Some policy ideas never die. They find new homes and reincarnation is the Government's preferred approach to the Total Place public service reform programme.
Emerging from the Treasury-led Operational Efficiency Programme in the wake of the 2008 financial crisis, Total Place's neat aim was to put the citizen at the heart of service design, map all public spending in a place and redesign services collaboratively to save money and improve outcomes.
Shifting cash from crisis response to prevention was a key objective, but the coalition government slapped the lid down on the promising initiative soon after the 2010 election.
Fast forward to last autumn's Budget announcement of five Place Based budget pilots alongside Greater Manchester's Prevention Demonstrator, and the Government is raring to go after dusting off New Labour's Total Place playbook. For many in the public sector that will come as a relief. One participant told a May 2024 Institute for Government roundtable ‘we've spent 14 years trying to reinvent Total Place'.
Greater Manchester's Prevention Demonstrator is a government supported programme that turns the region into a testbed for prevention focused public services models, with the goal of potentially scaling proven models across the country. Added momentum for the agenda came last week, when the Government unveiled the agreed focus of each of the Place Based budget pilots on the day of New Local's Total Place Now convention in London. The Government and Mayoral Strategic Authorities are working to develop pilots covering:
• Special educational needs and disabilities across the Liverpool City Region
• Young people at risk of offending in Gateshead and South Tyneside
• Adolescent mental health across four local authorities in the Black Country (Dudley, Sandwell, Wolverhampton and Walsall)
• Adults facing multiple disadvantage in Doncaster
• Preventing youth unemployment across West Yorkshire
The Place Based budget pilots are part of the Test, Learn and Grow programme and are being delivered jointly by the Ministry of Housing, Communities and Local Government and the Cabinet Office.
Last week in Westminster, Parliamentary secretary for the Cabinet Office Satvir Kaur opened Total Place Now – a one-day convention bringing together local system leaders and national policymakers – with a warmly received speech. Kaur, who led Southampton City Council from 2022 to 2023, pointed to youth hubs, the reintroduction of Neighbourhood Health Services and the launch of hundreds of Pride In Place programmes as examples of a ‘mindset shift' that had already started within government. She said: ‘This is policy work that is going beyond a single government department and [is] breaking out of the traditional silo short-term thinking'.
She added: ‘I'm ensuring this vital cross government partnership working is being maximised for people and place. Let's be clear, this new way of working goes beyond putting complementary services in the same location. This is about reforming the services themselves.
‘It is one thing to be in the same boat, but another to ensure everyone is rowing in the same direction. This is where the Test, Learn and Grow programme comes in. It puts people in the centre, with services that not only work around them, but with them.'
Test, Learn and Grow is about ‘shaking up the system, not tinkering on the sidelines', she emphasised. She pointed to the example of Plymouth, where leaders of local services are driving a community-focused approach to health by offering preventative services through wellbeing hubs to frequent users of GP services, and to Barnsley, where the place's technology ambitions are being supported through Test, Learn and Grow ‘by harnessing the power of AI to improve children's safeguarding'.
This is a critical moment for the ‘state reform, meaningful, place-based, people-centred reform' that she said gets her ‘up in the morning', and with a new Place Unit being set up in the heart of government, ‘the stars are aligned'.
Addressing the convention over a video link, and giving details of the pilots, local government secretary Steve Reed said they would test ‘how pooled budgets can make public services more effective, more human and more sustainable'. He homed in on the need to rebuild trust in politics, and said that he intended to set out a vision for public service reform later this year.
The first panel session discussed the necessity of rewiring systems nationally and locally. Success metrics were also mentioned, such as improved outcomes, empowered individuals and reduced bureaucratic inefficiencies.
The arrival of the strategic authority tier of government was an important boost to the convening power needed for public service reform, said deputy director of local government and reform at the Treasury, Henry Elks. ‘I think in 10 years, if we have greater coverage, and more mature strategic authorities working in partnership with local government, and we've got a system that thinks about those two tiers of government working together, that's quite exciting.'
Treasury will of course be keeping a firm eye on the financial gains. ‘I do also think it is about savings and efficiencies. Why is prevention important? Well, obviously it's because we care about the outcomes for our citizens. But also, almost all preventative measures are cheaper than crisis management and, as soon as children touch the care system, their outcomes get worse for the next 30 years, statistically. I think it would be a great signal of success if by 2035 we are sat there saying there's a demonstrable downward trend because of the system change of place-based budgeting and place-based delivery.
‘And I don't think it's an individual service thing where we will know exactly what has happened in every place. I think it's that kind of system change and feeling the effects of that flowing into public finances in 10 years' time as well.'
Programme lead for public service innovation at Liverpool City Region Combined Authority Rob Tabb said the time had come to ‘get out of our own echo chamber and build a connection with sceptics'. He added: ‘Either start something or find out who's already doing stuff and help them.'
Chief executive of Sutton LBC Helen Bailey was working in the Treasury at the time of the Total Place pilots. Asked how place-based budgets could drive change and what particular changes she would want to see enabled in her place, she said: ‘It's about enabling people to be a single person in their relationship with services, rather than [having] multiple points of access.'
Looking ahead to the view from 2036 and what Total Place working could unlock longer term, key points included the need for integrated public services, early intervention and the effective use of technology and data to improve the flow of information. The panel stressed the role of philanthropic funding, mission-based public service and the need for culture change within organisations.
Claire Dhami, head of systems change and inclusion at West Midlands Combined Authority, said of the Place Based budget pilots on adolescent mental health pathways within her area that in 10 years' time ‘we'll have the information flow that means we've reduced crisis demand, and we've got good support packages that work for people who need it, and careers that work for those people experiencing mental health issues'.
Also looking to the long term, director of strategy and innovation at Test Valley BC James Moody said it was about ‘recognising we can work at the most local level, but we're purposeful and intentional about demonstrating the evidence and the impact, to show how that can influence genuine system change'.
He raised the question of how to invest in and energise the public service workforce ‘in a way that they are genuinely community centred, that they're empowered and able to make decisions and not having to go through lots of bureaucracy to do that'.
Speaking to The MJ, the minister Satvir Kaur said it will not be a case of having to get things right first time. Public service reform has been talked about for decades, ‘but what makes this moment exciting and special is not the idea of preventative, total place reform, it's how we're trying to do it differently with local leaders'.
She concluded: ‘It's this understanding that we can't keep doing delivery top down, accepting that those on the front line will often have the best ideas, and making space for inevitable trial and error.'
To be involved in learning from the pilots email PlaceBasedBudgets@communities.gov.uk.
• The Test, Learn and Grow network is at www.linkedin.com/groups/16090028/
