Shambolic” Universal Credit may never realise promised benefits

A devastating report published today by the NAO concludes that “Universal Credit has not delivered value for money and it is uncertain that it ever will”. 

The report catalogues a series of extraordinary failures of design and implementation, and portrays a Department ‘stuck’ making slow, fraught progress on a policy that it cannot now go back on – with neither direction offering value for taxpayer money.

Department for Work and Pensions

Commenting on the NAO’s report, Rt Hon Frank Field MP, Chair of the Work and Pensions Select Committee, said:

“This report blows up the DWP’s constant assertion that everything is going well and that any criticism comes from those who wish to make trouble for Universal Credit. The points that individuals have raised with the Select Committee are now writ large as systemic faults within the system, and the Government is caught in a trap of its own making. Because ministers were taught to be in denial earlier the programme, it has advanced to a stage where there is now a mega cost to scrap it and a mega cost to taxpayers to continue with it. Either way, too many claimants are being screwed down into destitution while the DWP insists that all is okay. The Universal Credit we have seen is a shambles, leaving a trail of destruction in its wake. Sadly this report will make little difference if the senior officers running Universal Credit remain firmly entrenched in La La Land.”

Progress:

The Department is stuck: it is making much slower progress than expected. As such, “Universal Credit is still at a relatively early stage of progress”. It cannot halt the programme, however. Its “incremental approach has led the Department to make many changes to its jobcentres, its digital systems and the working practices of the 12,000 people working on Universal Credit. As it has rolled out Universal Credit to more claimants and areas, these changes have become increasingly embedded across the Department. It would be both complex and expensive to revert to legacy benefits at this stage”. Consequently, the Department “does not have a realistic alternative but to continue”.

The business case approved at the end of May 2018 “should have been the final check” on the decision to invest in UC: but it was produced “at a time when the Government was already committed” to rolling out the programme. It is therefore questionable whether it constitute a “check” at all, given the existing commitment to the programme.

Source: https://www.parliament.uk/

Transformational change in health and care: five small steps to make a big difference

Durka Dougall writing at the King’s Fund: The growing demands in the health and care service reinforce the need for transformation.

Much has been achieved already but more is needed, for example by focusing on staff and communities, and further understanding their lived experience. Our recent report, Transformational change in health and care,  explores the stories of 42 people involved with transformational efforts in four sites. This work shows that five small steps can make a big difference to strengthening the work of transformational change – for example, by those in sustainability and transformation partnerships (STPs), integrated care systems (ICSs), or more widely.

Health and Social Care

Reaching out
All four stories show the importance of partnership working and the great value of involving local authorities, communities, clinicians, politicians and the voluntary care sector – all of which hold invaluable insights about local needs as well as powers to help address them. Those working to integrate care should assess how well-represented these groups are in local partnerships. Colleagues from Salford emphasised the point that reaching out requires an understanding of the people you are reaching out to. For example, engagement with clinicians and communities can be considerably enhanced by changing the language used. Instead of setting out plans for integration and what changes are needed, they found that it was far more effective to seek ideas and to focus on quality and what it means for patients and staff.

Listening
It sounds simple, but a conversation with a whistle-blower recently reiterated how little we, as a system, listen, and what a detrimental impact this can have on individuals and on care quality overall. The case studies in our report show the need to proactively identify issues and work from the inside to enable solutions. This requires three things. First, as Don Berwick and Chris Ham advocate, those involved need to take a personal interest to understand situations and find out more about them. Second, Northumbria interviewees describe the need for greater self-awareness – choosing to put aside biases to hear what is being said, patiently assessing each time whether there is a need to act. Third, power dynamics need to reversed – for example, Ben Fuchs describes how ‘open door’ policies, even with the best intent, can be ineffective or act to reinforce top-down power dynamics unless they are coupled with open and curious mindsets and behaviours.

Accepting

Open door policies, even with the best intent, can be ineffective or act to reinforce top-down power dynamics unless they are coupled with open and curious mindsets and behaviours.

Wendy Saviour, from Nottinghamshire Integrated Care System, echoed our message about the need for a more organic approach based on local needs rather than one that seeks a simple solution or a single model. Multiple interventions are likely to be needed, as is a learning approach across the system to develop, test, review and refine plans. As Wendy notes, ‘It is not the easy thing to do to work in this way, but it is the way to quality and sustainability’. This message is important for national and local efforts to reform health and care organisational structures and approaches – for example, fostering new ways of commissioning to ensure quality and partnership working.

Learning
The stories show the need to focus on learning and to build from the rich experience that already exists rather than to keep starting afresh. The stories highlight the importance of focusing on lived experience and not just on form or models, and they can be used to aid local discussions. The research team and advisory group members have already outlined plans to do this – for example, with Shropshire and Telford and Wrekin Sustainability and Transformation Partnership, which has been awarded £300 million for emergency care transformation. The stories also highlight the need to learn from ‘successes’ and ‘failures’ and this requires the need for open cultures and freedom to both speak and learn.

Developing positive approaches
The stories show the importance of positivity and of building on assets that already exist. For example, Birmingham shows the power of using data positively to motivate staff to improve quality rather than negatively to criticise. This is seen in our wider work as well. For example, Frimley ICS reiterates the power of clinical leadership to deliver transformations that improved quality and morale, decreased demand, and reduced staff turnover. This includes providing the time and support for people to get involved and creating structures that support rather than hinder transformational change efforts.

Next steps
These five small steps will require an individual and collective approach to truly transform health and care. We hope that this report will spark conversation and action to strengthen the many impressive efforts already under way. For now, we’re asking you to share your thinking: how will you use the report to transform health and care? What would be helpful from us and others to supplement your efforts?

Source: The King’s Fund