How might government offer support to residents before they are in crisis?
There is much discussion about how to move to more preventative service models across the UK public sector. To summarise: it’s hard. But the prize is huge, and ultimately, we will have to implement a preventative approach to ensure high quality and financially sustainable services.
Our frontline officers work with people at the most difficult times in their lives, helping them through homelessness, debt, and poor health. But what if we could prevent such poor outcomes before they happened in the first place? Could we identify which people are headed towards crisis? Could we intervene early with light touch preventative services rather than high-cost services during crisis?
Local authorities hold a range of data about their residents. Data on things like debt, household composition, and previous service involvement can be used to identify residents at higher risk of poor outcomes. One way this can be done is to identify residents that have certain indicators which tell us that they might need support right now.
This is the approach we followed with our debt pilot project where we proactively contacted residents with multiple arrears to offer support with managing their finances. Another way to look at prevention is to identify residents that are at high risk of poor outcomes in the future. This can be done using data and advanced statistical techniques such as predictive analytics.
At its core, this is about analysing historic data to identify specific risk factors associated with poor outcomes such as homelessness. That could then allow us to proactively support people with those risk factors.
Predictive analytics is not a new approach, but it’s relatively new terrain for local authorities. As an insight and innovation team, we are keen to explore its possibilities for improving the lives of our residents. At the same time, it raises new questions around data ethics and transparency in the way we work:
1. To what extent should authorities use resident data to target preventative support?
2. How comfortable are authorities in using these types of advanced data-driven approaches; are services confident using the outputs? How do residents feel about their use?
Before we embarked on this journey, we wanted to first understand resident perspectives on predictive analytics and how best to use the outputs to do proactive outreach.
What we did
We worked with Care City (a local community interest company supporting innovation across health and social care) to conduct a qualitative research project. We met with residents to understand how the community felt about the council reaching out to residents using data-driven approaches and how they could go about offering preventative support.
Our key lines of enquiry included:
- In what scenarios should the council proactively contact residents? Are there particular thresholds of need the council shouldn’t go above or below?
- How should we approach consent when proactively contacting residents?
- How much context should be provided when we reach out?
- What are the best channels for reaching out to various groups?
- Who should the message come from and what is the appropriate messaging and tone?
We conducted three focus group discussions with 24 Barking and Dagenham residents, ensuring a spread of residents from across the borough. The discussion was facilitated by Care City, using a mix of open questions and hypothesis led discussions. We outlined three scenarios where the council could potentially predict poor outcomes for residents to bring the concept to life:
1. Predicting the likelihood of someone having a fall
2. Predicting the likelihood of someone becoming homeless
3. Predicting the likelihood of someone becoming frail
Storyboards and high-level prototypes were used to gather feedback and insights from residents. The prototypes helped us test different outreach channels such as letters and calls, language used, and amount of information provided.
Our Research Tools
What we found
1. Prevention is seen as a win-win
The benefits of data driven prevention were understood clearly by people. They see it as the council’s duty to offer preventative services and undertake a proactive outreach.
“I have no problems with data being used. I am very much of the belief that you should be proactive rather than reactive. The idea is brilliant. If you can get to the cause before it becomes a problem, it’s cheaper to solve and saves money in the long term.”
2. People are concerned about scams
There is a raised awareness of scams that makes people cautious about being contacted when they do not expect to be. Taking a proactive approach will require giving people confidence that they can trust the source and the prevention offer more widely. People would like to be provided with information about the prevention offer so they can be better prepared for the possibility of being contacted.
“Any communication should make me feel confident that I’m speaking to the right person.”
“It would be good if information was put out before the call. I go to the doctor now and see they are doing social prescribing. Do marketing about it — so people know the council is doing it.”
3. People want transparency over how their data is used and handled
People are generally happy for their data to be used to predict issues, provided they can access information about what their data is being used for and how it is being handled. Residents want to be reassured that the council is a responsible custodian of their data.
“The council needs to have clear print — we are not going to use it for xyz, we store it in this way, and this is what we are going to use the data for.”
4. Sharing data between organisations is met with suspicion but people are happy with data sharing if they understand the benefits
People expressed concern about the council knowing too much about them. They want to be able to consent to their data being shared between organisations, such as personal health records being shared with the council. However, people are also willing to give the council additional data if they understand how it can be beneficial to them or the good of the public. Giving clarity about how and why data is shared will be important to gain acceptance.
“Definitely, yes I’d give more data if it benefited me or others.”
“I would want to consent to the GP referring me to the council. I would feel threatened by them knowing all the info. I want to know what data has been shared and with who.”
5. Letters are familiar and seen as a trustworthy source
There is not one perfect channel to reach out to people to tell them they are at risk or to talk about prevention. However, we’ve heard that letters are the most trusted channel to reach out to people in the first instance and prepare them for a further conversation. Letters still have the aura of official-ness that gives people trust and reassurance. They also allow people to digest information at their own pace and do their own research, giving them agency and control.
“I prefer a letter; you can then do your research online.”
6. People prefer face to face conversations to talk about risk and prevention
Whilst people prefer being contacted by letters, they ultimately want a face-to-face conversation to talk about risk and prevention. People prefer to have those conversations in trusted locations and with people that are credible and whom they feel comfortable with. Providing a variety of options for where and when to have the conversation will make it more likely to engage people.
“Would be good is someone came around physically — with their ID badge, I would feel more comfortable.”
7. Get the balance right between empathy and action in the communication
There is a difference between what kind of communication people prefer, and what would make them take action. People told us they want to feel addressed personally and get a sense of urgency whilst also not being scared off and intimidated.
“I like the letter except that it is so generic that I won’t take it too seriously. (…) I would need something in the letter to catch my attention and highlight that this is for me.”
8. People skills are crucial for engagement
Proactively contacting people to tell them that they are at risk has the potential to scare and upset people. Whoever does the outreach needs to take a relational approach by being respectful, empathetic and culturally sensitive to allow people to maintain their dignity and feel empowered.
“Dealing with the elderly, a lot of them are very proud — they might say they don’t need help. Families have put carers in place and elderly have not wanted them there — had to win them over to get them to accept support.”
9. Prevention needs to consider a person’s whole life
People’s lives are complicated, and the reason identified for reaching out proactively is just one part of the picture. Making contact with people provides an opportunity to take a holistic perspective of their needs and develop more sustainable solutions together.
“Start by asking the person why they are struggling and then offering help, rather than telling them the risk.”
10. There was some concern about the council’s capacity to deliver
There is some skepticism about the council’s intentions to do proactive outreach and its ability to deliver as intended. Based on previous experiences, some people lacked trust that conversations with a prevention service will lead to support being provided to them.
“Is it realistic that the council, with its struggles and capacity concerns, would be able to do this well enough? I don’t feel comfortable with people doing this to tick boxes. I want to see if this does have any impact.”
What’s next
There was a consensus from participants in the research that an approach like this is a good idea in principle, provided it is executed well with accountability and transparency from the local authority. Overall, participants seemed happy for the council to proactively support them by using and processing council-held data to predict who might need support.
The insights highlighted some key design considerations for any future proactive outreach work we do:
• Reassure people that handling their data is taken seriously and strict laws are adhered to.
• Be transparent with how data is used, including publishing the approach on the website.
• Offer multiple entry points for talking about prevention, ideally with options for face-to-face discussions.
• Demonstrate credibility and authority when reaching out, including designing communications to ensure they are not mistaken for scams.
• Exercise caution when data sharing between organisations; people are worried about the council having full access to health records.
• Take an empathic, culturally sensitive, and relational approach; consider the whole person’s needs, not just the risk you have identified.
• Build a network of specialists to bring in when needed.
Each of these design considerations would need further thinking, depending on the specific use case and context of the project. We are now working on a number of different proactive outreach projects where we are using these guiding principles to design the end-to-end service offer.
This blog has been written by Saumya Singhal, Senior Service Designer at Barking and Dagenham’s Insight and Innovation Support Team. Project team: Saumya Singhal, Jan Blum, Julie Atkins, Kiran Dhillon. A shorter version of this blog was recently published by LOTI.
