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An external report commissioned by London Councils, the local authority association covering the capital, identified huge savings if a proper Total Place approach was applied to the public sector, reports Dick Sorabji. London is ideally suited for the whole area approach of Total Place. The diversity of its people demands more effective tailoring of services to meet differing needs. The interdependence between different parts of London, whether in handling employment markets, or gangs, means that many solutions rely on better co-ordination across geographical boundaries. That is why London Councils decided to apply the Total Place approach across the whole city to see whether public services could improve and become more cost effective. PwC were commissioned to map spending across London and consider the opportunities for better public service design in three critical areas. The study complements other formal and informal pilots. PwC did not try to replicate the detail of single authority studies, but instead looked at the challenge on a broader scale; they used a telescope, not a microscope. PwC looked in detail at £10.6 billion of London public service spending. By drawing on their wider knowledge across Britain and globally they make broad proposals to improve these services delivering better results for Londoners that may generate savings up to 15%, or £1.6 billion. Total spending in London by all arms of the state was £73.6 billion in 2008/09. Spending by national organisations, including pensions, made up 37% of the total. Quangos spent £5.6 billion. Local spending was 56%; or £42.9 billion. Diving deeper, London boroughs spent about one third of this sum; the NHS another third and the GLA family about a sixth. From Whitehall's perspective it is work and health that are the big tickets in London with departmental spends of over £11 billion for DWP and almost £9 billion for the Department of Health. Mapping spend by quangos revealed the organisational crowding that Total Place predicts. Most extreme were the 60 organisations which Total Place methodology categorised as in the economic affairs sector. All useful for policy wonks; less useful for Londoners. PwC used their experience of best practise across Britain and globally to make inferences from these spending maps about how services could be better designed around individuals and so improve both service quality and value for money. PwC looked at chronic care where £5 billion is spent in London. 1.3 million Londoners are registered with at least one chronic care condition. It is a huge cost on hospitals accounting for 72% of ‘bed days' and 65% of out patient cases. Applying their global experience PwC suggest that different design of chronic care services can ensure that people stay healthier and that costs come down. This requires earlier interventions; more self-directed care and more joint design of care; where professionals and patients develop the best package of care together. PwC concluded that improving care in this way may also reduce costs by 18%; potentially delivering £880m in savings across London. PwC looked at the impact of anti social behaviour by young people. Here the state spends £650m in London. 16 different public service organisations are involved and this creates the problems of overlap and duplication that Total Place seeks to address. They describe a locally integrated approach that could deliver better results and suggests savings to public finances near 10%. More important are the wider benefits both helping young people create successful adult lives and reducing the impact on quality of life across the capital. London spends £5 billion on worklessness. PwC proposed centralised systems where less complex support was needed; local integration where multiple types of support were needed. Localisation permits joint design of support packages by the job seeker working with the case manager to tailor solutions meeting their individual needs. PwC concluded that this approach would help more people back into work and as a result might generate savings near £630m. This research provides evidence to back the case that changing the way we co-ordinate public services can both improve quality and reduce costs. The Prime Minister endorsed its broad conclusions at the liaison committee in Parliament this month. While the potential for savings is important, it is the implications for a new approach to the design of public service in Britain that will go on generating benefits into the future. Earlier interventions and a closer focus on individuals' differing needs are at the heart of the analysis. This in turn depends on integration at a local level. That has important implications for the relationship between Whitehall and local government. It shows how our current silo system can too easily add costs and reduce the success of our public services. These lessons provide evidence that long held political aspirations for greater local accountability reinforce better management, better outcomes for people and better value for money. London borough leaders are now taking the next step and offering a pathway to reform spelt out in the recently launched Manifesto for Londoners. Dick Sorabji is corporate director, policy & public affairs, London Councils

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WHITEHALL

Why London is ideal for a Total Place Approach

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