NHS and local
authorities. We struggled, however, to find an
example where this shared objective had been
translated into a true win-win partnership (rather
than an exercise in corporate social responsibility).
Social enterprises are good sources of innovative
solutions, but there are too few examples where
commissioners strike up partnerships that amplify
this entrepreneurial spirit to the advantage of
both commissioner and provider.
Train commissioners in development
programmes focused on how to get the
most from partnerships with the private
sector and social enterprises. Support
this by commissioning a piece of work to
investigate and make recommendations to
enhance incentives for establishing mutually
beneficial cross-sectoral partnerships

Conclusion: world class
commissioning pioneers
In compiling this report, we set ourselves the
challenge of identifying some practical routes
towards world class public services – without
further structural reform or significant additional
resources. It is by no means comprehensive but
it has aimed to illustrate some practical ideas.
A number of core assumptions have underpinned
much of what we have set out in this report.
These have been informed by the experiences
of Turning Point and Dr Foster in the health and
social care sector, as well as by the views of those
who have contributed.
World class commissioning is going to depend
on a step change in the culture of public services.
It will demand teamwork and a pioneering spirit
to achieve shared goals. Our belief is that world
class commissioners will be characterised by a set
of values and skills to ensure:
n Commissioners place in-depth population
intelligence at the heart of commissioning, and
allocate resources on the basis of this intelligence.
n Commissioners are guided by what works on
the ground and proactively engage citizens in
designing services – working from the specific
to the general, not from the top down.
n Commissioners routinely and demonstrably
use information from patients, the public, and
service users on their experiences, expectations,
satisfaction, and outcomes.
n Commissioners specify outcomes, not
processes, so as to maximise innovation
among providers.
n Commissioners feel empowered to hold
providers to account for delivering quality and
value and to effect changes where necessary.
n Commissioners are prepared to decommission
services, releasing resources for innovative
new services.
n Commissioners’ mindsets move from “not
invented here” to one of maximising the use
of best practice “wherever invented”.
n Commissioners are prepared to demonstrate
their performance in delivering:
– improved health and wellbeing,
– fewer inequalities,
– better user experiences,
– a dynamic provider market, and
– increased value for money.
“All commissioners need comprehensive
local needs analysis, based on shared
information and standardised data gathering.
They also need to be prepared to abandon
some current providers.”
Development Agency
“The expensive and unnecessarily
longwinded bidding process for contracts
is most to blame for undermining creative
and innovative solutions from smaller
community groups and charities.”
Rod Aldridge. Executive Chairman, The Aldridge Foundation
“The measures of good commissioning
are whether the supply side is dynamic
– is there choice, is there a range of
provision – and whether people are
leading better lives.”

“There’s scope for all organisations to move on
from traditional approaches towards delivering
health and social care services which are
focused on people’s needs. I’d urge both PCTs
and local authorities to look towards world
class commissioning.”
Mark Britnell. Director General of Commissioning and Service
Management, Department of Health
“There needs to be a shift from detailed service
specification to identifying where preferred
providers can get involved in designing
different services at the local level. This would
result in more flexible services, focused on
different needs within the local population.”
Andrew Cozens CBE. Strategic Adviser for Children,
Adults and Health Services, IDeA
“PCTs should be incentivised by
published information on the impact
they are having on health outcomes,
patients’ experiences, and on the
efficiency of the local health economy.”
“Commissioners need to get together
to define what their communities need,
rather than shifting the burden onto
providers, who have to negotiate with
multiple commissioners. As a provider,
you spend a lot of time just trying to get
different bits of government to join up
and think outside the box.”

References, credits
and acknowledgements
Editor
Hilary Rowell
Editorial
Henry de Zoete Emily Frith
Suz Kumar William Little
Design and Production
Zoe Bedford Patrick Breen
Kristina Feldmann Leanor Hanny
Advisory Group
Lord Victor Adebowale. Chief Executive, Turning Point
Tim Kelsey. Chair, Executive Board, Dr Foster Intelligence
Members acting in a personal capacity
Andrew Cozens CBE. Strategic Adviser for Children, Adults
and Health Services, IDeA
Professor Julian Le Grand. Richard Titmuss Professor of Social Policy, LSE
Nigel Kershaw. Chief Executive, Big Issue Invest
Henry Pitman. Non-Executive Director, Tribal Group
Additional Interviewees
Rod Aldridge. Executive Chairman, The Aldridge Foundation
Nina Bhatia. Head of Public Sector, McKinsey
Graham Boffey. Managing Director, Norwich Union
Mark Britnell. Director General of Commissioning and Service
Management, Department of Health
Steve Bundred. Chief Executive, Audit Commission
Jeremy Burden. Director of Strategic Commissioning, Tower Hamlets PCT
Peter Colclough. Chief Executive, Torbay Primary Care Trust
Professor Paul Corrigan. Director of Strategy and Commissioning,
NHS London
Sir David Henshaw. Chair, NHS North West
Richard Kramer. Director, Turning Point Centre of Excellence
in Connected Care
Peter Martin. Chief Executive, Tribal Group
David Morgan. Chief Superintendent, Metropolitan Police
Roger Taylor. Research Director, Dr Foster Research
Development Agency
Anne Williams. National President, ADASS
Case study contributors
Association of Greater Manchester PCTs: Will Blandamer. Director
for Health Improvement and Warren Heppolette. Associate Director
of Partnerships
Hammersmith and Fulham Council: Chris Naylor. Director of
Residents Services
Homerton University Hospital: Jennie Negus. Deputy Director of Nursing
in Control, Wigan: Carl Poll. Communications Director
Isle of Wight: Sarah Mitchell. Director of Community Services
The Trees Group: John Montague. Group Chief Executive
Westminster City Partnership: Marco Torquati. Church Street
Neighbourhood Manager
1. Experian’s Mosaic™ lifestyle segmentation system was created by
the credit rating and information services company Experian Ltd.
2. Developed on the basis of research conducted with Birmingham,
Taunton Dean, Uttlesford and Somerset by Tetlow Associates
and Dr Foster Research. More information can be found under
the publications section of the LGA website: www.lga.gov.uk
3. DfES research 2000 and YouGov poll, Future Services, 2004,
cited in Empowering Neighbourhoods: delivering better local
services for local people, CBI
4. Social Exclusion: the next steps forward. Speech by Rt Hon David
Miliband MP, Minister for Communities and Local Government (2005)
5. A report on in Control’s first phase, 2003-2005, In Control,
12 October 2006
6. Ibsen – Individual Budgets Evaluation: Summary of Early Findings
7. www.in-control.org.uk
8. Department of Work and Pensions statistics, Feb 2007
9. Drug and alcohol use as barriers to employment, Centre for
Research in Social Policy, 2004
10. ‘Keeping People out of Hospital – the challenge of reducing
emergency admissions’. http://www.drfoster.co.uk/library/
newsarticle.aspx?articleid=22. Analysis updated for 2006/07
11. Youth Justice, 2004
12. DWP estimate (2006)
13. Home Office website
14. Keynote address to the Individual Budgets and Modernising
Social Care National Conference, January 2007
References
Credits and acknowledgements
Photography: Getty/Alamy

Turning Point Standon House, 21 Mansell Street, London E1 8AA Tel: 020 7481 7600 Fax: 020 7481 7620
Email: info@turning-point.co.uk Web: www.turning-point.co.uk
Dr Foster Intelligence 12 Smithfield Street, London EC1A 9LA Switchboard: 0207 332 8800 Fax: 0207 332 8888
Email: info@drfoster.co.uk Web: www.drfoster.co.uk

report_shaping_services_around_individuals_needs_274

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (15)

Semelhante a report_shaping_services_around_individuals_needs_274

Semelhante a report_shaping_services_around_individuals_needs_274 (20)

Mais de Hilary Rowell

Mais de Hilary Rowell (6)

report_shaping_services_around_individuals_needs_274