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The challenge for public services around the world is to meet rising expectations for more joined-up, tailored services and greater fairness but still improve value for money.

1. Coping with a new baby can be a stressful time for any parent. But for those with a newborn in Nova Scotia, Canada, life is made a little bit easier. Bringing together provincial and federal services, new parents in Nova Scotia can now register the birth of their child, apply for a birth certificate, a Social Insurance Number and child tax benefits all in one easy application in the hospital where their child is born.

2. This is one of the outcomes of the creation of Service Canada. In 2005, the Canadian Government set up Service Canada, a ‘one-stop’ delivery network providing multichannel access to over 77 government programmes - allowing citizens to choose how they want to interact with different services, not the other way round. Service Canada is driving forward ever-increasing integration of public services in Canada. The ‘Bundled Birth Services’ initiative in Nova Scotia is an example of such innovative service delivery and is now being rolled out to other areas across Canada.

‘There is huge potential in “one point of access” systems like Service Canada, especially in terms of efficiency savings. The real gains will come from getting all customers through the same door, triaging them effectively, and answering as many queries on the spot as possible.’ Marcus Robinson, Managing Partner, PricewaterhouseCoopers

3. Service Canada is just one example of how the best public services across the world are moving from a ‘one-size-fits-all’ approach to one which joins up and aligns services around people’s full range of needs. The concept of personalisation encompasses two main ways of making services more person-centred - firstly, joining up and integrating services across traditional service boundaries so that they are simpler to use, and secondly, tailoring services and channels of access to users’ specific needs. Often these two aspects of personalisation come together. They characterise a new generation of services able to reach out and develop effective relationships with citizens who are empowered with stronger rights and better information.

Figure 2: From siloed to personalised services  

Why does personalisation matter and is it possible to have more of it at a time of fiscal pressure?

4. Personalisation is, of course, what the best teachers, doctors and judges have always strived to achieve. But the system has often been stacked against them: too often services can be static and siloed, leaving people to negotiate a host of different agencies to get the services they need.

5. In recent years, innovators have started to challenge these embedded systems. They have developed services which are both more integrated and flexible in their response to people’s needs: for example, more specialist treatment for conditions such as cancer; flexible employment support through Jobcentre Plus Personal Advisers; and better assessments of children’s particular educational needs.

‘The concept of patient-centred services has become accepted across the majority of developed countries.’ Mark Pearson, Head of Health Division, OECD

6. Talk about the personalisation of services has been frequent for more than a decade. Delivery has been slower. Looking around the world, however, we see there are some powerful forces driving personalisation from a leading-edge innovation towards becoming mainstream practice:

• The continued rise of a service culture means greater demands on public services: the emergence of new markets, more flexible provision of services and more sophisticated tailoring of products in the private sector has given people a greater appetite for customer service. Many now want the same choices from public services.⁴² Over half of respondents to one MORI survey in England strongly agreed that public services should fit around their changing lives.⁴³ Likewise, as people have generally become busier, significant proportions state that ‘being able to contact them at weekends and in the evening‘ is something they want from public services.⁴⁴, ⁴⁵

‘What characterises Singaporean public services is a real focus on the customer experience, and the flow of people through public services.’ Professor Kishore Mahbubani, Dean of Lee Kuan Yew School of Public Policy, National University of Singapore

• The benefits of joining up services are becoming greater and more evident: the rise in the number of people with chronic diseases and other complex needs mean that services have to adapt to manage people up and down pathways of care. The highly successful outcomes of the Kaiser Permanente Foundation health care system in California, for example, has been built on providing person-centred, integrated packages of care around the needs of individual patients from the hospital to the home.⁴⁶ These benefits are particularly evident in health care, but also extend much further. For example, there are real gains to be had in further joining up employment, welfare and training provision, and different elements of the criminal justice system. There is also huge potential to join up and integrate different transactional services - for example, queries to local authorities can be much more effectively and quickly dealt with if the people answering the phone can cover a whole range of local authority services.
• Services have to become tailored if they are to promote fairness for all: the emerging evidence points to fairness for all in the future requiring services which adjust to the level of need of the individual citizen. Providing the same service to everyone often leads to unequal outcomes, particularly for those with the greatest needs. For example, in health, the best drug or alcohol rehabilitation or mental health care relies on closely tailoring what is provided to the specific needs of the individual. Tailoring can lead to huge gains: in Finland around one in five students receive extra support from specially trained professionals known as special education teachers - and partly as a result, the bottom 10% of students in Finland perform at a higher level than the bottom 10% of students in any other country in the world.⁴⁷

7. This strong weight of evidence behind personalisation means the debate across the world is shifting from whether to personalise services, to whether it can be afforded in the current global economic downturn. Some people argue that greater personalisation simply means pressure for additional services at an additional cost. Our conclusion from looking across the world is that personalisation can actually, if managed effectively, be part of the answer to rising needs and tighter resources. Leading international examples show it is possible to re-engineer services so that instead of adding an extra layer of service, they become simplified, better targeted, and more tailored.

8. In particular, the best systems are accelerating three approaches:

• streamlining transactional services so that they are more integrated for the user, for example by making it easier to claim a range of benefits online;
• using lead professionals to better engage with people with complex needs who access a range of services; and
• giving users of services genuine control , for example by providing new funding mechanisms, not just one-off choices.

The best public services in the world are joining up and streamlining transactional services and making better use of online communication

9. What world-leading public services have in common is that they make sure users do not have to navigate various different hurdles to get the public services they need. Rather, they fit within their lifestyles. This is not a new aspiration. The 1918 Haldane report into the machinery of government considered the idea of organising government around ‘the persons or classes to be dealt with’ but in the end decided that a more practical departmental structure would be organised around the main functions of health, education, defence and other services.⁴⁸ In recent years, this 90-year-old aspiration has started to be realised.⁴⁹

10. One of the most successful examples in the UK is Jobcentre Plus. Jobcentre Plus has brought together employment and benefits services and given people the choice of accessing services and support in person, over the phone or on the internet. This has delivered over £450 million in efficiency savings between 2004-05 and 2007-08. An international overview suggests, however, that there is scope for British services to go much further.

11. Looking at world-leading examples, Service Canada (see case study box on page 37) has led the way since 2005, bringing together over 77 government programmes, partly driven by the need to integrate services in areas with a low population density. Similarly, Centrelink in Australia is a highly advanced national system of 300 ‘one-stop shops’, with integrated telephone, online, in person and mail access points, distributing around A$70.5 billion in social security payments every year and processing around 6.6 billion electronic customer transactions each year. Centrelink reduced the cost of service delivery on a remarkable scale: in 2003-04 approximately A$270 million were returned as efficiency savings to the government. This has resulted in cumulative savings to the budget of A$1.352 billion for the period 1997-98 to 2003-04.⁵⁰ Building on Centrelink, Job Services Australia came into force in July 2009, replacing nine previous employment services and programmes with an integrated one-stop shop.

12. Service Canada, Centrelink and Job Services Australia do not stand in isolation. Our survey highlights a series of rapid developments that are integrating services and making them easier for citizens to use:

• Tell us once: many services across the world are simplifying the collection of data from citizens and sharing it more intelligently so that people do not have to keep answering the same questions over and over again for different public services.⁵¹ This ‘ask me once’ vision has been taken the furthest in Belgium, where the creation of the Crossroad Bank has drastically reduced the number of forms people have to complete and introduced a safe, sophisticated data-sharing system - saving taxpayers significant sums of money every year (see case study box opposite).
• One telephone number for all services: following the example of the 311 non-emergency telephone number in New York and the successful spread of similar integrated telephone services across the USA, even countries with relatively fragmented public services such as Germany are looking to develop a single telephone number for services. France has already introduced a 3939 number across the whole of the country for nationally-provided services, backed up by online access at servicepublic.fr, and cities such as Paris have introduced similar phone numbers for integrated access to local services.
• Sharing space and resources with the private sector: in Australia, the police are building stronger relationships with local people by co-locating with private sector businesses - police shopfronts have been set up in shopping centres and central business districts. And in France, public service one-stop shops also provide services for private utility companies, delivering economies of scale.

13. The greatest opportunities for joining up and tailoring services lie in the next generation of e-government. Although e-government strategies need to recognise that many people are still not online or prefer not to access services in this way, broadband internet coverage is growing fast across countries. In 2008, 65% of households in the UK had access to the internet at home, an increase of 46% since 2002, and this is projected to rise rapidly.⁵² As set out in the recent Government strategy, Digital Britain, this opens the door to new opportunities for public services to shift some transactional services almost entirely online, with a safety net for those unable to access services online.⁵³

14. One of the opportunities e-government offers is to enable people to use a mixture of ways to engage with all services, rather than simply confining e-government to traditional transactional services. A simple example of the way in which e-government is developing into new areas is the Police on the Web scheme in Belgium. This allows people to report thefts or vandalism online 24 hours a day, with a direct, immediate connection to a police officer. The online declaration is legally binding and submitting it takes 15 minutes compared to a minimum of two hours at a police station. Going further than this, the Sundhed.dk website in Denmark helps take the pressure off front-line services by providing personalised online access to health information, medical history, consultations with professionals and transactional services such as prescription renewals and purchase (see case study box on page 42).

For people with complex needs, world-leading systems are bringing services together through a new generation of lead professionals and pooled budgets

15. People with complex, multiple problems have the added challenge of getting access to the range of public services they need to get their lives back on track. Too often, they have to negotiate numerous different government agencies and deal with a collection of different professionals in different places and changing faces within services. And too often this can mean that the services they receive are impersonal at a time when a close personal relationships are essential for supporting and encouraging them to address the interrelated challenges they face.

16. There are about 140,000 families in England who experience multiple disadvantages and interface with more than five services at the same time.⁵⁴ This generates enormous economic impacts: estimates indicate that a family suffering from depression, alcohol misuse, domestic violence, short periods of homelessness, and being involved in criminality can cost between £35,000 and £80,000 per year. Taking into account the wider costs to the economy and society, economic impacts can rise to between £55,000 and £115,000.⁵⁵

17. For a far wider group, times of life transition, such as the birth of a child, leaving education or preparing for retirement, can also bring challenges which require the use of a number of services at once. As with transactional services, the best services in the world have recognised that duplication is wasting money for government and opportunity for service users.

18. Over the last two decades, services in Britain and around the world have therefore tried to coordinate services for those with greatest need to achieve better outcomes and to save money. Merging organisations, multi-disciplinary teams, case conferences and working collaboratively with third sector support services are all common in public services today, and there is no doubt that there have been real improvements in the coordination of services. But the best services appear to have a common characteristic.

19. People having fewer, more productive relationships with lead professionals - someone who can negotiate a package of support with users across different service boundaries - characterises the most successful programmes.⁵⁶ One of the best examples is Wraparound Milwaukee in the USA. Instead of caring for children with mental illness in institutions, Wraparound Milwaukee uses strong lead professionals to work with the family and the child to design a tailored package of support which allows the child to remain at home in a caring family environment. This leads to better outcomes for the children and also provides real evidence that a lead professional approach can lead to significant savings: the cost of the Wraparound Milwaukee programme is $3,850 per child per month, compared with $27,000 per child per month for inpatient psychiatric care  (see case study box on page 44).

20. Similarly, the Homeless Outreach Project in British Columbia provides coordinated help to homeless people though one lead professional. The lead professional makes initial contact with the homeless person, takes them to the welfare office to assist with their application through a special fast-tracked process, and then secures housing for the person - usually in one day. The lead professional also provides ongoing support over the longer term to help the person stay in accommodation, for example making referrals to drug or alcohol addiction services, accompanying them to appointment and negotiating on their behalf.

‘Lead professionals are often an excellent way to join up and tailor services to meet individual needs and expectations - producing better outcomes for citizens, families and communities, as well as being very good value for money.’ Judith Smyth, Director Public Governance and Commissioning, Office for Public Management

21. In Australia, the Logan Beenleigh Young Person’s Project is a prominent example. This was set up as an experiment in moving away from the traditional model of service delivery for complex cases, which was characterised by lots of different government and non-government organisations all trying individually to make an impact on the life chances of the young person. The project project now provides coordinated intensive support to young parents, pregnant teenagers and other vulnerable young people through Lead Support Coordinators. These coordinators are professionals drawn from existing agencies who work closely with the young person to design a tailored package of support. This example demonstrates the importance of collaboration, not just between government agencies, but also with third sector organisations which are trying to help exactly the same cohort of young people.

22. Our analysis also suggests that there are some common elements to the most successful lead professionals. Firstly, it is important that those in the lead have some element of control over the budgets. Without being able to flex resources, lead professionals are far less able to design or procure services which suit the individual. Linked to this, successful lead professionals must have a high level of authority in the system, taking on a strong professional role alongside the coordination of care. Finally, they do not simply coordinate services, they also directly challenge users of services to plan a stronger role for themselves.⁵⁷

Delivering day to day control to citizens, not just one-off choices

23. Personalisation is enabled through practices such as one-stop shops, e-government and lead professionals. But to drive these and other person-centred approaches, citizens often need to be given greater power over the services they receive. The debate on choice has been focused on one-off choices such as choice of hospital or school. Yet international evidence suggests that the greatest improvements often come from also giving people more ongoing, day-to-day control over the services they receive.⁵⁸ The most advanced systems are therefore building on institutional choices to provide ongoing, day-to-day control for people over the services they receive.

24. Although this control can be given in non-budgetary ways, such as through care plans, international examples highlight the frequent importance of moving the money from a static administrative pot and into the hands of service users themselves, especially with the support of a lead professional. This form of control complements entitlements to core services, giving people the power to ensure more specific aspects of their care are personalised.

‘Personal budgets have real potential for improving the lives of citizens by giving them greater control over the services they receive.’ Vidhya Alakeson, Department of Health and Human Services, Washington DC

25. The UK has introduced personal budgets and direct payments to offer more choice and control to service users in social care, and is establishing pilots of personal budgets in health care andother areas. But, there is still more we can learn from international practice. In Oregon in the USA, for example, people with mental health conditions are helped to live independent lives through a personal budget of $3,000 a year. They are assigned a personal advisor to identify goals and how to best use the personal budget to buy goods and services which will help them achieve these aims.

26. While the Oregon example is very small in terms of the number of clients the programme takes on each year, other international personal budget initiatives are on a much larger scale. In Australia, the Employment Pathway Fund gives those searching for employment a sum of money to spend on goods or services to help themselves back into work - for example, driving lessons, work clothing, training courses, apprenticeship fees, mental health or drug and alcohol counselling, and even haircuts. Similarly, across the USA, Flexible Service Dollars are being used where children need intensive social care support from public services - the Flexible Service Dollars are a personal budget which allows the family and child to design a package of care to meet their individual needs. The programme is intended to enhance the child’s quality of life, improve the likely success of treatment or to help the family keep the child at home.

27. The Netherlands has also extended personal budgets to a whole range of services, including childcare, social care, and services for disabled people - and giving people more choice and control in this way has led to high levels of citizen satisfaction. However, the large scale uptake they have experienced, especially around childcare, has highlighted the untapped demand in the system and has led to budgetary challenges.⁵⁹ International experience shows that there is huge potential for personal budgets to make real differences in people’s lives, but that success and achieving value for money depend on the details of how programmes are designed and managed.

Conclusion

28. Empowerment through entitlements and information will only foster a new relationship between services and citizens if services can also reach out and meet people’s aspirations. Without this, services will fail to achieve better outcomes for people and will not command the trust and respect which must underpin collective provision.

29. Our findings suggest that to achieve this, services need to go beyond simply trying to improve their individual interactions with people and embark on a new wave of joining up and tailoring. The good news is that this can also raise productivity and save money.

30. These changes do not necessarily require mergers of services into ever larger units. In fact, small, agile providers of services, such as the best of the third sector, have a vital role in personalising services. But personalisation does require some fundamental changes in the way individual services collaborate such as:

• creating a shared front office through which the public can engage with diverse providers of transactional issues such as tax and benefits, employment advice and reporting crime; and
• introducing new lead professionals with pooled and flexible budgets held by the professionals or users themselves.

31. For these changes to be embedded in the way services operate, government will need to offer leadership by:

• establishing standards for transactional services, such as protocols for sharing information;
• incentivising multiple providers to join up in different configurations for different groups in the population;
• ensuring that professional boundaries do not undermine the greater use of lead professionals; and
• joining up funding streams.

32. But more importantly than any of these, government needs to ensure citizens have the control necessary to ensure that services work with them to meet their needs.