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Prevention and early intervention in local government: opportunities and challenges

Jocelyn Bailey writes about the drive towards ‘prevention’ across the public sector, and how organisations can take staff with them on the journey.

If our recent commissions are anything to go by, there has been a resurgence of interest lately in preventative approaches across the public sector. This is presumably partly a knock-on effect of austerity, and resource pressures. But there is also a narrative that says that much of what the public sector (especially health) has to deal with is potentially ‘avoidable’: obesity and ‘lifestyle’ related illnesses, homelessness and mental health crises, cycles of poverty and unemployment. The social safety net today is not only – as the name implies – helping people ‘bounce back’ after a one-off problem, but predominantly supporting people over long periods of time whose lives and capacities are compromised by systemic issues, and problems that have deep and multifarious roots. A prevention approach suggests that you start tackling the problem much earlier, before it escalates into a full-blown crisis: helping people manage their money so they can afford their rent and don’t become homeless, for example – rather than waiting until they turn up with rent arrears and an eviction notice.

A human-centred design approach (coupled with other expertises) is a natural approach to prevention, because understanding how to prevent problems arising means understanding people’s life journeys, motivations, opportunities and environment/ contexts – and designing strategies with those things in mind. On a number of projects our entry point has been creating the preventative strategy, but in delivering the strategy we have rapidly found ourselves in the world of systems and organisational change.

In fact, coming up with the idea is the easy bit. With a bit of insight, it’s not difficult to think of solutions at both a micro and macro level. Preventing childhood obesity might be about supporting local healthy eating opportunities (e.g. a healthy tuck shop or an affordable healthy recipe kit), or taking policy-level steps such as banning sponsorship and advertising of fast food at public events – as in the famous Amsterdam example. But what that example shows, and what our own work in Hackney on the same topic has shown, is that effective prevention relies on system coordination, in a particular place. Multiple people, in different organisations, different sectors, and in private and public life, all involved in working towards a new normal and recreating their local environment together. It means throwing all the pieces up in the air and letting them land in a different configuration of relationships, roles, actions and norms. This is much easier said than done – and there are often competing interests and agendas which work against a system pulling in the same direction. Nevertheless, it is worth trying – and from our own discipline (design), we have found that introducing a visual and material aspect to this process – a prototype, an artefact (such as Make Kit, the aforementioned recipe kit) – can be a powerful ‘node’ to convene people and enable that reassembling of the social and material system. Sometimes involvement in a practical project, however imperfect, can be the thing that starts to shift behaviours and norms.

So if it’s relatively simple (with a bit of creative thinking!) to identify sensible prevention strategies, but we know that delivering them requires the harder task of coordinating systems, in a place – what is the role for local government in that? And will it be possible for local authorities to play it?

The RSA has recently coined the phrase (in response to the needs of problem-solving in the public sector) ‘think like a system, act like an entrepreneur’: recognise that complex problems need a number of different players across a system to coordinate and mobilise (no single organisation has the power to do it alone), and be creative, innovative, opportunistic, commercially-minded etc. This sounds attractive, but is it realistic? There are reasons to pause before we start exhorting public servants to transform themselves into entrepreneurs.

First, as a work environment, almost every bit of government and the public sector has actively dissuaded its employees from ‘thinking like a system and acting like entrepreneurs’ for years. Management by targets has very closely circumscribed employees’ autonomy and freedom to exercise judgement, and disincentivised them to do anything that falls outside of their immediate remit. This also means that work in government appeals to some personality types and skillsets more than others. In a Venn diagram of ‘why people go to work in the public sector’ vs ‘why people become entrepreneurs’, there might be little overlap. Second, in recent years numbers and resources in local government have been decimated, meaning that those who are left have to do their work in much more challenging circumstances.

And yet, across many local government clients we work with, we are currently seeing senior leaders asking how their organisations and teams can become more effective ‘problem-solvers’. This has to be handled carefully. On the one hand, an organisation is its people, achieving anything means doing it with them, and there are indeed some public sector employees dying to be let loose on problems where they can see the solution but haven’t previously had permission to do anything about it. On the other hand, it risks looking like asking the most vulnerable and hard-pressed (and probably worried for their jobs) people in the organisation to solve problems that might be better addressed at a strategic and political level.

A starting point – and something we have been doing with a number of councils trying to transition to a preventative approach – is to try and understand where the organisation is (at every level) psychologically, mentally, emotionally. Consult and listen. And then work out how far off you are from where you want to be: do staff see problems as being interrelated? Are they predisposed to think like a system? What stops them from doing that? Ultimately, do they see it as the council’s responsibility to get at the underlying causes or problems? Or to treat the symptoms? Do they want the additional cognitive daily load of ‘problem-solving’ for residents? Or would they prefer to play by the current rules?

Answering those questions gives some sense of the nature of the organisational change challenge. The next step is to co-create – with staff – the strategy that gets the organisation there. Staff come in all shapes and sizes, levels and motivations. They will have distinct roles to play, journeys to go on, and activities to get them started. A well-considered, people-centred change journey is essential to get going.

Early Intervention, Prevention and Resilience (EI, P & R) has become a common refrain in the public sector in recent years with a move to steer away from expensive crisis intervention services. With an EI, P & R approach, there is the opportunity of serving a cost savings agenda as well as benefiting citizens by providing them with the support needed to avoid reaching crisis point. Below, we showcase a range of examples which illustrate the variety of formats which EI, P & R can take. The distinguishing factors which make each an example of EI, P & R are highlighted as are some critical success factors.

 

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