By Luke Price
Evidence from the New Policy Institute suggests that we are entering uncharted territory with regards to local government finance. By 2020 the combined current and capital spending of local government as a share of the economy will reach its lowest point since 1948.
This is likely to have a huge impact on local communities. ‘Service transformation’ are buzzwords in both the policy and practitioner communities at the moment, and early action – addressing the causes of social problems rather than their consequences – is the best response to an increasingly urgent local situation where finances continue to deteriorate as the need for acute services continues to rise.
Our new briefing, written in collaboration with the New Economics Foundation (NEF) sets out a bold new model for thinking about how we can act earlier in different localities. It draws on learning from the UK’s first Early Action Commission (EAC), based in Southwark and Lambeth, and aims to share insights from how it worked in their area, and therefore how it might be approached elsewhere too.
Co-author Anna Coote has written a blog on NEF’s website that gives a bit more detail about the briefing itself. Here we have a guest blog written by Gordon McCullough of Community Southwark, an organisation that was integral to the establishment of the UK’s first EAC, focussing on what has been achieved since it was set up:
The morning after the night before
Following the launch of the Southwark and Lambeth Early Commission report last November the hard work really began. That is not to say the Commission itself was plain sailing but that producing the recommendations was only half the story. The Early Action Task Force’s new guide on how to make early action happen locally is a very insightful document. What it doesn’t cover is what happened on the morning after the report was launched. But before going into that I thought a couple of my observations on the work of the Commission might be useful.
My first observation is that the lament about early action being common sense but not common practice may not be entirely true. Throughout the process many felt the Commission provided an opportunity to ‘hold a mirror up to’ what they were already doing’ with regards to prevention (the term early action had yet to gain traction). A lot is going on to be sure, but these examples didn’t form part of a wider prevention or early action strategy – they were isolated cases being pursued in addition to other services. My second observation relates to this point. Many wanted the Commission to provide solutions to specific problems that Southwark and Lambeth faced (for example, 44% of 10 to 11 years being obese or over weight). A reasonable ambition I hear you cry. In fact, it was mentioned that in trying to bring achieve systemic change there was a danger that the Commission was trying “to boil the ocean” ultimately achieving nothing. Thankfully the Commission was not seduced into dealing with the here and now but stuck with its wider ambition; taking a system wide view of how early action could be embedded into local processes, structures and culture.
A tepid ocean?
To begin with I can only talk about what has happened in Southwark. As a first step, the Southwark Health and Wellbeing Board (which sponsored the Commission) have agreed to commit to working towards a cultural shift in their organisations to deliver the ambitions of the Early Action Commission. Southwark Council have agreed to include overarching statements in the Council Plan and the Southwark Plan outlining their commitment to working towards early action. These high level strategic documents are seen as important levers in driving a change in behaviours across the organisation. It is still early days but the commitment to co-designing a new voluntary and community sector strategy that will have a strong emphasis on early action is a welcome step forward.
The Clinical Commissioning Group (CCG) in Southwark have also made a number of strategic and operational decisions in light of the recommendations of the report. In their response the CCG has set out in their Five Year Forward View an ambition to have a much stronger emphasis on early action. The CCG hopes to achieve this by replacing its current commissioning intentions and work plans. A programme structure will be developed within which early action will be a key objective. It will be driven by an ‘Early Action Challenge’ group that will have VCS and local authority representation. This is particularly exciting as Southwark Council and the CCG are developing a joint commissioning team. The challenge group will have an important role in championing early action. Finally, the CCG, in their future plans, have committed to shifting investment to early action and preventative measures. They noted that The Early Action Taskforce classification of spend provides a useful tool for establishing current investment in early action. The CCG have committed to undertaking a review of current spend, which will utilise this approach and use the information as a baseline of investment into upstream preventative measures.
Will this change anything?
I hope so. Strategically the pieces are being moved into place and there is a growing understanding and acceptance of early action (even amongst those who felt that it was already happening). There have been some disappointments, in particular since the publication of the report the two boroughs have yet to pursue a joint early action agenda.
Nevertheless, a number of things have changed as a result of the Commission. So when someone asks me how was it was for you. I pause and try and reflect on what words of wisdom I would give someone trying to do this type of thing. I won’t repeat what is in the Task Force’s report but I think the need for someone acting as a local Sherpa is really important. In retrospect that role partly fell to me and perhaps I could have sought to exert more influence earlier on and not assumed early action was common sense and everyone would agree. I should and could have acted earlier to prepare the ground for the recommendations. If pushed however, I would say that local leadership, political will and a clear vision about why systemic change is needed are the best ways to avoid a hangover on the morning after the night before.
Gordon McCullough is Chief Executive of Community Southwark which first called for the Early Action Commission to be established in December 2013.