Guest blogger Keith Coleman, Global Head of Capgemini’s Public Sector Consulting team writes about how effective government policy execution should engage citizens as partners to ensure the creation of desirable outcomes. For all the talk about preserving frontline services, cuts in government spending on the scale being proposed by the UK Coalition goverment will inevitably take staff out of frontline roles. As set out in the June Budget, many departments face cuts in excess of 25% over the next 4 years. If providers of public services continue with the same delivery models that exist today then fewer inputs can only mean fewer outputs. Taking the wrong approach to cost reduction is likely to cause disengagement and dislocation amongst citizens whereas taking the right approach would make use of engagement as an enabling tool to drive savings. Today I will explore a number of these engagement tools further.
Following the June 2010 announcement of the planned cuts in public spending under the UK Coalition government, there is a clear risk that its relationship with citizens will deteriorate and that their engagement with shared objectives will decline as resources are taken away. It is easy to imagine the relationship between citizen and state becoming more antagonistic as queues lengthen and services close. Slash and burn cuts would potentially put the most strain on the relationship with those citizens who are most dependant on public services and those who are already hard for the government to reach. The alternative to declining engagement is to create new models of delivering services that focus on increasing engagement with citizens. Building citizen engagement (at least in the minds of the uninitiated) may sound like a luxury that adds cost by augmenting services – a nice-to-have that should be put aside in time of austerity. But getting citizens engaged is crucial to both achieving policy objectives and controlling cost – as well as being a key part of the present government’s “Big Society” agenda. Letting the relationship decay may lead citizens into behaviours which cost both the government and society. Stronger engagement with citizens would save money for governments in three clear ways: 1. Citizens would consume more efficiently 2. Citizens would contribute effort 3. Citizens would drive-out costly behaviours through greater empowerment More efficient consumption When engaged citizens consume more efficiently they select only those services they need and make use of services using lower cost channels. At the simplest level this engagement might simply be in the form of providing online engagement with citizens, driving them to use lower cost online channels. Websites can help to drive users online by following the example of leading online retailers like Amazon in stimulating citizens to generate content of interest to others like them – very much in the manner of Amazon’s user reviews. More sophisticated examples might involve handing over control of the budget for a set of services to the citizen – as in the example of personal budgets in adult social care. Here users can choose the set of services which will best help them given the resources available. Consumers can be handed a budget significantly smaller than the amount that would have been spent on their total care as they will adjust their consumption to make the best use of the funds available. Expensive services which they see as low value will fade, whilst lower cost and better value services thrive. Encourage contribution of effort More engaged citizens would contribute effort that would otherwise need to be made by the state. By offering citizens the potential of a more bespoke, tailored service it follows that they will feel encouraged to help create the services that they or others use. A clear example of how an exchange of customer labour for quality products has worked in the private sector is IKEA’s self assembly furniture. IKEA makes an implicit deal with its customers that they will get a stylish customisable high quality product at a low price in exchange for their effort. Customers not only need to build the furniture themselves, they have to work out the set of parts they needs, pick them out of a vast warehouse and transport them home. This model of transferring labour demands onto the customer has been a huge success, and, customers have bought into this model in their millions across the world. To replicate the success of IKEA – and get customers to help deliver a low cost product themselves –public sector bodies need to remember that they need to offer something in return for citizen’s input. Perhaps they should also learn from the careful planning that goes into the components that IKEA supplies – furniture is easy to assemble with few tools –and the ways it both enables and controls customisation. Citizen empowerment With support, citizens can change their behaviour in ways that save everyone money and effort. A virtuous circle can be created as achieving better outcomes can reduce demand for public services in the first place. The rising demand for healthcare and other services resulting from an ageing population is the most important driver of long term cost control for the government. Controlling or reducing this demand is crucial and engagement can be a vital tool. Long term conditions are also a significant source of cost and one where demand is growing. Currently such conditions make up an estimated 52% of GP appointment and 65% of hospital outpatient appointments. Telehealth methods and technologies can be used to help enable increased engagement for patients with long term conditions. Telehealth places the responsibility for monitoring of measures like weight, blood pressure and blood sugar on the patient. Often telehealth makes use of remote monitoring technologies, but, can also simply make use of the telephone. Examples like Birmingham’s OwnHealth focused on telephone support to keep patients in their own homes. By giving patients access to their data they can see how their own actions impact the indicators and take a more active role in managing their own condition. As frontline organisations face the reality of implementing cuts it is essential they retain focus on building relationships with the citizen. Doing this requires both small and large innovation at the frontline, rather than a declining quantity of the same old service. Through improved engagement techniques such as those I have described above they can provide better, as well as more cost effective outcomes. Without such an approach to citizen engagement, short term budget cuts today may simply increase the longer term cost to the state.