Keep, Fix, Enhance, Swap, Replace: Five options for public service reform

What are our options when considering how to reform a public service?

Naturally, we’ll do our user research. We’ll follow something like the double diamond approach (or LOTI’s outcomes-based adaptation of it). We’ll explore the nature of the problems to be solved and establish some hypotheses about what we might do about them.

Ideally, we’d then have free reign to prototype our preferred solutions.

Of course, everyone knows that in the real world, options are limited by time, money and statutory responsibilities. Less obviously, the solutions we choose to implement may be constrained by our perception of what level of change is, in principle, possible.

For those working at the coalface of a service, it can be particularly hard to find the headspace to consider what alternatives to business as usual may exist.

With that in mind, I’d like to sketch out five levels of change we might consider, and say a few words about how we might usefully think about them.

Those levels are: Keep, Fix, Enhance, Swap, Replace.

(Note, some of what follows is based on articles and a report I wrote at Nesta.)

Keep, Fix, Enhance, Swap, Replace

KEEP — To state the obvious, we can choose to leave a service just as it is. Not everything requires innovation. Effective stewardship and maintenance are surely among the most under-appreciated yet vital skills in good government. That said, even if we don’t change the service itself, we might choose to change our approach to supporting and sustaining it. For more on that front, you might enjoy Freakonomics podcast episode 263 In Praise of Maintenance.

FIX — We can identify aspects of a service that are broken and put them right. There’s “broken” in a narrow sense: the URL that goes nowhere; the breakdown in communication that leads to a missed visit, and so on. There’s also “broken” in a broader sense. The service that, without intending to be, is effectively inaccessible to certain groups; or which consistently fails to meet one of several core user needs. If it’s broke, fix it.

ENHANCE — For services that are already functional, we can explore how they might be optimised to be more effective.

Before we dive into how we do that, it’s worth stating that the most familiar public service model that we’re likely to be trying to enhance is one where a public sector body either delivers — or pays another organisation to deliver — a function that meets a specific set of needs. Think of the council social worker visiting a family. Or the contracted waste management firm collecting the bins. This is the “traditional, top-down” model.

I’ve previously argued that within that dominant model, there are at least 18 variables we can play with to enhance a service. For example, we can:

• Change the level of time, money, staff and assets we apply to address a particular need.
• Put in place different structures, e.g. by subdividing or combining teams or functions.
• Refine or adopt new processes.
• Alter the timing of interventions — e.g. intervening earlier in an issue when it’s smaller, simpler and cheaper to resolve.
• Amend the locations we serve, or from which we deliver services.
• Create incentives or put in place other behavioural nudges to influence demand.
• Change (within legal limits) who is eligible for certain services.
• Alter the scope of a service, perhaps focusing on a core offer while reducing the provision of non-essential elements.
• Prioritise resources, time and attention based on cases of highest risk, need or importance.
• Raise or reduce awareness about a service.
• Train staff in new skills to make them more effective, productive and adaptable.
• Adapt the business model of the service and/or alter who pays, e.g. by charging citizens for certain aspects of a service, or paying suppliers by outcomes.
• Use technology and data to enhance our work in a wide variety of ways.

Three things are worth saying about these variables.

First, it’s an impressive list (and no doubt I’ve missed some). Using these variables, there’s significant scope to improve a service. For example, with data analytics, we can target inspections or allocate services at cases of highest need. With behavioural science, we can optimise the wording of appointment reminders to increase the likelihood that people show up at their appointments. And so on and so on.

Second, for those of us at the technology end of public sector reform efforts, it’s quite sobering to see that technology and data are just two (albeit incredibly powerful and important) variables in a much longer list. This should act as yet another reminder that we need to be in the business of digitally-enabled (see Tom Loosemore definition) rather than technology-enabled reform: considering culture, practices and processes as well as tech.

Third, and more fundamentally, I’d argue that there are some areas of service where these variables are no longer enough.

Rising demand and reduced budgets have rendered some services financially unviable, even in an enhanced form. And even if massive new funding were suddenly available, some services now look inadequate for the needs they were intended to address. That’s not a criticism. The nature of the issues public sector organisations are tasked to deal with has changed; so too has the suite of tools and methods we have at our disposal. It would be strange if some traditional services weren’t now deemed to be insufficient.

The reason I highlight this third point is that most public sector reform efforts seem to fall into the Enhance category. While well-intentioned, we should be wary of spending our time optimising or adding digital sticking plasters to fundamentally broken models.

As Hilary Cottam so devastatingly shows in her book Radical Help (and here I paraphrase), there’s little point optimising an alcohol support service that fails to appreciate that the reason an individual is drinking is due to the stress caused by being out of work, of worrying about their child who has behavioural issues, and who is at risk of being evicted from their home.

Are we just endlessly firefighting symptoms and never addressing the underlying problems?

So when enhancement isn’t enough, what are our options? There seem to be two.

SWAP — Option one is that we swap out a service that looks inadequate and/or unsustainable for a different one that plays with all the same variables above. It’s still the same traditional, top-down model of public service, but it’s been redesigned to much more effectively address the user need.

You can imagine the type of thing. An old means of applying for a paper parking permit is swapped for one where you simply let the council know your licence plate number. A service is completely redesigned end-to-end in a way that breaks down silos between different teams to enable a much more coordinated response.

Yet in some cases, this still might not be enough. And so to option two.

REPLACE: Now we’re in the land of much more experimental stuff. When the current paradigm of public services is insufficient, we may conclude it’s time to consider some alternative operating models.

What do I mean by “alternative operating models”? Broadly speaking, they seem to fall into two groups, which I’d label “micro” and “macro”.

The micro examples are essentially direct replacements for a traditional service.

To give a handful examples, we might:

Radically restructure: The Buurtzorg model replaces the traditional model of care workers directed by a large back-office staff with self-managing teams of no more than 12 community nurses. Those teams handle their own recruitment, time management, schedules and workload for their patch, which covers up to 60 people. The result has been the creation of >900 teams in the Netherlands, supported by a back office of around 50 administrators and 20 trainers. The model is being trialled around the world, including in the UK.

Augment the capacity of a public service: The GoodSAM app augments the capacity of emergency response services by intelligently tapping into a network of geo-located first-aid trained volunteers.

Act as matchmaker. Learning from the more positive characteristics of modern ‘platform’ businesses like Airbnb and Uber, public sector organisations might consider developing or using websites and apps that connect two sides of a market in a particular sphere, matching those with certain needs with others who can address them. Examples include TrustonTap and Equal Care Co-op, which replace the top-down model of council-run carers by connecting those in need of care with local carers; and the Tribe Project, which enables people to search for others in their community who can help them or create a call for help and post it to their community.

Create peer-to-peer networks. Beam connects homeless individuals with groups of donors willing to fund their back-to-work training.

Involve social innovators in addressing problems. There are many charities and other third sector organisations using digital tools to address social issues. We call this ‘digital social innovation’ or ‘tech for good’. Hundreds of these organisations can be found at digitalsocial.eu and could be proactively supported by the public sector.

Meanwhile, the macro models move “upstream” of social issues to prevent certain needs arising in the first place. These may not look much like a service at all.

My former colleagues Jenni Lloyd and Alice Casey have given a number of examples as part of Nesta’s Upstream Collaborative, including: Preston City Council’s work to democratise their local economy through community wealth building. Plymouth City Council’s approach to social enterprises, which has led to the formation of a community-owned energy company. And Staffordshire County Council’s #DoingOurBit initiative to reduce pressure on local public services by connecting people to community solutions, and encouraging people to help themselves and each other. (I’d recommend following Nesta’s work for more recent examples of all the above.)

What do these very different sounding models have in common?

In short, as well as using all the variables covered in the Enhance and Swap categories, they also involve playing with one or more of an additional six, namely: Who’s involved, Relationship, Organisation type, Funding Method, Power and Public sector role.

Here’s a quick explanation of each:

Who’s (able to be) involved. Citizens, volunteers, freelancers, charities, third sector organisations and businesses can be involved in shaping or providing for a certain need. E.g. Trained first aid volunteers are engaged in supporting ambulance crews through GoodSam.

Relationship. Instead of having a top-down or centralised model, we can adopt more decentralised or distributed relationships. That new structure could be in the form of a different set of relationships between individuals in a system (such as Buurtzorg’s front line staff and their back office); between clients and those who work for them (e.g. platform models like TrustonTap); or between different organisations in a field, such as when a public sector organisation works with digital social innovators in their community.

Organisation Types. We can use different types of organisation to change the incentives for those who work within them. A key example is the growing interest in cooperatives, where professionals are joint owners of the organisation for which they work, and therefore can receive better rewards. Platform coops — the combination of a cooperative legal structure and a platform technology and business model — are already being trialed by organisations like Equal Care Coop.

Funding Method. Alternatives to funding services solely through taxes include crowdfunding (e.g. Beam), matched crowdfunding, community shares, and so on.

Power. Power might be radically shifted to different people within a service to change who acts or how they act. The Buurtzorg community nursing model involves a radical shift of power and responsibility to the front line. The GoodSam app works through empowering trained first aiders with the information they need to work alongside the public sector.

Public Sector Role. Enabling alternative operating models entails local authorities playing different roles in their communities, shifting from being service deliverer or commissioner to (for example):

1. Funder / investor — providing money to support external organisations to develop new solutions to local needs;
2. Incubator — bringing social enterprises under their wing to support them in developing solutions and providing access to funding, expertise and mentorship
3. Signposter — councils already point citizens towards useful external services, but this could grow to include a far wider pool, such as the innovators listed at digitalsocial.eu;
4. Convenor — bringing different actors together to collectively address an issue;
5. Matchmaker — connecting people in a community with certain needs with individuals or organisations who can address them;
6. Incentiviser — for example see Essex County Council’s use of challenge prizes to incentivise external innovators to help them find novel solutions to local issues;
7. Place-maker — taking responsibility for the outcomes they want to see in their communities and building their resilience.
8. Data provider — publishing and providing rich context around the data they collect to enable the creation of a broader range of services created by others. (See Transport for London’s Unified API).

Testing our options

As we reflect on these five options (which are, of course, just one attempt to massively simplify a very complex reality), it’s clear that public sector organisations face two significant dilemmas.

First, while there’s growing recognition that the options to Keep, Fix, Enhance and Swap may no longer be enough in some service areas, we lack a firm understanding of and evidence base for the “Replace” option.

Second, there’s little point detailing those Replace examples unless we have a plan for how public sector organisations can transition from their current ways of working to alternative operating models. Unlike a business start-up, public sector organisations don’t choose their users. We can’t just switch off an old way of working until we have a proven alternative to move towards, especially for services on which vulnerable people rely.

So what’s the answer?

Common sense suggests we start small and share the experiment.

The mantra to “think big, start small” is helpful here; this is a classic area where prototyping, fast learning and iteration can help. But even for modest trials, public sector organisations would be wise to share the time, cost and risk of trialing new models — as well as accelerating the pace of their learning — by divvying up the experiments between them.

It would be extremely difficult for any single organisation to test models like these in isolation. Collective action is much more viable.

LOTI is one such collective and our sixth workstream is Shared Experiments. With a commitment to innovate — and given that many of the alternative operating models outlined above are enabled by technology — I’d like to explore boroughs’ appetite for taking a user-centred approach to designing and exploring a range of them over the coming months and years.

After all, we already know a lot about how to Keep, Fix, Enhance and Swap. They remain valid and important options.

But we have a lot to learn on how to Replace.

The question is, who’s up for the experiment?

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