In 2015 Daniel Carroll asked me if I would put together a guest mix to include in his show on Future Music FM. He asked for downbeat, ambient and electronic music.
Here is that mix. Enjoy.
Faced with an ageing population and cuts to public spending, early action can provide an alternative way forward for local authorities and the NHS
Yesterday, the National Audit Office (NAO) published a report calling for radical action to tackle delays in discharging older patients from hospital and stop the costs adding further strain to the financial sustainability of both the NHS and local government. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million. Delayed discharge also has a huge personal cost as people that are delayed more than 72 hours are far more likely to fall ill again, lose independence or mobility and be admitted to residential care.
The evidence clearly indicates that the care system needs to be transformed. We believe that adopting early action is a common-sense approach for the NHS and local authorities who face the worrying combination of an ageing population and cuts to public spending.
When considering the problem of delayed discharges, an early action approach encourages us to ask the question ‘where could we intervene earlier?’
The ideal solution to reducing delays in discharge is to reduce the need for admissions altogether by focusing on primary or secondary prevention. Primary prevention enabling older people to lead thriving lives could focus on adapting our society to be more ‘age-friendly’ through a myriad of relatively small, innovative interventions, for example by installing grab rails in homes to prevent falls or providing more public benches. There is also a considerable amount of evidence that interventions throughout a generation’s lifespan, not just in the early and later years, will help reduce pressure on health and social services from an ageing population.
Secondary prevention to reduce hospital admission would target individuals with more clearly identified needs. A good example of a simple intervention that does just this is the Call & Check Service based in Jersey. Postmen ‘call and check’ on older people, reminding them of medical appointments / prescriptions and connecting them with other support services. It prevents social isolation and enables them to live independently for as long as possible. This simple concept demonstrates that communicating and linking people with existing services is an effective way of using resources to act earlier. It also shows the strength of combining normally disparate sectors by using an existing service to increase the efficiency and quality of health and social care. 
Emergency hospital admission rates are correlated with chronic illnesses, so secondary interventions should also focus on enabling people with chronic illnesses to manage their own care. The US Veterans Health Administration ‘Health Buddy’ uses innovative yet simple technology to produce dramatic outcomes – an evaluative study showed savings of $3,506 on average per patient, hospital admissions reduced by 66% and bed days reduced by 71%.
Of course, even with the best of care some older people will need to be admitted to hospital, so early action is also about considering how services can be improved to ensure that older people can be discharged quickly and safely as soon as they no longer need acute care. The NAO report highlights that financial incentives for the NHS to reduce delayed discharges are not matched with incentives for local authorities to speed up receiving older people back into the community. One possible solution is to integrate health and social care, by pooling budgets in order to reduce departmental silos and encourage information sharing. The cost benefits accrued through improved efficiency could then also be shared.
The Government has shown some appetite for integration through the establishment of the ‘Better Care Fund’, designed to support local areas to plan and implement unified health and social care services. However, in a survey of local authority care directors, almost half (43%) said they believe the Better Care Fund has had little or no impact on care budgets and service quality. This is perhaps a somewhat negative outlook given the BCF is still in its infancy, but it does demonstrate that there is still a lot of work to do on integration. Different funding streams remain a major barrier and more must be done to bring them together.
Furthermore, integration alone is not enough. It is essential that services are designed with the involvement of both those who deliver the service and those who receive it to ensure buy-in to the new approach. ‘Co-production’ leads to a person-centred approach which focuses on the older person’s needs, rather than organisational targets. Hospital to Home, featured below, is one initiative which has adopted a co-production approach to redesigning integrated health and social care services in Scotland. The project is still ongoing, but practitioners from the working group report that the project has “greatly improved communication” with one respondent estimating that they have “reduced care home admissions from our hospital by about 50%”. Equally as important, interviews with older people and their carers evidenced positive relationships with staff but also helped to identify gaps in their care that still remained.
There is recognition amongst councils of the importance and benefits of investing in prevention – and the spirit of prevention is now embedded in the Care Act. However, overall funding pressures resulted in local authorities’ planned spend on preventative measures dropping from £937 million in 2014/15 to £880 million in 2015/16 – a 6 per cent reduction in real terms. If the government is serious about prevention, it needs to translate words into action – backed up with hard cash.
How can integrated services be designed whilst improving older people’s care experience?
Hospital to Home is an initiative aimed at improving the care experience of older people being discharged from hospital in the Tayside region of Scotland. Delivered by Iriss, the project worked with local health and social care practitioners, older people and their carers. This group shared their own experiences with each other and co-designed issues to be addressed. This resulted in three broad recommendations which have been adapted and embedded locally with partners from the case study areas of South Angus and Dundee over the past year.
Hospital to Home’s starting point is improving the experience of the person receiving care, yet its effect is increasing the efficiency of hospital discharge and improving community based care, with an aim to minimise hospital admissions in the first place. It demonstrates the process of redesigning services for early action, highlighting an approach that removes departmental silos by focusing on the desired outcomes of the person. Strengthening communication between practitioners, patients and their families and coordination between acute and community services is key in tailoring health and social care around patients’ needs and improving care and efficiency in hospital discharge.
We will be publishing a more detailed case study of Hospital to Home on our website soon. In the meantime, you can find out more about the project here.
 Coye, M. (2009) Transformation in chronic disease management through technology: improving productivity and quality in the shift from acute to home based settings. San Francisco (CA), Health Technology Center
Since first building a ‘service submission portal’ for G-Cloud 6, our aim has been to move the Digital Marketplace away from being a simple catalogue of services, to being a platform that can handle supplier applications and multiple frameworks.
We want the public sector to have a single place to go to find what it needs for its digital projects. We also want suppliers to have a single place to offer their digital services.
In terms of the questions suppliers need to answer in their G-Cloud application, the process for the latest iteration, G-Cloud 8 (G8), isn’t very different from G-Cloud 6 (G6) and G-Cloud 7 (G7). However, behind the scenes there’s been a huge amount of technical change.
When suppliers applied to supply their services through G6, they had to use 2 separate systems to complete their application. They had to give information about their:
We recognised that the user journey didn’t meet user needs. Our development team has rebuilt the Digital Marketplace so that since G7, suppliers have been able to complete their application to supply their services in one place.
The changes we’ve made meant that opening G8 for applications was simpler and faster than it has been for any previous framework iteration. In fact, it took 2 developers less than 2 weeks to get G8 ready for suppliers to apply to supply their services. The relative ease of the preparation shows the progress we’ve made towards becoming a platform.
Our intention was to build something that we could reuse: a foundation that would support all future frameworks on the Digital Marketplace. This is exactly what we did with the Digital Outcomes and Specialists framework – we made the application more general so that it could support something other than G-Cloud.
Our vision is similar to our colleagues’ at Government as a Platform (GaaP) who are dedicated to building something once and making it available to everyone in the form of reusable design patterns, shared code libraries and platforms. If we can get these things right, we’ll have more time to focus on delivering the bigger vision for the future of the Digital Marketplace.
You can read more technical details in my post Moving from portal towards a platform.
Things which caught my eye elsewhere on the web
Technology is neither magical nor neutral | Gerry McGovern
We are only now getting a new generation of managers who actually realize that technology is not magic. That is does require careful management to get the best out of it. This is what the essence of digital transformation is about. It is about the transformation of management practice so that it can better manage the technology that is essential to its survival.
How Technology Hijacks People’s Minds — from a Magician and Google’s Design Ethicist — Medium
I learned to think this way when I was a magician. Magicians start by looking for blind spots, edges, vulnerabilities and limits of people’s perception, so they can influence what people do without them even realizing it. Once you know how to push people’s buttons, you can play them like a piano.
And this is exactly what product designers do to your mind. They play your psychological vulnerabilities (consciously and unconsciously) against you in the race to grab your attention.
Our “No Asshole” Rule — adventur.es
In software there is a concept called “code debt,” which refers to future liability for continually patching bad code. The little fixes that save time in the short term, create a ticking time bomb. Eventually the system blows up and costs a tremendous amount of time and money to fix. But until that event occurs, things look considerably more profitable. Culture operates identically. Companies can offer retention bonuses and cajole a rosy facade for a while. Eventually though, the underlying issues show and the culture debt is paid.
Why the arrival, not the journey, matters | Memex 1.1
If, as now seems obvious, the Internet is a General Purpose Technology, then our societies are only at the beginning of a journey of adaptation, not the end. And this may surprise some people because the Internet is actually rather old technology. How you compute its age depends really on where you define its origins. But if you think — as I do — that it starts with Paul Baran’s concept of a packet-switched mesh in the early 1960s, then it’s now in its mid-fifties.
So you’d have thought that our society would have figured out the significance of the network by now. Sadly, not. And that’s not because we’re short of information and data about it. On the contrary, we are awash with the stuff. Our problem is that we don’t, as a culture, seem to understand it.
The Real Bias Built In at Facebook – The New York Times
With algorithms, we don’t have an engineering breakthrough that’s making life more precise, but billions of semi-savant mini-Frankensteins, often with narrow but deep expertise that we no longer understand, spitting out answers here and there to questions we can’t judge just by numbers, all under the cloak of objectivity and science.
If these algorithms are not scientifically computing answers to questions with objective right answers, what are they doing? Mostly, they “optimize” output to parameters the company chooses, crucially, under conditions also shaped by the company.
Would putting all Ministers in one building help them beehive? | Mark Langdale | LinkedIn
With so much change affecting both the size and location of the UK Government’s civil service machine, both in Whitehall and across the country, should Downing Street now consider creating a more effective physical centre for Ministers to work together?
In order for a product team to solve hard business problems, it’s not enough that the solution just work technically, and it’s also not enough that the customer loves it, but also, and often most difficult, the solution must actually work for your business.
The different types of design in government | GDS design notes
Design is a broad field, with many different specialisms. We’ve split design into four distinct roles. No one of these roles is more senior than the other. Our roles are specialisms, not a hierarchy. We’ve created specialisms because we operate at a massive scale, and no one person can be good at everything. There’s no ‘right way to be a designer’ you can be one, or all of these things – with more chucked in for good measure.
It’s not about the technology! (Apart from when it is).
“Digital/transformation/business is not about technology it’s about design / strategy / culture” is a recurring meme. It can be a comforting thing to cling on to, and it’s probably true a lot of the time, but is also not true in some important respects.
Technology does matter. Good digital / design / business / transformation / culture / strategy requires an understanding of the materials.
Alex Blandford — Digipology
Think of it like a Wikipedian in residence. Modern organisations conducting user research generate hundreds of hours of video, thousands of scirbbled or hurriedly typed notes and transcripts. Get someone to be a custodian of those with a remit to get deeper understanding out of them, and be open (but respectful to the participants).
Putting down roots | Catherine Howe
Look far ahead and in front of your nose at the same time: I am less and less of a mind to write a strategy – I am more inclined to work with people to develop a big ambitious vision and a series of reasonable steps towards it as no strategy ever survives contact with reality and change needs the momentum you gain from just getting stuff done
Audacious optimism: Really. You are trying to change a WHOLE SYSTEM – you have to be ludicrously optimistic!
Know you will fail: This is why the optimism is audacious . Your plans will be diluted down and you will make compromises but how you fail matters and if you have learned and if the world is a tiny bit better rather than a tiny bit worse then bank it as a win
Seven principles to help us strengthen our data infrastructure | News | Open Data Institute
Society is not currently treating data as infrastructure. We are not giving it the same importance as our road, railway and energy networks were given in the industrial revolution – and are still given now. Good infrastructure is simply there when we need it. We know our data infrastructure is working when it is boring – when we don’t need to think about it.
Alongside the rules for the official campaign groups on how they can act, what money they can spend and what publicity they are able to put out, the next 28 days also sees a change in the role of the Civil Service in supporting the Government over the question of the UK’s membership of the European Union. Cabinet Secretary Sir Jeremy Heywood has now issued guidance for the period leading up to the EU vote. Over the next 28 days, Ministers will not be able to call on civil servants for referendum-related publicity, help write speeches for the campaign, organise referendum events, put out new arguments or provide other similar support. The overall message of the guidance is similar to other guidance issued before local and European elections and before the Scottish referendum, and the Civil Service Code, that ‘public resources are not used for party political purposes’ and that civil servants should not ‘undertake any activity which could call into question their political impartiality’. However, there are a few areas where the guidance is focused on some of the key concerns that have been expressed about the role of the Civil Service more generally in supporting the government over […]
This is a list of what we’ve been working on since the last update on 13 May 2016, and what we plan to do next. As usual we’ve divided the work up into lists of what we’ve been doing to keep GOV.UK running, and what we’re doing to make it better.
To keep GOV.UK accurate, available and secure, to support government publishers and to meet the most pressing needs of end users, we’ve:
To improve GOV.UK in relation to the missions on our roadmap, we’ve:
In the next 2 to 3 weeks we expect to:
Government spends a huge amount of money through contracts each year. Unfortunately, at the moment, data about these contracts and the suppliers that win them isn’t available as easily as it should be.
In many cases, data isn’t captured well which means the quality of it is low. However, we’re working hard to improve this.
The Standards Hub was established to help set open standards in government IT and is based on open standards principles. It asks the public to suggest areas where having open standards could solve user problems when they use government services. Technology experts look at these suggestions and take them on as ‘challenges’. The challenges are published so that people can respond and recommend solutions before experts use them to put together a proposal to solve the problem.
The Open Standards Board then decides whether the open standard(s) in the proposal should be adopted across government.
Today on the Standards Hub, I suggested the Open Contracting Data Standard (OCDS) as a solution to the data problem. If it’s adopted, the OCDS will be applied across government and will make services better for users as well as cheaper to run.
Back in November, I wrote a blog post about the importance of improving and opening up procurement and contracting data in government. In the post I talked about how this was helping us think about and plan developments of the Digital Marketplace.
On 12 May, the Cabinet Office announced a number of important commitments as part of the UK’s Open Government National Action Plan 2016-18. This was the result of lots of collaboration between some really talented and dedicated reformers in government, in the Open Contracting Partnership, and in civil society.
A number of these commitments are relevant to how we can improve and open up procurement and contracting data, including:
On the same day as the Cabinet Office announcement, the Department for Communities and Local Government (DCLG) also began a consultation on a number of proposals to update the Local Government Transparency Code 2015, including:
Open data standards in public procurement and contracting is an important part of our vision for the Digital Marketplace, as we help the public sector buy what it needs to deliver great digital services. Over the coming months we’ll start to implement the OCDS.
As always, we’ll be thinking out loud by blogging here regularly. Sign up to the Digital Marketplace blog to keep up to date with our progress.
(Not my choice of title)
I gave a presentation at Better Connected Live yesterday (25 May).The slidedeck is available online including a cheesy stock image that amused me (but, it would seem) no-one else. And a slide only included so I could make a “Why did the chicken cross the road” gag. Which I totally failed to do.
The first half of the talk was a rambling discourse of my, possibly ill-advised, research into the use of local government websites. I have written extensively around this research so I will spare the reader what I failed to spare the audience.
First of all let me confess that I was never brilliant at engaging colleagues. My tactic of repeating “I don’t care what you think” was often not seen as an offer to collaborate.
However it did happen occasionally and since I’ve fled the shores of local government I have seen good examples of other people working closely with their colleagues.
The more I work with data the more I think it’s the wrong thing to talk about. No-one (apart from data-geeks) really cares about the data. They care about what the data tells them about their life or work. So let’s talk about that.
This also shifts the power dynamic. The web team “owns” the webstats. The service manager “owns” the service. So let’s talk about the service.
My old friend Google Analytics (don’t forget Google Analytics is used by 89% of local authorities) is good at capturing and reporting referral headers. Referral headers, broadly, tell the stats engine which website the user was on before they arrived here.
Except referral headers are not passed by many email clients or by social media apps (though typically they are passed by social media platforms opened in web browsers). Which has the effect, for many organisations, of under-reporting referrals from social networks and emails.
There is a solution but I don’t see it widely implemented across local government: campaign tagging. Essentially manually appending extra information to the URL when you share it.
The Google URL Builder tool makes this easy and the process can be automated or semi-automated for enterprise use.
Referrals tell you not just what channel they used, but potentially infer some information about the user (if they clicked a link on the St Mary’s School website maybe they are a parent or pupil there). Device use, browser choice all help build a profile of who is visiting your content or accessing your service.
One of the most powerful signals that your content or service is working well (or not working).
If people visit the missed bin page and then vanish from your site it suggests that they got what they were looking for. If people visit the missed bin page and then visit other pages in the waste area it suggests that page (or potentially the navigation leading to it) is failing the user.
The killer question.
For the service manager .
This is your service. Who are you expecting to use it? Where are you expecting them to come from. What are you expecting them to do next?
It’s OK if this is a back of an envelope calculation but my golden rule of not getting hopelessly lost in analytics data is never to look at it without a question. The best question (at least to begin with) is “did this work the way we expected”.
The answer is almost certainly “No it did not work the way we expected”.
Your chosen webstats package can tell you what happened and when but it cannot tell you why.
The why is the interesting question of course. It’s probably because the service isn’t working for the user. The best way to fix it, of course, is to go and talk to some users.
But now you know what to talk to them about.
In the same way as the longer I spend working with data the less I talk about data the longer I spend with graphs (or infographics) the less I want them to do.
My favourite infographic is a single word.
(this worked as expected) or
(this did not work as expected)
Time series bar charts and scatter plots are terrifically useful for investigating “Why did it happen this way” but they are, in my humble opinion, largely rubbish for engaging colleagues.
Keep it nice and simple. Add complexity only when the user needs it.
Goal tracking is a very powerful tool in Google Analytics. It’s not expressed in language that resonates with local government (lot’s of stuff about ecommerce). But goals can be expressed flexibly and give you really powerful insights into how people are interacting with your site over multiple visits.
It can be a challenge to define goals for your website. But if you don’t know what the most important tasks are right now then what do you know?
(As someone once said)
This stuff works well when everyone gets focused on the same task. I achieved most as a web manager when I worked alongside service managers looking at all of our data: web, calls, service levels together. I achieved least when I used data to try to win arguments (or service managers did the same with me).
There is mixed practice in local government around the use of webstats but I don’t think that can be broken out of the organisation’s practice around the use of data generally.
In fact data was a recurring theme at Better Connected Live. Which is good.
I find it helpful to remember that organisations don’t switch between binary states of “using data well” and “not using data well”. Instead data-sophistication is a journey.
In fact I’m involved in a data sophistication project in the voluntary sector called Data Evolution for just that reason.
(Photo credit: why by Art Siegel used under CC BY-NC 2.0)
I was Delivery Manager on the Find Pension Contact Details service, which is now Live.
That puts me in a DWP club with two members, with Carer’s Allowance Digital Service holding membership since 2014. We have 10 services in beta, so membership of the club is due to expand very soon.
Being the Delivery Manager was a great experience, and Find Pension Contact Details is a great service. It helps people find a lost pension and even though it’s small in scale compared to something like Apply for Personal Independence Payment, it’s a useful service for users, because:
The knowledge created in delivering this service could be a template for more services like it. I mean small-scale services delivering relatively simple transactions – they are perfect for the digital channel. I’d like to see a lot more of them so that we get fast and slick at delivering them, building our customer insight and strengthening digital presence at the same time. It’s a strategy that is (I’m told, I’m not an expert!) well-used in the private sector and is sometimes referred to as the ‘long tail’.
Many digital companies use the strategy: they build up digital presence by selling a large range of lower-demand items, which they can do cheaply via the internet. By so doing they engender a habit amongst customers to come to their channel which pays off when customers buy profit-making high sellers. In a government context, we don’t have the sales motive: our pay-off is offering the most efficient and easy-to-use service.
My point is that straightforward services like Find Pension Contact Details are strategically important, and become disproportionately important when they constitute a critical mass that tips people to that ‘digital-by-default’ behaviour. As with the ‘long tail’ strategy, the smaller things give leverage to the big things. Don’t forget the smaller things!
Technically, the service is relatively simple in DWP terms. It’s data from the Pensions Regulator accessed through an API and interpreted via some pretty clever micro-services to enable the user to search for information they might have about their pension. Our Operations colleagues use the service too, so that they can support users if necessary. The delivery complexity came in having to fight through many known unknowns on our way to Live, because we were one of the first down the path.
For example, things like governance approvals and ‘change management’ in a world of continuous delivery. We also came upon unknown unknowns such as the detailed process for getting a new domain set up and interfaced with GOV.UK – things we thought we knew but realised we did not entirely when the time came.
In Agile, the heart of our practice is the sprint. It is best if you sprint on a flat, straight track that removes all impediments to speed. The sort of track Find Pension Contact Details has been on has well-established root systems and plant growth trailing across it. The roots of old ways of working, traditional ways of thinking, of legacy processes and technologies all impinge. The core team were cohesive, inventive, resilient and professional but it sometimes seemed like they were running an obstacle race, not sprinting at all!
It’s an organisational job – not just the Delivery Manager’s – to make sure we don’t invest in sprinters only to find they end up tripping and limping because we made them run through undergrowth. Environment is a major factor of performance – it isn’t the few but the many who create repeated, sustainable success.
A club with two members is a bit dull by the way – I’m looking forward to some new joiners to the ‘Live Club’ soon!