Associate feature: closing the implementation gap in public services

“I think we all would want systems where public services are actually benefiting those we’re intending to benefit,” Centre for Excellence for Children's Care and Protection (CELCIS) executive director Professor Jennifer Davidson told participants at the CELCIS and Holyrood roundtable entitled ‘New Disruptors: Making Change Happen’.

“But the reason we’re hosting this roundtable today is because we feel that despite these best intentions … it’s still not closing the implementation gap, that the intentions aren’t necessarily met in the delivery of ultimately impacting on those who we are hoping to benefit in our work,” she added.

Bringing together change leaders from across the public and third sectors, those delivering services, coaching change and funding that transformation, the group considered why, with the best intentions, the aims do not match with the practice.

“You around the table… are people who have got under the skin of systems change in a way that many others perhaps haven’t,” Davidson said.

“Some of you are here with a real clear sense of evidence-based approaches, of lived experience informing design, thinking through more radical solutions, perhaps of working across sectors, perhaps investing in that change, and so all of your different perspectives are really critical to our thinking today.”

Discussion centred around three themes: what does transformational change really look like, how do we bring people with experience of services into designing those services, and what does it mean to invest in radical innovations and what are the barriers to that?

A focus on ideas and policy over implementation, use of data and the leadership needed for change were among the issues that were raised.

Adam Lang, head of Nesta Scotland, noted there had been “lots of fantastic bits of work” in Scotland in the last 20 years, but suggested there is “a bit of a rhetoric and reality gap”.

“I think, sometimes … we’re all in agreement about the things we say we want to be, broadly speaking, and we all sort of know where we want to go: enablement, wellbeing, a more inclusive society. But we haven’t backed that yet with the real radical agenda of change. And I think trying to understand why this is occupies my mind at the moment.”

Referring to a four-stage theory of change model – see, spark, shape and shift change – he said: “There’s a lot going on in the seeing and the sparking space. There’s much less of real meaningful note going on in the shaping and the shifting.”

Dhruv Sharma, user research lead and head of community at the Scottish Government, noted that a key part of disruptive innovation is trying and failing but an organisation like the Scottish Government cannot be seen to fail.

David Wallace, chief executive of Social Security Scotland, noted that as an accountable officer for a service, the idea of failing fast was “quite scary at times”, which tended to mean that good work was done at relatively small scale. No one asks for an example of a time you failed and there are no rewards for failing fast, he said.

“One of the things that I’m interested in, and I may be particularly interested in, having just stepped out of central government into a different part of the public policy world, is the question of where does power reside,” said Sarah Davidson, chief executive of the Carnegie UK Trust.

“A couple of you around this table have already heard me talk about what feels to me like we have a strong mental model that operates around the system in Scotland of a hierarchy, with central government at the top and by definition, everything else finding its place lower down – and I use the terms advisedly.

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“I’d be really interested to know whether other people [who] are operating at other parts of the system feel that as well.

“And I think one of the things that flows from that … is a risk that energy and focus and debate swirls all around the policy and the ambition end of that system and not around the implementation, operationalising end.”

“I think change for everybody in the system, wherever they are, is about a compelling vision for change,” said Celia Tennant, chief excutive of Inspiring Scotland.

“So actually, what is it that will be better? And we all need to work towards that. And I think it’s really, really important to get that message right and to engage people in getting the message right, because that allows people to follow.

“So, a compelling vision for change, backed up with data as well, so the evidence that the change needs to happen, and lots of different types of data to bring lots of different stakeholders on board with the change.”

Ruth Glassborow, director of improvemen at Healthcare Improvement Scotland pointed out that to get a system to change you need to get the will, the ideas and the ability to implement to align, whereas a lot of the discourse in Scotland is around ideas.

“We don’t see a lack of ideas at all in the system, we see a lack of will. But I have to say, where we see the lack of will, it tends to be because people are being asked to do something top down.

“When you work with a system using user-led research, when you put the people who are using the service in the room with the individuals delivering it, we often see that the will is there to make the changes. The big gap we see in our work is the ability to implement the change.”

Discussions with the Scottish Government often get stuck in the policy space and you later hear that there’s a problem in implementation, said Eddie Follan, chief officer for children and young people at COSLA.

“I think this with early learning and childcare is an absolute perfect example of where we had a really strong vision, a really clear idea about what it is that we want to do, we involved service users, we involved parents, we involved children, we involved young people, we did a whole series of consultations and worked with them to inform that policy, you know, and here we are, I think that was 2014, here we are in 2020 and we’re reviewing it.

“And we’re worried about implementation. Well, what happened in that time between the legislation being formed and now?”

“I think for me, the biggest point that’s been made around this [is that it] takes capacity,” said CELCIS deputy director Claire Burns  “and we just don’t want to have that conversation about the capacity this will take to make these kind of changes … We tend to layer this on to what other people are doing and I think that’s one of the critical things that we need to come to terms with.”

Questions too were raised about what constitutes success and failure in the system currently. Sarah Davidson asked: “What do people feel incentivised, rewarded and accountable for?

“Are they accountable and incentivised to create that space to learn to do things well or actually, whatever we say, are we really incentivising and rewarding something different? And to me, that gets right to the nub of the human aspect of system change, particularly disruptive system change.”

“It feels like there’s a theme about what do we tolerate intentionally or unintentionally,” said Tracy Webb, associate director of collaborative change at the Health Foundation.

“And as David said, often we don’t tolerate failing fast because that isn’t within our culture, that’s scary. But what we do tolerate is solving the wrong problem.

“The number of conversations [I have where] the discovery phase of the double diamond [a Design Council design process] is seen as a luxury. We kind of know what the problems are, we’ve got to get on, we’ve got to get on quickly, so let’s just move.”

Zahid Deen, director of digital and service transformation at the Health and Social Care Alliance, suggested that to disrupt and transform services, data has to be more citizen centred.

“And actually, that is a point about power, you know, it’s not just about us talking around this table but actually, if you’re genuinely interested in a data-driven economy, why isn’t the centre of power with the person to drive their data, and actually, they are the lever and the lynch point for making all those services join up, and they are seeing what’s happening to their life.

“So I think, until we actually get that spotlight, the data model and centred around the citizen, I don’t think we are going to sort the service design issue.”

Sharma also noted that disruptive innovation was not always popular, but data could help with that. “What data, or good data, allows you to do instead is be radical in your ideas.

“So, it’s the radical ideas that cause disruption, by design almost, rather than someone going, well, I’m going to come in and I’m going to change everything and it’s going to change everything for the better in future.”

“Certainly, I think all of us around this table seem to be agreed that user-led research is fundamental as part of that, and co-design, not just with people who use services, but also with people who deliver services, I would say, is fundamental to the transformation,” said Glassborow. “The challenge we see in doing that is this issue of pace.”

She added: “We’re under enormous pressure, I think, across the public services to transform at pace. And hence, one of the things we experience is almost, there isn’t the time to do that bit of the work. But if we don’t do that bit, we won’t transform.

“And so there’s a question for me about how do we create enough permission in the system to protect the time to do the co-design work on the basis that actually, if you do that bit right, you will end up implementing, whereas if you rush to implementation to be seen to be moving at pace, our experience then is implementation fails.”

Returning to the starting point, Peter Macleod, chief executive of the Care Inspectorate, suggested that the key question was whether we really believe in transformation or just talk about it.

“I think we believe in the terminology of it,” he said. “System change and transformative change are nice terms. I think that we often don’t actually see the shift and change piece of the spiral of transformation actually in practice.

"So I think we have to go to a point of almost a contract or a concordat where we actually say we’re going to do it and then we make it happen.”

The intention is that this is the beginning of an action focused piece of work that will enable leaders to support change to happen most effectively.

CELCIS will be working with the roundtable contributors – and others who want to link in – to develop a way to do this well.