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Integrated Care – 2016 to 2026

One 2016 new year forecast for all public services

An elderly lady with mild dementia has a fall and goes to hospital. Once her medical needs are resolved, she needs to be assessed for social care; but she waits too long on the ward because social care and NHS care are not joined up enough. When she is finally discharged, she is considerably more confused and has a more complicated care package – costing more and reducing her quality of life.

Meeting the double challenge of an ageing population and reducing budgets will be the make or break issues of local public service. Over the next decade, these two factors will amplify the creaking sound of local public services. An ageing population is a population with increasing frailty, dementia and related problems. This creates exponentially increasing demands on health and social care as well as on charities and police services protecting vulnerable people.

Ongoing organisational efficiencies – whilst essential – are insufficient to meet these challenges.

Integrated working across Local Government, NHS, blue lights and third sector is essential. Preventative measures in social care, community policing and public health, addressing root causes are “must have” solutions of 2016 and beyond.

Integrated working requires shared objectives, shared business processes and shared information systems. It does not require big national systems though. Instead it requires local public service partners to prioritise their integrated working requirements and work out what information sharing works best for them – and to implement their answer quickly, effectively and with shared learning.

As separate independent legal entities, each of these organisations is struggling to balance their books, so the notion of investing in each other’s efficiencies is hard to swallow. But its likely to be the only long term way to meet the double challenge of an ageing population and austerity.

2015 saw the first of these local integrated working arrangements beginning to take shape. The next decade will have to see much more. By 2025, more than a third of the UK’s population will be over 55.

For all of our futures, let’s hope that integrated local services have been a triumphant success.

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When “Cloud” is not the only answer

I have many cloud deployments and have found “the cloud” to be a fantastic answer to many IT provisioning challenges.

But here’s the learning;  “The Cloud” is not necessarily best value for everything.

Story

I run the IT services for a Local Government authority where I am putting more and more services into the cloud. I have a blended cloud solution, with some services from a conventional data centre and some from the Cloud.

I have a dozen systems from cloud providers, either live or in the midst of a cloud migration project. These range from a benefits portal, to schools email, to theatre event management.

That represents a good portion of my enterprise systems. Some remain in our data centre, because there is not a compelling case to migrate them anywhere else. Like every government agency we have numerous legacy applications that run reliably and have done for many years. These remain in the data centre.  Some systems in the cloud, some in the data centre; a somewhat pragmatic approach that the cloud purists seem to deride.

The building site

But more of the context. Like many local authorities, we recently agreed a plan to reduce our building footprint and in the process turn the data centre into a building site. So the existing data centre had to go.

“Fantastic opportunity to put everything into the cloud”, I thought.  That would give the organisation many benefits and I’d be a hero of the digital fashionistas.

Imagine my surprise and disappointment when I looked at the actual numbers, not the theoretical white paper ones, and realised it will be considerably cheaper to build a replacement data centre than any other viable option.

Cloud options

“Moving everything to the cloud” has many possible meanings. It can mean moving each system to a system specific “true” cloud provider. So you end up with as many cloud providers as you have systems. To be cost effective, you procure  as and when systems become available with cloud options and as they come up for renewal and refresh; which we did not have time for with the building project imminent.

Or Cloud can mean having someone else provide the whole data centre via “IaaS”. We used to call that “hosting”, “outsourcing” or “co-location”, but now the vendors need to call it cloud, for obvious marketing reasons.

The co-location option looked most desirable. I started with G-Cloud (Digital Market place), of course to see what the options and prices were. It is widely known that G-Cloud Framework prices are capped maximums and every supplier says they can beat their own prices on G-Cloud. So, of course I spoke directly to the suppliers as well.

I also spoke to most local public service organisations, across Health, Police and Local Government in the region, to see if they had capacity to host my entire data centre. None did, but I found two Local Authorities, one in Scotland and one in the South East who could. Their prices were very similar to the commercial co-location providers. The Crown Hosting Service had not at that time been launched.

Finally as a comparator, I also looked at the costs of building our own data centre.

The Economics of the Cloud

In our case it turned out to be substantially cheaper to buy a data centre, than to rent from the cloud. We own our own property and within that we identified a good space for a replacement data centre. This space could not be used for any other significant purpose. The major advantage of this location, is that it is on the same site as the major Council office buildings. So I don’t have to pay the data communications costs to connect all our enterprise users to our enterprise systems. This avoids a material cost.

Taking the data costs into consideration, on a like for like basis, co-locating in the cloud would have cost two to three times the cost of self provision.

I also host some systems for other authorities and am in discussions with commercial providers relating to hosting their services in my data centre – generating revenue for the authority, which would otherwise be lost.

The economic case for building our own data centre is extremely compelling. When the sales director of a leading cloud/co-location vendor tells me he cannot compete on costs against a self build with data costs, I know just how compelling that is.

Benefits of Cloud

Cloud is great when you are looking for elasticity, agility and resilience. So for those applications demanding that, it is worth paying extra for. But where we know our system workloads do not have significant fluctuation and where we can enable internet access for users, with reasonable resilience, why pay more?

Blended Cloud Architecture

So I emerge from this with a fairly common blended cloud architecture. Some on premise, some hosted elsewhere and some from true cloud.

jpeg Final blended cloud blog picSome people call the data centre a “private Cloud”. I don’t think that’s helpful, or even technically accurate. Over time I will, of course, migrate more services from Data Centre to cloud and procure more new services from the cloud. But I also will implement more services in the data centre, if that’s the location that works best.

The Press

I was amused by the press coverage as our data centre plans became known, but not altogether surprised. Fuelled by suppliers who wish to generate more revenue from cloud services (“cloud” has taken over from where “outsourcing” left off), some commentators seem to believe that there is only one answer to everything and that is cloud.

In my experience, there is never one answer to everything. There are innovations that need to be applied in judicious ways, where there is a business case.

To run a cost effective service, you need a certain amount of distance from believing in every “next big thing”. The business case is the king. Fashion is not a good enough reason.

Cloud Hype

I think of this in terms of the Gartner Hype Cycle. In the peak of inflated expectations, “enthusiastic and strong feeling around new forms of media and technology, in which people expect everything will be modified for the better,, is a common characteristic. We seem to be there with Cloud right now.

PNG Gartner_Hype_Cycle_svg

Moving from the peak of inflated expectations with “everything to the cloud”, to the plateau of productivity with a “pragmatic blend of cloud and data centre”, seems to me to be a reasonably likely forecast. I understand that there is good research emerging to support this position.

A word from the wise

Nothing is new under the sun; Who would have thought that Shakespeare had forecast this moment? About 400 years ago, the Stratford Bard summed up succinctly the counter-intuitive solution that is hidden only because it is so obvious:

“The world is still deceived by ornament…

The seeming truth which cunning times put on

To entrap the wisest”

The Tempest, Act III, scene 2

Do not be deceived by the ornament of Cloud.  It’s really good for some things. But that does not make it best for everything.

 

 

IT Strategy & Digital Strategy

We have now published the Solihull Council IT Strategy, following the recent publication of our Digital Strategy,

To make the IT Strategy accessible, we have reduced it to a single page of A3. There is, of course, a more detailed document, as well.

The ICT of Innovation, Cost reduction and Transformation

We have also coined a new definition for the Information & Communications Technology (ICT) acronym. For us, ICT means Innovation, Cost reduction and Transformation. That’s why ICT exists in the enterprise.

Digital and ICT

There is, of course, a blurred distinction between “Digital” and “IT”. We have taken the view that we will define what we mean by Digital and develop our digital strategy accordingly. IT is then everything else. Everything else that is technologically enabled, but is not in the digital strategy, that is.

Which leaves quite a lot for the IT Strategy, of course. All the systems and interfaces that the enterprise depends on to deliver its objectives. Finance systems, business intelligence systems, supply chain systems, case management systems, order processing systems, asset management systems, commissioning systems, HR systems and the network infrastructure that these run over are all part of the IT scope.

There is some overlap between “Digital” and “IT” of course – life is like that. Stuff does not always fit into neat boxes. The important thing is to be confident that you have clarity, vision, goals and projects that deliver to both agendas.

Our ICT Strategy was approved by Elected Members in March 2015 and replaces the previous strategy.

Some commentators have suggested that either one of “Digital” or “IT” are more significant than the other. Or that they are in conflict in some way. I’d like to suggest that they are simply in need of each other. If you switch off all the IT, there is nothing left of Digital. Without networks, fileservers, devices, databases and people to support them, digital collapses. Similarly, if you switch off all the Digital, there is little purpose in the ICT. The organisation will still operationally function for a little while, but without online customer engagement, it will soon wither away.

So Digital and IT are mutually dependant. The “Yin and Yang” of a modern, efficient organisaiton harnessing technologies.

Digital and ICT Strategic harmonisation -GIF

To quote from Kaplan and Kaiser in the American Management Association (2013):

“There is no better single expression of ideal leadership than the ancient Chinese concept of yin and yang. The Chinese saw nature as the interplay of dualities that had both complementary and opposing characteristics—sky and earth, day and night, water and fire, active and passive, male and female. Neither element in the pair takes prominence or precedence, but each is useful and valid and reinforces the other in a positive dynamic. The familiar yin-yang symbol represents this perfectly, showing two black-and-white teardrop shapes, curled and flowing into each other, continually adapting to each other to form a continuous and complete circle. The elements are negative images of each other, yet they are interdependent and inextricable”

Digital food for thought?

 

Saying “Yes” to User choice

We think we have found a solution to a common problem that all organisations face. As the technology industry produces more and more innovative, mobile devices (like tablets, smartphones, phablets, wearable technology – in all their millions of variations), every user wants something different. And they want more. More flexibility, more devices, more choice.

We give them choice and cap costs with our “points” scheme. Devices are assigned nominal points based on total costs. Privately owned devices attract far fewer points than corporately procured ones.  Users have 24 points to play with and can have whatever devices they want within their limit.

It’s a good mix of technology innovation and policy that enables us to say “yes” to user choice.

Points for user choices

Note: Glossary below

This solution has lots of advantages:

– It maximises user choice.

– It caps corporate cost.

– It encourages users to try BYOD (Bring Your Own Device).

– It places the decision making away from corporate IT and with the user and their cost centre manager, where it belongs.

The next device innovation can easily and quickly be incorporated. For example, say wearable technology suddenly takes off and my users want to see their work emails in their glasses. So long as that works with the secure BYOD solution, I’ll be quick to say “Yes”.

The challenge

Gone are the days when the corporate IT department could define standard user types and issue them with standard and limited mobile devices. Two people doing exactly the same role may now want and need quite different devices. That’s because what they use at home offers them choice, they want the same choice at work. To do their job to the best of their abilities, one may want an iPad and a smartphone. Another may want a laptop.

Some really only want to use Apple kit and some want to use Windows or Android – because that’s what they are familiar with from their other walks of life. People get quite passionate about this and if you give them something they don’t want and have not chosen, they will always find fault with it. Which drives up cost and drives down customer satisfaction.

So the users want more, and want more choice – but the finance director wants the total cost to be less. Even BYOD comes with a small cost. That’s the challenge.

The solution

Not all of the solution rests with allowing people to “bring your own device” (BYOD). Some people will simply not do that because they strongly believe the employer should provide the kit. Even though they buy their own pens, cars, clothes and other paraphernalia they use at work. They will therefore not be as effective at work as they might otherwise be. Also BYOD brings its own costs – for licensing, support and infrastructure.

There is a bigger solution, beyond and incorporating BYOD.

At Solihull, we have introduced a “Choices” scheme. First we implemented two secure technologies that deliver BYOD. One is a quick and simple access to key information needs. (We are proud that Solihull is one of the first Good for Enterprise public sector innovators)  The other gives a full desktop experience but requires the user to spend more time with authentication. Users can choose which one they prefer, or have both.

Then we agreed that the organisation would buy users mobile devices, if they would not be using BYOD. And we set up a way of capping the cost that the organisation incurs from offering more choice.

The solution allocates each device type a number of “points”.  It also allocates each BYOD device type a number of points. BYOD devices have much fewer points than corporately procured devices. Users have a capped number of points from which they can make their choices.

The table above shows how it works. The users each have 24 points to play with. If you want a corporate laptop and a corporate smartphone, you have not got enough points for a corporate tablet as well. But if you want to bring your own laptop and bring your own smartphone, we’ll buy you a tablet if you want one – and your cost centre manager approves.

The cost centre manager sometimes needs some help making the right decision. When a person asks for a corporate device, even if it is within their points allowance, we will question them closely on exactly what they will use it for, where they will use it, when they will use it – and only agree to the purchase if it is the right piece of kit for their job requirements. We’re in the business of minimising Council spend on IT, and maximising return on investment – not just capping spend.

SMBC BYOD iPad

 

With a securely managed, cost controlled and leadership encouraged approach to BYOD; its good to be the IT department that says “yes”.

 

Glossary:

BYOD: Bring Your Own Device. A privately owned device (laptop, tablet, smartphone or other device) that has security software running to enable it to safely access the corporate network.

COPE: Corporately Owned, but Privately Enabled. A device which accesses the corporate network as though it was a BYOD device.

YODAH: Your Own Device At Home. Same as BYOD, but where the device is privately owned and always used from home.

 

 

Local GDS – a disruptive responsibility for leadership

Local Government digital needs more pace. It also needs a disruptive approach to the supply chain.

Otherwise it will carry on getting just a little bit better every year and carry on duplicating costs. Becoming radically better very quickly and driving out substantive costs is not going to happen with the current ways of working.

My experience comes from being part of two local digital steering groups. At the LocalGovDigital steering group with Carl Haggerty, Phil Rumens and others we discussed the excellent ideas that people have but everyone raised concerns about how much you can do from volunteers. Capacity is the issue.

At the GDS Local Dashboards steering group with Matt Harrington, Kate Sahota and others we discussed the pace at which we can move, the big transformative ideas we have – but GDS is focussed on Central Government. Capacity is the issue.

A Local GDS could provide that capacity. But there is something much bigger that a Local GDS could do.

Big disruptive opportunity

Local Authorities keep buying digital systems from the same suppliers. A few write something with Open Source, but even fewer manage to share that widely. There’s a reason why a single web site for local government wouldn’t work, though.

To understand this, you need to understand the business culture of a Local Authority. They are

– Single Legal entities

– Governed by Locally elected councillors

– Address Local issues

– Make Local Decisions

They also procure business solutions by looking at their local needs first and assessing the market against their requirements. It’s hard to mandate a local authority to do anything. Its best that they to want to.

So a Local GDS needs to create a value proposition that Local Authorities would want. The disruptive potential rests in the value proposition.

The Value Proposition

If there was an Open Source web content management solution, backed by a Local GDS and continuously developed by a community of Local Authority digital enthusiasts – it would be a compelling proposition for any authority.

Enthusiasts like the Digital Makers at Local Gov Digital would contribute to its development, we agreed.

When an authority chose to replace its web solution it would find an offer from Local GDS that was the most affordable, had the best roadmap for development and was the most well suited to their requirements.

Most Local authorities would be unable to not procure such a solution.

Over time it would become the standard. And sharing would follow inevitably. If any council develops a solution for a specific challenge, it becomes absorbed into the Local GDS product, supported and made available to every council in the “club”. Free of charge.

Local is not just about Local Government. Local GDS should also support other local public service organisations, particularly third sector. More and more local delivery will be jointly delivered and Local GDS would recognise and respond to that.

Deep Digital

The front end of a web site accounts for just 20% of Digital costs. The bigger costs are in integrating with line of business systems, so that the user experience is a seamless interaction with the authority. As authorities develop deep solutions with Local GDS, they will make these available as well. Driving deeper and deeper into the digital infrastructure. This creates the opening for a business architecture that disrupts the stranglehold that a few suppliers have over the sector.

Next big thing

Right now the Care Act is creating new digital challenges. Across the country councils are scurrying about to find digital solutions. They are re-inventing and duplicating effort – imagine if a Local GDS existed now. It would be commissioning solutions that could be deployed with minimum fuss and little cost to all authorities who chose to be part of it. We have probably missed the opportunity to create LGDS in time for the Care Act. But there will be another big thing. Let’s get ready for that.

Leadership responsibility

Every Local Authority has done something well with Digital. No authority has done everything well! But if we put all the good bits together, we will deliver a substantially better Digital experience to our users at a substantially reduced cost.

In a time of austerity, Local GDS, or something like it, is not just a good idea. It’s a responsibility.

 

 

£7.6m for Local Digital GDS – What would you do?

If you had £7.6m to spend on Local Digital, how would you spend it?

Martha Lane Fox’s vision for digital was about “how efficiencies can best be realised through the online delivery of public services”.

That’s a vision for all public services – not just for central government services. Its a vision that includes Local Authorities and local third sector organisations. It was this vision that resulted in the creation of GDS, the Government Digital Service.

Today however, GDS spends virtually all its energies and budget on Central Government. There are a few exceptions. I have been fortunate enough to work with GDS on a local digital project – but it has to be fitted in around the central government work that is GDS’s focus.

A huge amount of talent, energy and budget is invested in GDS – and it simply does not reach local public services in any significant way.  That’s not because GDS is not interested in Local – it clearly is. It’s more because Local is really hard to engage with in a cohesive way. More of that below, but first some figures and evidence based financial logic:

  1. GDS has a budget of £58.3m for 2014/15, employing 635 staff (“425 civil servants and 210 interim staff”)
  2. GDS mostly works on central government projects
  3. “Local” makes up 13% of Public Sector expenditure (£98bn out of £732bn) – although some estimate it to be 23%.
  4. 13% of £58.3m is £7.6m. And 13% of 635 is 82.
  5. THEREFORE: Local GDS should have a budget of £7.6m and a staff of 82 people.

 

I feel like an adolescent raging that “its not fair”! But quite frankly, it is not fair. Even if you accept that half of what GDS produces can be used across all sectors, there still should be 40 people working for Local GDS. How could this have happened, that central government digital has become so well invested in, whereas local government has not?

Its not because Local is already fixed and there is nothing to further to do with digital. That’s not it.

Its not because Local Authorities don’t need help because they can spend their own budgets on Digital. They can, but then so can Central Government departments.

And its not because there is no requirement for shared digital assets for local public service. I can think of many.

I think its more because of the way in which local and central government is organised – this makes it hard for GDS to reach local. Hard, but not impossible. And anything created by people can be changed by people.

The enthusiastic volunteers at Local Gov Digital and Digital Makers are busy creating digital assets that can be used by many authorities. How much more productive they would be if they just had a couple of staff to develop their ideas. That would still leave 80 people.

Another crowd of local authority enthusiast volunteers, loosley associated with SOCITM, are working with GDS on a local government digital performance platform.  Performance Dashboards are at the top of the GDS business plan priority list. Our local variants been slow going, because GDS is focussed on the central government exemplars and central government dashboards. We are not going to transform government with two dashboards in 6 months. How much faster and better we would have been if we had just two people to develop and co-ordinate this. That would still leave 78 people.

The problem with Local fixing its own problems with volunteers, is that the authorities paying the salaries for specific local outcomes, require their people to work for them. I know too many situations where well intentioned and energised initiatives have withered on the vine because it is distracting from the “day job”.

I don’t think Local GDS needs anywhere near £7.6m and 82 people. But I do think it needs some central capacity.  And I’m convinced that the culture, methods and passion of GDS make it the right place to host Local GDS. It does not have to be in London but, for the sake of the users, it does have to be joined up thinking.

I can think of hundreds of things a Local GDS might produce. There’s a debate coming up at which I have been invited to speak and I’ll share more of those there and on this blog.

There has been some discussion about a single web site for all local authorities. I strongly believe that there is a requirement for Local GDS, but I don’t believe one monster local government website would improve user experience or drive down costs. Local Authorities are politically and financially autonomous – the governance alone for a single web site across all of them would almost certainly make user experience and cost effectiveness worse.

Also, most of the costs of digital are not in the front end of a web site. The costs are in the digital business processes; how the website transfers information to and from the “back office” systems. I know there is a lot that a Local GDS could do to standardise this and drive out costs from suppliers.

So a single web site for Local is not the solution. But imagine a Local GDS that produces open source code that each authority can freely implement; and then switch off expensive commercial software, while delivering better digital services for their local customers. It would be irresponsible not to do that.

So, if you are passionate about Digital in Local, claim your Local GDS investment.

–  Do you think it’s unfair that Central Digital has all the GDS money?

–  What would you do with £7.6m and 82 staff for local digital?

 

Local Digital Insights from libraries

Digital Insights from libraries

Local Government now has a Library Renewals Digital Dashboard with GOV.UK. This builds on the Performance Platform developed by GDS and follows the Missed Bins dashboard reported on earlier.

The Library Items renewals dashboard shows live data illustrating how library users are migrating to digital channels. Libraries don’t just lend books any more, they are becoming community hubs and also lend many other items like CDs DVDs and online material.

Our first example comes from Warwickshire County Council and is led by the Digital by Default Programme Manager Kate Sahota, with Matt Harrington from GDS, who has also blogged on this subject.

At Warwickshire we can see that 45.1% of renewals are online.

Library Digital Dashboard GIF2

Users can also renew items at unstaffed digital kiosks around the county. 33.8% of Warwickshire’s users do that, which added to the 45.1% gives a resounding 78.9% digital take-up for this transaction.

Digital Inclusion

We also collected data on the type of users renewing items. That reveals some interesting digital inclusion insights.

Library Demographics

Many people would not have forecast that the numbers of Senior Citizens (60+) renewing items digitally is 43.7%, only marginally behind 15 year old teenagers at 46.2%.

Young adults (16 to 17) being substantially ahead of Adults is perhaps less of a surprise. It will be interesting to see how these figures change over the coming months and years.

Next steps

The intention is to carry on publishing this data every week and to invite all other libraries in the country to provide their data to the GOV.UK website. Presenting this data on maps is also in the pipeline. That will provide some great digital inclusion insights for the country.