Building Tech-Powered Public Services is a new report published by the Institute for Public Policy Research (IPPR), looking at digital innovations in health and social care.
There are 7 major case studies in the report, including Patchwork. The other case studies are Casserole Club (a community that links people who like cooking with their neighbours who are in need of a hot meal), ADL Smartcare, Mental Elf, Patient Opinion, The Digital Pen and form system and Woodland Wiggle.
These grassroots projects focus on the frontline experience of delivering and receiving public services, and avoid some of the pitfalls of top-down IT projects.
Sarah Bickerstaffe, the report’s author, answers two main questions:
Can technology improve the experience of people using public services?
“Technology can improve people’s experience of receiving public services, just as it has improved the user experience in so many other sectors. In health and social care particularly, the era of chronic conditions – which cannot be cured and are caused in large part by lifestyle factors – means that technology can play a critical role in placing power, responsibility and control in the hands of individuals to help them manage their own health.”
Could tech-powered public services be an affordable, sustainable solution to some of the challenges of austerity?
“Technology can also help to bear down on bureaucracy and ensure that the transactional elements of public services are as efficient as possible. More significantly, it can make a contribution to delivering more preventative services that stop or delay problems escalating, costing the taxpayer more downstream.”
There were clear and consistent lessons on how to successfully implement tech innovations in public services, which is covered on the FutureGov blog.
Here is the full Patchwork case study, but we encourage you to download the full report on the IPPR website.
Patchwork emerged when FutureGov founder Dominic Campbell watched a documentary on the catastrophic failings in care in the ‘Baby P’ case.
Campbell had experience working in local government as a head of back office strategy, as well as experience of implementing big IT systems.
He explains that while working within local government he became disillusioned by technology consisting of ‘inelegant inhuman systems that make you rewire your brain rather than fitting into the world around you’.
He was astonished that the terrible circumstances around Baby P were able to come about ‘in an era of Facebook’, when the general public can be so closely connected to one another .Campbell explains that he wondered:
‘How can one case worker not know what another might be concerned with?… I found information governance wouldn’t let us share information within ourselves, let alone across organisations … so putting that together with the [Baby P] documentary I thought “I know it doesn’ t have to be this way”.’
Instead, he became interested in the potential of:
‘… using modern open source networked technology to work in areas like CRM [customer relation management] and case management in particular – so a lot around case records and joining the dots a lot of the time between silos of information in the public sector to make sure that the public sector is working as well as possible and also empowering practitioners to do the best job possible.’
This process saw the founding of FutureGov, set up around five years ago, to begin to think about new ways of developing technology for and with the public sector.
The organisation benefitted from early Nesta investment, and used this to spend six months testing the Patchwork hypothesis with Lichfield in Staffordshire.
This process began with 12 weeks of design interventions and roughly 8–10 weeks of prototyping. Campbell explains:
‘We think that design research is totally fundamental to articulating the problem accurately … [Patchwork] has been going on for about three and a half years now, and I would say that a year and a half of that at least has been around design research of one form or another. In that first six months [design research] was two-thirds of it. Easily 50 per cent of our time.’
Following a pilot of the project in Lichfield, FutureGov expanded the process and went on to develop Patchwork in Brighton and Surr ey local authorities.
Quality of care: In connecting different practitioners around a child or family that they are working with, Patchwork can lead to better, more complete decisions and earlier interventions.
Practitioners can express concerns and add comments and observations, all without sharing confidential case information. In cr eating a ‘social network-like’ environment around an individual, outside agencies, GPs, local authority practitioners, education services and other health practitioners can see who else is working with the child or family in question, and get in touch with queries or comments.
A user -centred design process ensures that the programme is tailored to suit the users and that the various levels of team are satisfied with its use, meaning a more efficient take-up.
Productivity: Patchwork can save time for frontline staff, avoiding the need to spend time calling around to find out who is dealing with a child or family .
It can help to build relationships between health and social care agencies and enable earlier intervention to prevent problems developing and worsening.
Insofar as it pr events children and families from developing a need for more intensive public services, such as hospital stays or foster care, Patchwork has the potential to have a big impact on productivity, but it is very difficult to quantify the potential savings fr om avoiding future costs.
For FutureGov, the first problems were a lack of trust and of basic contemporary and social technology literacy. So Campbell says that their initial work was around:
‘… teaching them the basics, just trying to get them to get back … to the possibility of major corporate transformation through social technology. But they were so behind you had to show them the basics and make the market before they could even imagine that it was trustworthy enough to do something serious with.’
FutureGov also encountered specific resistance in the working culture of the local authorities to the idea of transparency.
Campbell talks about how digital technology ‘codifies’ practice – how normal, logical practice quite often happens outside of official frameworks of behaviour.
Putting this into a system as a supported behaviour acknowledges practices that everyone does in day-to-day work, but no one talks about.
These are actions that officially might be frowned upon but are taken because the practitioner believes them to be in the best interest of the service user.
Exposing these practices can be incredibly disruptive:
‘Patchwork is so challenging as a change to working, in ways we didn’ t even realise … people moan about the silos [of information on cases] when they’re in them and how disruptive they are to services, but if you give them the opportunity to join up those silos you realise that kind of openness and connectivity terrifies them … It’s like going from dark to light overnight, you’ve gone from “this is my case, it’s locked down, I know I’m the only person who can see this stuff, I can write whatever I want about this individual” to the next moment where, for example, the drug and alcohol team are terrified because even though there’s no information sharing (it’s just a way of connecting practitioners) the police and JobCentre can see that they’ve also got a connection to that client. That’s suddenly … a new level of transparency and openness that they’re just not used to.’
Frontline workers also sometimes felt that they did not have the capacity needed to learn how to use a new technology.
While the Patchwork software is timesaving, learning how to work with it does require an initial time investment. An internal evaluation document produced by FutureGov notes that a significant response from practitioners (especially around the adoption of technology while ‘in development’) was a concern about a lack of time.
‘Another participant saw this as an additional administrative task that duplicated work already undertaken for their own agency/service requirements by stating that s/he had already ‘a lot of admin tasks for our own record keeping’. It became apparent that participants ‘only [saw] this as a pilot’ and thus the amount of ef fort given to contribute and maintain Patchwork when balancing challenging workloads was reduced. One participant summed this up by stating ‘ if other people don’t get in involved maybe we haven’t got to do it ’. Some practitioners made it clear that they were ‘told’ to work with Patchwork, but workloads prohibited any deep engagement. Notwithstanding the ease of use of Patchwork … participants felt it was difficult to remember to log on and contribute to the system. They proposed that it has not yet become automatic to go to Patchwork as part of their daily work, suggesting if it were to be a substantial part of their working practice, rather than a pilot, it would become more automatic.’
Campbell believes that educating public sector workers on the process of user-centred design will help to overcome the perception that existing workloads make the adoption of new technology impossible: involvement in the development process requires investment of time, but develops a better, more efficient product.
From the perspective of a technology developer, having team members with public sector experience was important. FutureGov relied heavily on this expertise to find an authority with which to begin a pilot, when they received an initial grant with the provison that they were to spend it within a matter of months.
‘But if you were outside of the kind of network we have, I just don’t know where you would start’.
For this reason, FutureGov are also involved in setting up a platform called Simpl, described as ‘an ideas crowd-sourcing platform’ – which ‘surfaces good ideas’ – solutions to problems that practitioners and public alike can highlight, and crucially ‘in one place’ that councils can look at. Employing people with experience of the public sector means they have a shared language and a meeting point when it comes to the design and development process.
It was also important for product development, as it provided an understanding of the context in which products would be used.
‘The thing that drives me most nuts about the “cool kids” who are getting into this space now is that they haven’ t got the patience to go and engage with councils and practitioners, and therefore they build things that are kind of right – because [they] lead with technology rather than design.’
This ‘kind of right’ innovation feeds the resistance in the public sector to technology that is unwieldy or ‘fashionable’ but not, ultimately, useful.
Looking at Patchwork in action, Campbell notes the difficulty in quantifying impact when interventions are designed primarily to prevent future problems occurring.
‘It’s a preventative tool, so working out how many issues you prevented a vulnerable adult having, or how many kids you protected, it’s challenging, but it’s stuff we’re getting very heavy on, demonstrating impact … It’s vital, especially if we’re talking about new creative social technology too, which is more about social capital – more nebulous … I think the evaluation framework for this stuff is still to be born. There’s nothing good out there, yet – probably because most councils aren’t working in that way yet.’
Building a sound business case, based on a proof of concept, pilot evidence and strong evaluation techniques, is crucial.
Once the business case is ready, exposure to key decision-makers in procurement and public sector innovation is also incredibly important.
This is still a problem for FutureGov:
‘I see people like Jeremy Hunt paying £9.2 million for a child protection system for NHS and A&E hospitals, to join them up (but not to councils) and I know that with a third of that we could offer Patchwork to the whole country: A&E, council, social care team, whatever you wanted.
So when I see that, that’s when I realise you have to connect to the top level … the people who cost out those ridiculous £9.2 million budgets. There isn’t an opportunity for new entrants at that scale.’