‘Why Total Place is vital for Labour’s chance of reforming public services’

Towards the end of the last Labour government, a programme called ‘Total Place’  offered a radical new way to reform public services that would deliver better outcomes for the same public spending.

Anyone who works in public services – and everyone who  relies on them – knows the gulf between the way services are delivered and the way we live our lives.  No family sees their health, childcare, schooling, housing, work, skills, benefits or the cost of living as separate issues that they deal with one by one. But public services assume they do – NHS here, child welfare over there, schools there, elderly care somewhere else, housing in another building run by a different organisation.

We make the public find their way round the system, instead of designing it round their needs. And the more complicated their problems, the more separate services and professionals they are likely to have in their lives, and the greater the chance that people will fall through the gaps.

READ MORE: ‘Turning public services around: Haringey’s story of child protection’

The human cost of failing people is high. But it also wastes public money. The pressure is always to tackle crises, rather than prevent problems arising in the first place. Offenders re-offend because support services are not available. Older people go into care too early for want of inexpensive support at home. Families with complex problems become expensive challenges for schools, social services, the health service and the criminal justice system. Investing in youth provision will cut crime; social prescribing will reduce care needs; flexible multiple agency teams can together on complex problems.

Most public servants recognise the problem and would like to work more closely with other colleagues. But they are often under pressure to meet targets set in Whitehall, rather than meet the needs of the people they are working with. They are encouraged to defend their own budgets tightly, even where they could help cut costs across the whole system.

The Total Place approach is based on the simplest of  ideas: that all the money spent in an area on health, schools, social services, benefits, police and other services can be seen as a single pool of public service spending. Once we do this, we can then ask how best to meet local challenges, working across budgets and services where needed and not being trapped by them. Total Place encourages leaders, frontline workers and communities to ask how to organise services around people’s needs.

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The original Total Place pilots showed that better outcomes could be achieved for less public money. Labour promised to give all local authorities more flexibility over spending than even Mayors get today. Total Place was scrapped by the Coalition, though the idea lived on in short-lived government programmes and in a growing number of local areas where determined innovators have found ways to work differently.

Since Labour came back to power, the underlying principles have become government policy again. Rachel Reeves has made ‘People, Place and Prevention’ the cornerstone of public service reform. A Total Place style health initiative in Greater Manchester was backed in the NHS Plan. Five ‘prevention pilots’ will be launched in five mayoral areas. MHCLG has set up a Local Place unit to support the idea and the Cabinet Office’s ‘Test, Learn and Grow’ programme is exploring similar principles across other local areas.

Effective change will challenge current cultures, organisation and accountability systems. Finding the best ways to do this will rely on local knowledge and innovation every bit as much as on changes in government policy. Total Place is a radical idea that is not owned by any one organisation or government department. It needs to be a movement, not just a policy idea.

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