Designing and Commissioning To Tackle Demand Simon Johnson AdviceUK Kate Kennard Portsmouth City Council.

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Designing and Commissioning To Tackle Demand Simon Johnson AdviceUK Kate Kennard Portsmouth City Council Slide 2 Systems Thinking: a counter-intuitive approach Doing different things Doing things differently... When we want to improve performance... Performance System Thinking Slide 3 Thinking governs performance By helping organisations change the way they think the system changes and performance improves as a consequence Performance System Thinking Slide 4 Its the System Stupid! 30 40% of the demand for advice shouldnt be there. Its caused by the failure of public services to get it right for their customers Procurement of advice typically drives the wrong behaviour eg activity targets lead to transactional services Pressure to hit activity targets cause cherry-picking of easier cases and a revolving door clients dont get their problems fixed so keep coming back Slide 5 Purpose Help citizens to pay their rent and council tax by making a decision and paying benefit quickly Slide 6 Slide 7 Portsmouth Approach: Background Portsmouth CLAC opened on 1 April 2008 Partnership between You Trust and Portsmouth CAB funded by PCC and LSC LSC contract inflexibility meant service not meeting residents needs CLAC partnership therefore dissolved 7 Slide 8 The commissioning maze: where do we go from here? 8 Slide 9 Understand what we want! 1 st April 11: PCC awarded interim one year contract placed with previous providers; Interim service called Portsmouth Advice Centre, based at same location Interim contract period used to review service and better understand customers needs. Learning informed procurement process for new contract (which started Apr 12) as follows: 9 Slide 10 Look at work a bit differently... The performance of anyone is largely governed by the system he works in. If we set targets and make peoples jobs depend on meeting them... ...they will likely meet the targets even if they have to destroy the enterprise to do it. Dr W Edwards Deming 1900 1993 10 Slide 11 Systems Thinking Advice Services Previous experience of systems-thinking approach in Portsmouth: Repairs Rent arrears Community Wardens Partnership with AdviceUK (Nottingham work) May 2011 Interventions: Portsmouth Advice Centre (PAC) PCCs Tenancy Support (TS) and Money Advice Team (MAT) 11 Slide 12 Understanding demand: getting in the work Understanding purpose as commissioners: Listening to customers at front desk Sitting in on interviews Finding out what matters really matters to customers Understanding the system Realisation that the system was driving the work, not vice versa 12 Slide 13 Waste Steps Waste = Spending time doing things again which have not been done right the first time Waste = Duplication of effort Waste = Doing things which add no value to the customer or the organisation 13 Slide 14 56% Value 44% Failure 205 - 345 per week Take ticket from machine Take a seat Called to reception & handed green form Take a seat and fill in form Hand in form to reception Take a seat Form details entered on IT, ticket number on form, board in back office updated and form placed in tray Advisor picks up oldest form from tray and calls client number Advisor and client go to interview room Advice given Client leaves Average 69 minutes : could take 2 hrs 39 mins Client enters centre Avg 33% of clients leave before adviser is free Purpose: Give me the right advice and appropriate level of support to help me resolve my problem(s) On 56% of days we are open for less than 50% of advertised hours What we learned Slide 15 Levels of need Low level need Give me the information/tools I need to solve my problem myself - 42% Medium level need I need help/support to solve my problem 36% High level need Sort my problem out for me 24% Service needed ability to respond flexibly to each level of need, designed around the high frequency demand we identified 15 Slide 16 Defining purpose Better understood our customers needs Defined purpose in customers terms Purpose supported by underlying principles Learning then drove the commissioning process: 16 Slide 17 Redefined Purpose: To provide an advice service that supports the people of Portsmouth to solve their problems. This advice will be offered in the areas of: Debt* Money Welfare benefits* Employment* Housing* Consumer rights Family law * Indicates those areas that are predictable, high-volume demand. However list should not be considered exhaustive and providers should assume that the needs of the citizen may change during the term of the contract. 17 Slide 18 PAS Principles Responsive Enabling High quality Professional Flexible Collaborative 18 Slide 19 Knowing what we didnt want to commission: Understanding the customer journey and blockages in the system (mapping flow) Understanding what was value work (always back to purpose); leading to Understanding what wasnt value work (failure demand our own and other agencies waste steps) 19 Slide 20 Commissioning: Learning drove the commissioning and tender specification Purpose and principles overarching framework Applicants presented with learning through open day presentation and tender documentation 20 Slide 21 Commissioning: Applicants required to demonstrate, against each principle understanding of the continuous improvement approach evidence of where they have designed and delivered services in a similar customer- focused manner how they would apply the learning to the Portsmouth model 21 Slide 22 Commissioning: How did the process feel? Looked very different to previous tender specifications Needed to get procurement on board Element of risk (would organisations get it?) 22 Slide 23 Commissioning: Did it work? Yes! The framework used for submissions demonstrated clearly whether organisations understood the approach; whether they could relate it to ways they had worked previously and most importantly, whether they could think about the work in a new way, in accordance with our particular needs 23 Slide 24 Measuring success Number of people trying to access the service by type and frequency Number of people successfully accessing the service by type and frequency Number of people who abandon trying to access the service by type and frequency Number of repeat visits End to end measures i.e. length of time taken for customer to receive service, total time taken for customer to resolve their problem % value and failure demand % of people referred to other agencies 24 Slide 25 Slide 26 Just the beginning New transformed service launched beginning April But still lots of work to do: Deeper understanding of root causes to inform response Exploring common areas of failure demand across the wider advice services in order to switch it off Building on the measures Building on the partnership shared Risk Register, monitoring meetings in the work 26