Better value better services

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Transforming, not just delivering public services

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Transformation, not transfer

• Agenda of citizens and consumers at the heart of
  reform
• Voice and choice
• Holistic approach that delivers effective,
  joined-up services to citizens
• More sophisticated understanding of the
  efficiency agenda

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Roles of the VCS

• Identifying service need
• Helping to design solutions to meet a need
• Delivering services
• It is this combination of the three roles
  across the sector that means that the VCS as a
  whole can help to truly transform public
  services

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Definitions

• What is efficiency?
• What is value?

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Defining efficiency efficiently November
2006 Duncan OLeary
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Who are Demos?

• The think-tank for Everyday Democracy
• Demos provokes exactly the sort of long term
  thinking missing from the current debate The
  Financial Times
• Achingly trendy, mind-bogglingly esoteric and
  ridiculously pretentious The Times

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Five areas of work

• Public Services
• Cities
• Culture
• Science and Innovation
• Security and Identity

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Who we work with
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(No Transcript)
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Spending levelling off
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Baumols cost disease

• In 1979, workers at GM needed forty-one hours to
  assemble a car. In 2003, they needed just
  twenty-four
• It takes as much time and as many people today to
  play Mozarts String Quintet in G Minor today as
  it did when it was composed in 1787
• efficiency in classical music is stagnant!

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Gershon

• Public services have to do MORE with LESS
• Reducing the number of staff posts
• E-procurement
• Back office savings
• More collective and professional purchasing
• Squeezing out cost works in the short
  term, but you can only do it once. In the longer
  term, you have to innovate

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Competition as a route to innovation

• Diversity works
• Keeps incumbents on their toes, encouraging
  efficiency and innovation (i.e. improves the
  performance of the public sector too by providing
  challenge)
• Promotes a diverse range of approaches from
  different suppliers, which can be scaled up
  across delivery systems

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We need to think differently

• The current approach is still based on new public
  management
• Competition to do the same thing a bit better
• Output-based contracts
• Upward accountability
• The private sector is very good at this, but it
  often delivers only incremental innovation
  benefits

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Public Value

• We dont just want a good service, we want one
  thats fair, trustworthy and open
• In a democracy value is ultimately defined
  by the public themselves. Value is determined by
  citizens preferences, expressed through a
  variety of means and refracted through the
  decisions of elected politicians
• - Prime Ministers Strategy Unit

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Desired qualities in public leaders
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Creating (and destroying) public value
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Outcomes

• Delivering hospital operations well matters, but
  supporting healthy lifestyles matters more
• The core difference between the health
  outcomes in the fully engaged and solid progress
  scenarios is not the way in which the service
  responds over the next 20 years, but the way in
  which the public and patients do
• - Wanless Review

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Valuing partnership and prevention...
vs
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Accountability, legitmacy, responsiveness

• Not just upwards to a contract, but downwards to
  citizens/consumers and communities
• Progress in a post-political age depends
  not primarily on the design or management of
  institutions, but on the way in which they draw
  on and interact with the people they serve
• - Tom Bentley

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The effects of local government consultations
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Five principles

• Whole systems Focus on outcomes opens up
  innovation and avoids shunting cost around More
  competition not always best length and scope of
  contract matters
• e.g. Local government savings on care homes that
  lead to costs through hospital beds
• e.g. Schools that are cheap to build, but
  expensive to maintainor difficult to teach in

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Five principles

• Valuing culture/intangibles trust, legitimacy
  and a sense of values matter, but well never be
  able to account for them. Efficiency and a public
  ethos aligned, not antithetical.
• i.e. Delivering to the spirit as well as the
  letter of the contract is an expectation and a
  factor in future decisions

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Five principles

• Allocative efficiency asking people what they
  want and need is valuable in its own right, but
  it also allows better resource targeting
• e.g. Direct payments for disability, community
  consultation, participatory budgeting

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Five principles

• Find new ways to commission a step change
  through procuring for outcomes, innovation and
  learning, integration and downward accountability
• e.g. SKIPS in New Zealand a set clear set of
  aims, flexibility on how to achieve them
• e.g. Project-based government in Finland

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Five principles

• Understand the value-added of different sectors
  recognise specialism, networks, ethos of
  different players
• i.e. The VCS not just as another player in the
  market, but as a set of organisations with some
  unique characteristics
• e.g. sources of strategic insight and
  disruption for public service institutions and
  local authorities

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Thanks for listening...

• www.demos.co.uk
• duncan.oleary_at_demos.co.uk

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Transforming, Not Just Delivering Public
ServicesThe Economic Impact of the Womens VCS
24 November 2006

• Tania Pouwhare, Womens Resource Centre

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About the WRC

• Established in 1984
• Infrastructure and capacity building second tier
  organisation since 2001
• Training, information, one-to-one support,
  events, voice
• 300 members and extending reach across England
• Our values Feminism, Equality, Integrity,
  Professionalism, Collaboration Sustainability
• campaign

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About the womens sector

• Lack of representation on decision making bodies
• Rarely represented by other organisations
• WRC responsible for half of all womens VCS
  research sector is evidence poor
• Womens VCS is a direct result of feminism and
  womens movement

• 7 of registered charities
• Over 30,000 womens organisations in UK
• Receive only 1.2 central government funding and
  2.7 of charitable trust funding
• Womens and LGBT sectors most consistently under
  funded

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Why economic impact research?

• Important to show womens VCS contribution to the
  bottom line
• Demonstrate womens VCSs cost effectiveness,
  examples of savings to the state and added
  value
• Describe what will be lost if
• No intervention into current funding crisis
• No full cost recovery to aide sustainability
• No recognition of added value
• Not effectively engaged in public service
  delivery/procurement/commissioning agendas
• Effectively used in other areas (domestic
  violence, volunteering) and countries (New
  Zealand, Australia)

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About the pilot

• Funded by London Councils and carried out by
  Matrix
• Limitations timeframes, small sample, economic
  cost to determine value for money, baseline
  data, data gathered, reasonable assumption, no
  GDP contribution analysis
• Uses four womens VCOs as case studies in the
  fields of domestic violence, sexual violence,
  health and ex/offenders or those at risk of
  offending
• Data gathered through interviews with staff and
  other stakeholders and financial accounts

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Definitions

• Total economic cost
• The real, full cost of the service. Economics
  measures the whole cost rather than just which
  were paid for, so includes a market cost for
  volunteers time, goods provided free by hosts
  etc
• Value for money
• The difference between funding received to
  deliver service and total economic cost
• Breakeven
• The point at which funding received is off-set by
  savings achieved by outcomes/interventions

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Summary of results
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Savings to the state

• Measuring economic cost
• Unit cost per incident x no. of incidents per
  person economic cost OR through scenarios
• Example domestic violence (Walby report)
• A DV homicide costs 750,640 x 102 deaths over
  76m
• Those who sustained either serious or slight
  injuries make avg 3 GP visits in addition to
  hospital services x avg consultation costs 15.91
  x 65,000 est women suffer serious wounding
  3,102,450 per annum

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Savings to the state

• Measuring prevention
• Based on reasonable assumption
• Example CAST
• Costs to CJS for a reoffending ex-prisoner is
  65,000, 65 reoffend within two years
• CAST works with 140 women and reoffending rate of
  14
• Reasonable assumption that CAST responsible for
  lower reoffending rates (interviews with service
  users, survey 80 important that women-only
  service, 44 would not have attended otherwise)
• Average cost 5.070m / CAST cost 1.105m /
  Savings 3.965m
• Difficulties
• Need cost data and VCO rates to compare against
  the average or show improvement before and after
  or over the course of the service/intervention

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Added value

• Why? To demonstrate the distinctiveness of the
  womens VCS
• How? Womens VCS added value identified through
  interviews (why women? campaign) and WRC
  knowledge of the sector
• Examples of womens VCS added value
• Women-only services
• Models of intervention based on 30 years of
  feminist theory and practice
• Focus on women and gender
• Resulting in better outcomes

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Added value

• Communicating added value
• Improved outcomes e.g. engagement or retention
  rates, prevention, harm reduction etc
• Case studies
• Service users
• Describing what would be lost
• Added value includes
• Volunteers
• Levering in other funding
• Other in-kind contributions
• Voice, cohesion etc

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Recommendations

• National, large scale research
• Full cost recover/economic cost if not
  sustained then significant and identified loss of
  economic benefit, increased costs to the state
  and loss of added value will result
• Refining the model to measure prevention and more
  thinking about how to measure voice, cohesion etc
• Mapping of the womens VCS
• Use of Cost Benefit Analysis, including
  counterfactual (comparative) analysis with public
  and private sector services
• Develop methodology which can be used by VCOs

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Lessons

• Economic cost (funding vs. full cost) not enough
  to demonstrate value for money
• Volunteers and other in-kind contributions (e.g.
  premises) should be included in added value and
  not value for money
• Cost Benefit Analysis (outcomes of interventions
  are valued in monetary terms and set off against
  the costs of achieving them) with counterfactual
  - better model to measure value for money
• Not all organisations could separate out funding
  for specific services
• VCS researchers

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WRC information
To download the report www.wrc.org.uk/policy/wrcr
esearch.htm For more information about the
Womens Resource Centre www.wrc.org.uk For more
information about the why women? campaign
www.whywomen.org.uk To contact Tania Pouwhare
tania_at_wrc.org.uk or 020 7324
3030
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Resources
Drummond, Sculpher, et al. (2005), Methods for
the economic evaluation of health care
programmes. Oxford Medical Publications Oxford.
3rd Ed. Taillon, R. (2000), The social and
economic Impact of womens centres in Greater
Belfast Summary report, Womens Support Network
Belfast. Petty, A. and Hawtin, M. (2004), Impact
of the voluntary and community sector in Greater
Nottingham, Policy Research University/Leeds
Metropolitan University Leeds. Walby, S. and
Allen, J. (2004), Domestic violence, sexual
assault and stalking Findings from the British
Crime Survey, Home Office Research, Development
and Statistics Directorate London. Nettan, A.
and Curtis, L. (2003) Unit costs of health and
social Care, Personal Social Services Research
Unit Kent. Home Office (2005), The Economic and
social cost of crime against individuals and
households 2003-04, Home Office London. The
Sainsbury Centre for Mental Health (2003), The
economic and social cost of mental illness
(Policy Paper 3), TSCMC London.