Buying Quality Performance

The commissioning of public services reinforces their separation and siloisation.  At the front end, this can mitigate against meeting service user needs. There have been various attempts to address this, but few examples of success – possibly because the structures, from central government out, require and reinforce the disconnection. I am currently advising Brent Council on creation of a new pilot that aims to sit outside of the structures and act as an interface between the services and the users. A key driver behind this ‘Navigator’ pilot, giving it a vital sense of urgency, is the forthcoming (largely ignored) impact of housing benefit caps and the rollout of Iain Duncan Smith’s Universal Credit: tens of thousands of families are likely to be made homeless.

The following paper sets out the background to the Brent pilot and what we are aiming to achieve, including an indication of timeframe, targets and cost.

The Navigators – an overview

The cacophony of service provision

A large proportion of service delivery (public, voluntary and private), and therefore much of the public/social service expenditure, is targeted at the most excluded, deprived communities. 50% of local authority expenditure is targeted at 5% of the population. However, as a direct consequence of their social exclusion, the members of these communities are not reached by the services and their often complex needs are not addressed. In fact, the operation of these services may actually exacerbate the exclusion, creating an expensive vicious cycle.

This is partly because the services are organized, probably funded and traditionally delivered in disconnected silos. In many instances, as well-developed professions, they clearly frame situations in terms that are consistent with their profession – often this is characterized by the use of jargon and can also mean that process-driven responses are emphasized.

To the socially excluded individuals, this siloisation does not necessarily reflect the nature of their lives, in which a number of complex challenges are all interconnected. An emphasis on process can feel like the de-emphasis of person, with the processes of disparate services at times in competition and conflict. The use of professional language, or jargon, can be hard for an outsider to understand and is alienating.

With multiple needs, the socially excluded individuals are brought into contact with multiple agencies/services. However, their experience of this is of a cacophony of sound, the multiple voices hard to understand on their own and becoming a wall of impenetrable noise in combination.

This is, of course, exacerbated in some cases by a lack of adequate basic skills, or first language competency, or by possibly behaviour that is (or is perceived as) difficult or anti-social. There are likely to be health issues, physical or mental. Children are likely to be under-performing in school and may be on the edges of care.

A burning platform and immediate focus

Imminent changes to the welfare system in the UK, particularly the introduction of Universal Credit and the capping of benefits, are creating a burning platform for many people. The full impact will take years to ripple out, however, there is also a dramatic looming deadline.

In some parts of the country, including all of London, many people currently dependent entirely on benefits, will, from 1^st April 2013, no longer receive enough money to pay their rent and cover their living costs. A significant number are likely to be made homeless.

The families most likely to be hit in this way are single parents with three children or more. It is also likely that the families concerned are socially excluded. They are residents of the poorest wards with the highest levels of deprivation, facing multiple challenges. They are already – or should be – on the books of multiple service providers.

Given the position of Brent on the edge of central London, and the consequent level of local rents, more families in this Borough will be impacted than in any other part of the country. More than in Manchester and Birmingham combined. Current estimates suggest that over 3,000 families may well be displaced.

These families need urgent assistance to understand the impending threat and, as far as possible, helped to secure some sort of sustainable solution. If ONE member of the household can find and keep work of 24 hours a week or more, most of the benefit cap does not apply. If this is not a viable solution, and the rent cannot be renegotiated, then a smooth transition must be facilitated which minimises negative impact.

Bridging the gap

Attempts to address the disconnected, conflicting nature of service delivery can roughly be characterized in two ways.

In a ‘multi-agency front door ‘ approach, representatives from multiple agencies are co-located and encouraged to offer, at the point of delivery, a coordinated response. They pool their knowledge and create a single, shared caseload. They are challenged to change their established ways of working and co-create new systems. The difficulty is that the established systems are an integral part of each service’s professionalism.

(An inspiring example of such an approach, in action and working effectively, is the Bromley-by-Bow Centre established by Andrew Mawson 25 years ago. Though a key question raised by this example is why its success has not been replicated.)

In an approach such as the Navigators (in other places called Key Workers, Coordinators or Intensive Mentors), a new intermediary is introduced to act as a bridge between the excluded individual and the service providers. The intermediary acts as an interpreter, enabling the individual to comprehend the messages they are receiving and make them relevant to themselves and their context. At the same time, the interpreter is framing and presenting the individual’s needs so that the services are able to understand them.

(Interesting and exciting, though different, examples of this approach include Participle’s innovative Life Programme in Swindon, and the wonderful Intensive Mentors in Liverpool deployed by Local Solutions.)

The multiple service doors remain, but the intermediary navigates and guides the individual to the right door and helps them to knock on it. The intermediary may also act as advocate, assisting the individual once through the door, to understand the service’s response and holding it to account.

The Navigators are able to provide invaluable feedback. They build a unique understanding, from the very frontline of delivery, of an individual’s needs. This can be used to improve the effectiveness of services and to inform overall system design.

In some instances, the Navigators may be targeted to reach and assist particular individuals. However, it is important to recognise the role of ‘significant others’, ie the family, peers and other influences on the individual. Targeting households rather than individuals can mitigate this. Given the burning platform of benefit changes and possible flood of homelessness, this will also be the target for the Brent Navigators.

The Brent pilot

A pilot team of Navigators will be recruited and inducted, to be fully operational by the 1^st January 2013. There will be six Navigators in this first tranche, with one Navigator Manager.

The precise way in which the Navigators work must be developed by the team and over time. A structured approach must be developed that: gives them a clear framework within which to deliver; ensures a high level of person support; drives close team working; enables robust performance management; provides risk assurance; facilitates joint working with the relevant agencies/services; determines reporting mechanisms to build and maintain the profile of the pilot and to demonstrate accountability; builds a cost-benefit analysis; and informs future development.

The Navigators will be caseload carrying. Each Navigator will work with a caseload of around 50 families per annum. This drives a personalized approach, giving the households continuity. The Navigators can build relationships and trust with their families. It also enables a focus on outcomes and performance management.

In the pilot plan, this would be a total of 300 families/households (at a cost of c.£1,400 per family per annum).  The target will be for one member of each family, in 35% of these households, to secure and sustain employment of 24 hours per week or more. This means, in the pilot, 105 families/households securing a job for someone, at a cost of c.£3,900 per outcome. In securing that 24 hours of work, the household will be exempt from the housing benefit cap.

The families will be identified as those at most risk of being made homeless in the next twelve months – and the ones least engaged with existing assistance.

The objective will not be for the Navigator to achieve this outcome as some sort of employment advisor, but to make, monitor and drive links with other organisations with the appropriate resources and expertise. The Navigators must sit above other services, maintaining their position as intermediaries rather than providers.

In the early days of the pilot, the Navigators will have to focus on building their own knowledge of and relationships with the extensive network of service provision in the Borough. The Navigators will have to consider together what tools will help them and their families to navigate this landscape.

The Navigators will also track, and be managed against:

• Mapping of the families’ current engagement with other services;
• Enhancement of that engagement;
• Identification of other needs within the family;
• Engagement with new services as required
• The results of that new engagement.