Item 4 on the agenda forms part of the committee’s work on prevention.
I welcome Peter McColl of Nesta and Malcolm Beattie and Dr Colin Sullivan of the Northern Ireland public sector innovation lab.
I intend to allow about 60 minutes for the session, starting with opening statements from each organisation.
Good morning, and thank you for the invitation to come to speak to the committee.
I am happy to lead from the Northern Ireland perspective. My colleague Peter McColl will then cover the work that he does.
The Northern Ireland public sector innovation lab started in 2013 as part of an initiative that Simon Hamilton, the Minister of Finance and Personnel at the time, launched on public sector reform. The drivers were the resource pressures that we faced and increasing demand.
We have taken a three-pronged approach to public sector reform in Northern Ireland; we have looked at it from the strategic point of view, from the perspective of operational delivery and from the point of view of improving engagement. The lab was one of the tools that we developed: it ticks all three boxes. The committee will be aware that a number of such teams and innovation labs have been springing up around the world. There are now over a hundred of them.
For Northern Ireland, the minister specifically commissioned the innovation lab to deploy new ways of addressing complex public service issues. Our remit is to help to improve public services. We are a regional lab—the only one within Government in Northern Ireland, funded by central Government and housed within the finance department, at present. We provide support across central Government but we are also keen to work across the wider public sector and with local government.
To date, we have tackled a range of different topics, both at strategic level and at operational delivery level. We have looked, for example, at dementia services, at business rates, at how our voluntary and community sector can prosper, at internal issues such as data analytics within Government and reward and recognition of staff.
There are three main methods to the operating model that we have deployed. The first method draws on the approach of the Helsinki design lab: that approach is often called hothousing. It involves bringing people together for a number of days and using them in a concentrated effort to examine a subject in depth and to generate ideas and solutions. We used that approach when we looked at regulatory impact assessments and our big data strategy.
The second method places greater emphasis on co-design and human-centred design and involves the development of solutions that could be prototyped and tested with users and citizens. We used that approach when we looked at dementia.
We are also looking at behavioural insights, which are sometimes called nudge approaches. That has been inspired by the work of the UK behavioural insights team. We are beginning a number of such activities, at present.
In crafting our approach to public sector reform, we have looked at different approaches across the different jurisdictions in these islands and beyond, including the approaches that have been adopted in Scotland previously, such as the work of the Christie commission.
We welcome the opportunity to participate today.
I bring apologies from my colleague Simon Brindle, the director of the Y Lab. I think that is how it is pronounced: there is a common accent at this end of the table and I do not think that any of us speak Welsh. Y Lab means “the lab” in Welsh and is a programme delivered by Nesta, the Welsh Government and Cardiff University, as a government innovation lab. I will talk a bit about that and will also talk about the wider principles of government innovation and why a government innovation lab is a strong way to adopt a more preventative approach in public services.
Nesta recognises and is excited by the work that has been done in Scotland around the Christie commission and the prevention agenda. We are keen to bring to that some of what we have learned about bringing together Government and external agencies to deliver on social and broader forms of innovation through an experimental and social innovation approach.
The lab approach is common in Governments around the world and it is growing. I think that there are around 200 Government innovation labs—
The number has grown by 100 in the past five minutes.
There is a good question to be asked about what a Government innovation lab is. We think that there are about 200, but there are obviously issues to do with the definition.
Substantial opportunities are available from the labs. By bringing together practitioners and people who want to innovate, and by taking an experimental approach to Government policy without necessarily being drawn in by the monolith that is the randomised controlled trial, Government can effectively change how it works and can innovate and enable change.
We are very keen for there to be greater understanding of the value of risk. For understandable reasons, Governments can be risk averse, so we want to find ways of building more risky approaches into the delivery of public policy.
If we look specifically at the opportunities in Scotland, it appears to us that the creation of integration joint boards in the context of health and social care will create an enormous opportunity for experimentation, evaluation and rapid profiling of public services, and that spreading what is learned from that throughout health and social care and broader public services will have considerable value, in general and in delivering a preventative agenda.
I invite members’ questions on anything that I have said.
Thank you both for your interesting opening remarks. I will ask a few questions before opening out the session to other members.
Dr Sullivan talked about the lab that has been set up in Northern Ireland to consider how to alleviate pressures on the public sector. What has been delivered in practice in Northern Ireland as a direct result of the lab’s work?
We have completed 15 labs. We started in April 2014 and have worked with seven of our 12 Government departments. We are based in the finance department, and currently there is a team of eight staff in the lab. In many ways we are facilitating a process; we set up the infrastructure for the lab and we encourage colleagues to bring to the lab their thorny, difficult issues. Initially we were, perhaps, more embracing of topics, because we did not have a portfolio to work to, but we have now developed criteria that we apply when choosing whether the lab is the best place to progress an issue.
As I said, a number of different methodologies can be deployed. We have been asked about and responded to strategic and big issues including dementia, which has huge implications for public service delivery, as well as smaller issues, such as how we help citizens to respond in particular ways. For example, we looked at a change in the wording of letters in relation to the payment of court fines, and we helped our social security agency with a benefits uptake campaign, to encourage people to take up benefits to which they are entitled but which they are not taking advantage of. We have taken diverse approaches. As time has gone on, we have developed a body of knowledge about methodology.
What has the response been in the public sector? It is human nature for people not to want to be moved out of their comfort zone. If people have been delivering a service in a particular way for years and have come to believe—we hope rightly, but perhaps wrongly—that that is the best way to deliver the service, but then your lab looks at that and says that they would be more effective if they were to do things differently, how do they respond? Has the response been positive or negative? Has it been mixed?
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The response has been very mixed. It is important from the outset to get the right people in the lab. We are keen that we have a committed sponsor department that wants us to explore. As we have developed our work, we have seen the importance of getting the sponsor to sign up to the importance of our taking away a group of staff with “experts”—in inverted commas. The officials concerned may not be open to the experts’ ideas, but they must be prepared to look around the issue and to take away their thoughts. We take the staff away from their work setting; sometimes, the work is done in a residential setting and sometimes it is done on a 9-to-5 basis. We give staff the freedom to think outside the box.
With that approach, the sponsor department takes a risk that it might not get the answer that it wants and that issues may be raised that it had not thought of. In order to be truly a lab, we must not only come up with the idea; we must test it, prototype it and take it to the next stage.
Malcolm Beattie will be able to give you more practical examples.
I cannot overemphasise the importance of having a fully engaged sponsor. Our work is not something that we do to people or to organisations; rather, they must buy in from the start. The big lesson that we have learned from our experience of trying to open doors is that we just have to accept that we are not getting in so we have to leave it. As Colin Sullivan suggested, it is about involving in the whole process the people who own the problem and who administer the particular service, so that it is not about something being done to them. Instead, they are front and centre in designing the new interventions and they work collaboratively with the people whom we bring to the process.
It is interesting that, when you corral together the right mix of people and expertise, attitudes change. Sometimes, resistance filters away when people begin to hear that there is a bigger world and that there are different and smarter ways of doing something. That process has been a big help to us in introducing some proposals. Involving the end user in the innovation lab is critical to that success.
We did work on dementia, during which we located ourselves in a residential home that had been specifically built for folks with dementia and their families. People with dementia and their families participated in the events, and the people who deliver services heard the lived experiences of people who were contending with dementia and their families. That richness and experience change views and attitudes. By those means, it is possible to work to a point at which we help the problem owner to find a solution, or we make recommendations that we want—as Colin Sullivan said—to trial and to prototype.
You want to find a solution that everyone has bought into so that when that solution is deployed you do not meet too much resistance or too many barriers. That is the theory that we try to deploy in the innovation lab.
That is interesting. The public sector’s holy grail is improved outcomes with savings. Have you been able to achieve that to any significant degree?
Our objective is to get away from the hothousing that we mentioned. That approach comes from Helsinki and tends to look at strategic issues. The experts provide perhaps six or seven big recommendations—that is where they leave you. People must then take the recommendations and turn them into operational reality.
In our operating model, we now focus more on the design of small measurable interventions. We would need to see some of the projects pull right through the process, so I cannot give an example to the committee today of where we have saved so many millions of pounds.
We are trying to get to solutions that have been designed by service users and service delivery people that we can test in small areas and morph in the live environment before we get to point of implementing them more widely.
My view at the moment is that we need to see the innovation lab not as a holy grail or magic bullet, and that is what I say to sponsors when I meet them. We do not have the answers, and it is not going to revolutionise the world overnight. It is about taking a measured, structured approach, bringing people with you and the best minds being applied with a view to delivering tangible benefits at the end of the process.
That is important. We are not talking about savings on their own; people are looking for savings with enhanced outcomes. It is relatively easy to make savings, although it is painful for people at the sharp end. The challenge is in trying to persuade people that they can deliver more for less. That is often talked about, but the proof of the pudding is what we are looking for.
Page 4 of the Nesta report states:
“We need to move to a position where prevention is about catalysing social innovation to help people”,
which you talked about in your introductory statement. You continue:
“Some of this needs to harness developments in technology, but much of it can be done on the basis of community action and supporting those with the best ideas.”
How can that be delivered in practice, and how is it being delivered?
There are huge opportunities. Scotland is extremely well placed because of its existing health data, which is world leading. The potential addition to that of social care data, and some of the really interesting things that are coming out of the Scottish Government at the moment about identifying individuals who are users of public services and identifying their care journeys, could unlock for us ways to intervene earlier and more effectively in order to ensure that those people have a better journey through care and the health service. That means using things like predictive analytics to identify who is likely to be using health services so that we can put in place the adaptations, structures or support to either ensure that they end up not needing the health service—we put the adaptations in their homes so that they do not fall over and break their hip—or find ways in which to manage their journey.
When we cannot prevent a condition such as dementia, for example, identifying care plans early and co-producing with the individual their journey through the care system or finding ways in which we can empower the individual will, I think—the data will give us the opportunity to analyse this—reduce the overall cost. It would give us the optimal outcome of ensuring a better outcome for the individual while also reducing the overall cost to the NHS and social care.
Malcolm Beattie is nodding vigorously at that. Clearly, there is similarity in your approaches.
I am sorry, Mr McColl. Did you want to say something else?
I will deal with the second part of the question, as well. We know that there are a lot of programmes, projects and community groups out there that want to deal with the pressing problems of our age. However, they quite often come up against institutional barriers or find that funding is short term and does not support them to deliver appropriately. We need to develop rigorous models so that we can identify what is successful and replicate it elsewhere, and so that we can identify the financial models associated with that. That would enable a third sector organisation that was delivering a very effective community service to identify the savings through the system so that we would know what we should protect. Often, when it is time to get tough, organisations that are external to local government are the first to be cut, despite the fact that they may be delivering more effectively than some other services. We need to understand exactly what an organisation is delivering, and we need to be able to assess that. That is an important element of the process. It requires some externality and much more rigorous use of data.
Thank you for that.
In your report, you talk about adding
“a new dimension to healthcare by creating networks of volunteers and non-clinical professionals that support people to take control of their health maintain healthy behaviours and stay on top of their health conditions on a day-to-day basis.”
I am a wee bit unsure about that. How sustainable is that? It sounds like the kind of thing that you might to be able to do here and there, but how sustainable is something like that on an all-Scotland, all-Wales or all-Northern Ireland basis? Is it practical to seriously consider relying on volunteers? Most people would consider health to be beyond that and would believe that most of it should be delivered not only through individual responsibility but by a very strong, professional health service with volunteers as an add-on rather than the mainstay. Can you talk us through your thinking on that issue?
After this, I will ask one more question and then open up the discussion to colleagues around the table.
I absolutely agree—and Nesta would absolutely agree—that we must have a strong, professional health service; what we are talking about is the additionality that can be delivered through volunteering. We can deliver something that is worthwhile for the individuals concerned—the volunteers—that adds real value to public services and which helps the users of public services.
There are all sorts of examples of that; indeed, I will give you a practical example. In a previous job, I worked with former nurses who had retired but who wanted to stay in a health setting. They would go into hospitals to accompany people while they ate their meals, and it was found that that increased patients’ hydration and nutrition, which helped with discharge. It was fulfilling for the retired health professionals, reduced costs in the system and improved the quality of the service that was being provided.
Of course, such a service is not free, and it is not something that can be done purely through voluntary action; we need to put in place structures to support it. Nevertheless, volunteering is in itself health promoting and, if we can introduce it into the health system—which we all know needs as much help as it can get—in addition to the excellent professional services that we already provide, we can begin to improve outcomes while, as you say, reducing some of the costs.
My next question is again directed at Mr McColl, but I would also like the other witnesses to respond. On page 6 of your report, you conclude:
“There are huge opportunities to transform our public services”,
and you say that by
“adopting a rapid prototyping approach we can begin to make prevention a reality.”
I think that we would agree with that. However, I wonder about scaling and mainstreaming. It is wonderful to have lots of innovative approaches, but how can we make that the mainstream rather than something around the edges? That is key to the entire issue. If you could respond to that, Mr McColl, I will then ask Dr Sullivan or Mr Beattie to respond.
One of the observations of the change fund process has been that, although a lot of good things were done and although the fund delivered very effectively right across Scotland, at times effective things that were happening in one place were not being transferred to another. We need to find a way to take the things that work in one place and allow them to be delivered in others.
In order to do that, you would bring together practitioners from across Scotland—indeed, from across public services, as things that work in public health might also work in criminal justice or education. One way of doing that would be to have a lab with practitioners coming together to discuss common problems and how the solutions that they tried either worked or did not work. If we could back that with good, robust data, we could begin to get the experience and learning from particular areas and apply it more generally. At the moment, that structure is not being delivered through the processes that we have, but it could be delivered through those processes quite easily.
In the 100-day change programme that we have in the NHS in Essex, we get management buy-in to bring a lot of front-line practitioners together to identify and solve problems. On some occasions, the interesting thing about that programme is not so much the solution that is reached as the fact that professionals on the front line in different areas of public service come together and develop strong working relationships, which allows them to deliver more effectively on solving problems. That focus on problem solving and solutions builds relationships that can help with integration.
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The fact that best practice has never been adopted across the whole country, even in a country such as Scotland with a population of 5 million, is frustrating for many people.
I would make a number of observations about that. You have highlighted one of the key difficulties, which is that good ideas do not necessarily translate quickly into the system. I think that the lab could come up with good ideas but with the ideas that stick, you need to evaluate them and compare the old with the new. You could have randomised control trials, say, or you could have just a straightforward evaluation to indicate whether the new world that you are predicting, prototyping and testing is better than the old one. That is not just a matter of getting evidence; it is also about hearts and minds, and getting sponsors in the room as part of the co-design exercise is also absolutely key.
Of course, other impediments to rolling out and mainstreaming are finance and releasing finance from existing services to use in what will be your new services. I can give you an example that involved new finance that was allocated through a relatively straightforward process. We had a change fund, which was on a smaller scale than Scotland’s, through which we encouraged bids for ideas. Those ideas had to meet certain criteria: they had to be cross-cutting and preventative, and they had to offer a new approach. One department in Northern Ireland put together a project targeted at improving good relations for youth between 16 and 24 years old, with a focus on employability. It was a new approach that had not been adopted before; we funded it through the change fund, which was managed by the finance department, and fortunately we were also able to access European funds to roll it out. We had the benefit of separate finance that was not tied up in anything else, and that enabled us to facilitate the roll-out of the project.
Of course, things become difficult when you have to take numbers out of existing services. In order to turn these things into reality, you have to get the hearts and minds of those who are already in the services.
I will complement or supplement what has been said by emphasising that, as far as our approach to the lab is concerned, it is all about the sponsor’s views and ambitions. We might develop a prototype and prove that it works, but the sponsor needs to have the legs or finance to take it forward.
Our aim, which we have borrowed from our Nesta colleagues, is always to make a systematic change, but you have to start small, get proven prototypes and then begin to make the case. After that, you have to answer all the questions about funding. It is all about achieving something tangible, measurable and sellable that you can grow from there.
Thank you for that.
I will now open up the session to questions from colleagues. The first to ask questions will be Mark McDonald, to be followed by Jean Urquhart.
I listened to the description of how the lab operates and the point about testing ideas before they are rolled out. What kind of time period is there between people coming into the lab to discuss how to do things differently and your having something that is sellable as a policy on a wider scale?
Our work on behavioural insights is a sort of microcosm of what you are asking about. From beginning to end, we can look at a particular problem that a Government department faces and set up a trial within three or four weeks. In that time, we will have analysed the problem, come to an understanding of the sort of intervention required, designed the intervention and agreed with the department that it needs to trial the intervention over a short period of time with a group of customers or service users. By the end of that process, we can very rapidly begin to see whether the small intervention that has been designed actually works. Obviously, if the problem is more complex—or if we are talking about one of the wicked issues—it can take a lot longer than that.
Once you really understand the problem and have a design, you can go from there. The idea of rapid prototyping adds value and if you have a sponsor that is able to open doors and which allows you to test these things in the real world, you quickly begin to see the relative merits of various ways of doing things, get something that works and begin the process of rolling that out.
I am interested in hearing about who gets brought into the initial discussion. A number of us around the table have previous local government experience. When I was a councillor, some of the best ideas for changing the way in which things worked came from those working on the front line. How involved are they in the discussions? Although it is great to have strategic directors and heads of service in the room, the best innovation can sometimes be suggested by those on the front line who are living with the situation every day and might well have been thinking about how to fulfil their roles in different ways that could themselves make a difference.
You are absolutely spot on. Getting the right people in the room—the people who know the situation and who are dealing with it every day—is key to resolving some of the practical issues.
When we looked at the structure of the Helsinki design lab—typically, it brought together a group of eight to 10 international experts, 80 per cent of whom were external to Finland—we thought that it was very expensive and that there was no local ownership. Instead, we decided that it was better to turn the equation around and have only a small number of external experts from outside the jurisdiction; most of the people would be from Northern Ireland, working in the setting and dealing with particular problems. Having the right professionals is key. It is important to have external scrutiny and challenge in the lab—it should not be totally made up of local people—but the balance needs to be more local than international.
As for the timelines, they depend on the scale of the issue. During the initial research, it is important to take the time to ensure that you are asking the right question and to get the right people in the lab. The lab itself might run over a week, but the whole exercise could run for four to six months.
Mr McColl, you have highlighted the importance of the change fund for health and social care. From my local experience in Aberdeen, I am aware of a number of projects that have been funded through the change fund. Some have been successful and some less successful, but that is always going to be the case when people are doing something different or innovative. I expected that, after the change fund moneys ran out, people would look at mainstreaming any new successful way of working that had been developed, but that did not seem to happen. In a number of areas, a short-term project was discontinued instead of any serious attempt being made to mainstream what had worked. Indeed, I think that the convener has made that point already. How do you break that mindset?
That is related to an answer that I was thinking of giving to your previous question. It is all about permission. We find that the solutions often come from the front line, sometimes from outside the public services and very often from the users of public services. We need the permission of senior management to allow those solutions to develop, but often that permission is not forthcoming. We need that to change.
Moreover, one of the things about the change fund is that successful projects were either self-evaluated—they were evaluated by the organisations themselves, sometimes very well—or they were not terribly well evaluated and the evaluation was not very robust. Therefore, if a project was not going to continue, little learning could be taken from it. In the move to integration joint boards, it will be important to create robust data mechanisms and research mechanisms so that we can conduct appropriate and on-going evaluation of what works and what does not work. Then, even if a project does not get funded—in some cases, it might not—we can take the learning from it and use it elsewhere. That is one of the absolutely critical things that need to emerge from the process, and it should be at the heart of that process if we are to do prevention properly.
For a long time now, I have had the opinion that the biggest barrier to prevention is our electoral cycle. There is an election coming up this year and there will be another election next year, and it is very difficult to get a consensual approach to changing the way in which things are done, because there will always be a temptation to say, “Vote for me and things will never need to change” instead of selling the message that we need to change things to derive a longer-term benefit. How can we get beyond that? How can we break out of that and ensure that we get wider buy-in to the idea of a preventative approach that might require radical changes to take place in the short term that will nevertheless pay off in the longer term?
It is important to have robust data and evaluation. I will give you an example of something that we did in the 100-day challenge. If a frail elderly person appeared at the front door of an accident and emergency department, they were refused admission, unless they had an identifiable problem that could be fixed in hospital. Such a policy sounds as though it would be unpopular, and I imagine that, if you were to take it to the electorate, it would be unpopular. However, we know that the second greatest cause of admission among frail elderly people, after falls, is their having a turn or an unidentified medical episode. Very often, that sort of thing is helped not by a stay in hospital but by a referral to social services and a change in the person’s care plan. Nevertheless, we tend to admit the person to hospital, which has low political risk but generally has a higher risk for the individual. If, through rapid prototyping and actual experimentation, we create the evidence to show that the policy of refusing admission is good, not bad, for people, we can begin to build a consensus around it. That is how we can begin to answer that question, although I entirely understand the difficulties involved.
Does Dr Sullivan or Mr Beattie have anything to add?
I concur that you need evidence to drive those political decisions, which can be difficult if there is a short political cycle.
I guess that the issue, initially, is getting people to buy into the need to gather that evidence before we can sell the change.
My final question relates to the convener’s point about best practice being a bad traveller. No nation is monolithic from top to bottom; there are variations between rural communities and urban communities and between communities of poverty and communities of plenty. How robust is it to say that an example of best practice from a well-off community is going to translate well to a deprived community, or vice versa? Similarly, there are different pressures in urban and rural communities and different considerations when it comes to service delivery. How robust is it to say that you can translate best practice? Does there need to be more variation in the way that you look at things?
It depends on the topic, because it depends on whether rurality or poverty is the key issue. With service delivery, the response required in a city could certainly be different from that which would be required in a rural community, and the lab might need to look at different ways of delivering in those two settings. However, I would not have thought that people’s behaviour on getting a letter about a court fine would be linked to the rurality issue; it would just not be relevant in that case. The answer is that it depends on the circumstances.
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Your question is one that we need to answer and, indeed, which needs to be answered for each programme. I think that the answer is for us to be more robust in our analysis and to identify what the differences and problems might be.
We can now collect and analyse data in a way that we have never been able to previously. However, I am anxious that, for all of the reasons that you have described, the Government is not going to do that analysis and that Tesco will be the one able to tell you about your impending chronic health condition—although you will not know that. It has the data analytics about what you buy that will allow that to be identified.
That is a real prospect. There is an opportunity for the country that gets data protection, data security and the person-centred nature of data right to be a world leader in data analysis. We could be talking about a new Scottish enlightenment with regard to data, and I think that we need to embrace that idea. It seems to me that some ways of embracing that are risk laden, so we need to find ways that are not. For me, it is important that we begin to use the ability to analyse what is happening to determine whether rurality or poverty is a factor in that respect.
That is why I do not have a Clubcard—Tesco is never going to know anything about me.
That is what you think.
I will follow on from Mark McDonald’s point about good ideas not travelling. The Finnish lab sounds very exciting and has clearly been inspirational. Do you try to incorporate pointers from its experience into the work of Nesta and the work in Northern Ireland?
The Finnish lab was very helpful. I should say that it is now disbanded—not because it was not a good idea but because the people involved wanted to do other things with their lives. They saw the lab as something that stimulated ideas, and we certainly learned a lot from it. Marco Steinberg, one of the key participants in the lab, is on a ministerial advisory council for my minister. The council helps to advise us on structure, ideas and guidance on structuring the lab. The Finnish lab has been a very important part of that.
When you look at lab methodology, you come to the conclusion that there are different ways to skin a cat and, with that in mind, we have looked at various methodologies. We have links with labs in France. The SILK lab—the social innovation lab in Kent—has also been very helpful to us. Some of the labs are specific to a particular area of business. There are labs that work on transportation, and there are labs in New York that are concerned with local government and other specific issues, such as education. We have drawn from a lot of different areas, but the Helsinki design lab and the MINDLab in Copenhagen have been some of our main sources of inspiration.
Do you look for solutions within the lab, or do people come to you with solutions? Do people come with problems and ideas? Is the lab generally known about in your respective areas? Do you have links with researchers at universities and so on who can introduce ideas? Would the local health service use your service? Would anybody approach you to find the solution to a situation?
We have had a lot of approaches from across the public sector in Northern Ireland. People come in with assumptions about what we are and what we do, and we have to show them that they have the wrong perception of what we are and what we do.
Each innovation lab tends to reach out to academia. As Dr Sullivan said, we aim to have an academic expert in each lab, along with a practitioner from another jurisdiction who has had big success in solving a particular problem that the lab is seeking to address. They come into the group with us as a moderating point. They can talk about international research or the richness of their lived experiences.
To try to answer your question more precisely, we tend to have conversations with, for example, Belfast City Council. We go out and introduce ourselves and spread knowledge about what we try to do. We tend to have problems presented to us. The people who own those problems may have a very fixed view of exactly what their problem is and, as Dr Sullivan said, we spend a lot of time unpicking that. Sometimes we find that the problem is quite different from what they thought that it was. They also tend to come with some ideas about what the solutions will be. Part of the purpose of the innovation lab is to take a step back from that and to help the problem owner or sponsor to understand the problem that they are handling. We then work with them to get recommendations or prototypes that we can trial.
The approach that Nesta took with Y Lab was to partner with the Welsh Government and Cardiff University. Some of the people from those organisations sit around the table, and they know the contacts of other relevant people in academia and the Government. I think that the experience elsewhere is right. It tends to be that people come with problems, because that is the nature of this sort of thing. Our innovation lab, which is part of the organisation, tends to offer solutions that people subsequently pick up. The experience that I have is of people picking up how-to guides and other pieces of literature, and using those to do things that are similar to what has been done through the Nesta innovation lab.
I think that you mentioned that there were 15 labs in 2014. If you were to give a presentation, what would you use as an example of the most interesting or successful lab? What made that one the most successful? What was the magic formula?
They are all very different.
I have two examples. I never answer with one.
The piece that we did on dementia was exceptionally rich. It really got to grips with a specific problem, and the people suffering from dementia were involved in the work. It was a seminal experience for me—a public servant of 35 years—to hear what it is like to live with some of the problems that public servants attempt to solve. I am sorry that a lot of this is personal, but I learned a big lesson through that work. In my experience in the public sector, we always tend to think that we know the answers. We design, build, deliver and implement solutions for lives that we do not live and, very often, we have no perception of what it is like to live in those worlds. For me, that was the richness of that particular event.
The other piece was the one that we did on data analytics. I will echo what Peter McColl said about the fact that citizens in our jurisdictions are used to services in the private sector that are tailored to individuals. In contrast to that, the public sector is continually wedded to the notion that one solution will fit everybody. The richness of data analytics is that it gives you the ability to tailor solutions to meet individual circumstances. From that lab, I learned that it is vital that the public sector really gets to grips with data science and with what predictive analytics can do to shape services to meet individual needs.
Those are the two big things that we learned in those two labs.
Finally, you mentioned a change fund, and I believe that you also gave an example of something that had been put in place but which had been weakened when the funding came to an end. Do you find that a challenge from the very beginning of a piece of work? There might be funding to find solutions to things, but how do you bed that work in? The issue is not necessarily the funding itself but how it all works thereafter.
The change fund in Northern Ireland lasted just a year—there is another fund in this year’s budget—and it was a relatively small sum of £30 million. It was allocated on a competitive basis; in other words, we asked departments to come up with good ideas and make bids against certain criteria. We were oversubscribed five times over, which means that we could have spent £150 million but, in the end, the money supported 19 projects. However, the funding was given on the basis that it would be used for a year’s trial, the people involved had to demonstrate that the idea worked and they then had to go back to the core department to look for a change in how, in light of the evidence, resources that had already been voted to that department would be utilised.
I have already talked about the expansion of a good relations youth programme that targeted those who were finding it difficult to get into employment and who were facing challenges with regard to community difference issues in Northern Ireland. We were able to access European funding to expand that programme so that it had more possibilities and helped more people. However, with these labs and the resulting prototypes, we very rapidly get into big decisions about questions such as, “Does this actually work?” and, “If so, what are we going to do about it?” After all, there is no new funding; the normal procedure is to go back and use what you have in a different way.
The experience that we would like to create is one in which you can make a very strong case for shifting resources into something that is effective. All too often, we have programmes that do good work but, as Mr McDonald has made clear, we move on from them without mainstreaming them or moving them to a position where they are delivered on an on-going basis. A lot of that has to do with the case that is made for such programmes and the way in which they are delivered, and that is where we need to do things much better and where, I think, there are real opportunities.
Thank you.
I have a couple of questions. First of all, this is about the scaling up of projects. For example, I have been involved in projects that pulled data from the primary care and acute sectors into a predictive risk stratification model. As a result, projects get designed around putting in extra nurses to help loads of people, because it is meant to save so much money, but they run for only six months, after which there is an evaluation. Nothing moves forward, as Mark McDonald has said. There is always a balance to be struck between spending on the acute sector, where people are turning up right now, and trying to front-load. Most of us will agree with what you are saying, but how do you implement that in reality, when hospitals need the money now? How do you front-load funding to ensure that you can provide, say, nurses in the community? After all, not all of these services will be voluntary—you will need to pay for them. How do you make the case for bringing the money forward when budgets are constrained and, indeed, shrinking? Is there not going to be a double spend initially? How do you avoid that sort of thing?
It is really difficult to avoid double spending, but what we need to do is to identify the problems where we think we can make very substantial savings, particularly in year or across a comprehensive spending review, because those tend to be the problems where, if you address them, you will have the greatest impact on the quality of the lives of the people who use the services. Generally speaking, the way in which you can most improve quality of life also happens to be the way in which you can save the most money, and that will allow you to free yourself up to invest more in preventative services and to shift the balance of care in the way that I think everyone is committed to.
12:00However, there is a real issue about having to double fund at times; indeed, given the current financial situation, that is going to be particularly difficult. We need to understand what works best and to identify how we can do it. With delayed discharge, for instance, getting better data through taking a real-time rather than a census approach would allow us to identify in a much more accurate way the causes of delayed discharge and to find a way of reducing it. Nobody agrees with delayed discharge, but the problem has been to identify and overcome the barriers. We now have the ability to use real-time data and to catalyse activity.
Please do not misunderstand me: I am suggesting not that we have lots of volunteer nurses but that where we can catalyse social action, we do so, because it adds a huge amount of quality to the process. That is something that we have not necessarily been good at in the past. It has to be additional to what exists, not a replacement for it.
With regard to big data, I remember that, in the work that I mentioned, we spent two years pulling data together and getting a good picture. When I took what we had produced to a general practitioner in Wigan and said, “Here are your high-risk people,” he just said, “Do we really need that? The fact is that these people are poor, and the real issue is poverty.” Obviously you want a parsimonious model and the key factors, but what is your big line for selling big data, other than saying that the underlying issue is poverty? What is the benefit of having big data instead of focusing on one key thing?
There are some problems for which I can suggest a solution using an innovation lab or innovation approach, but others are simply big social problems, and it is a category error to try to solve one by using the other.
I agree with you that if the problem is poverty, we need to solve poverty, but if we have to deal with that situation, we can take certain approaches that better identify where resources can be spent. That is the case that I am making today. I agree that we cannot end all the world’s problems with these approaches, but what we need to do is use our resources in a smarter way.
Big data can be used to help with the symptoms of poverty, to target resources at those who need the help the most and for educational and health support. It can be used to ensure that those in greatest need get the services that they need.
I would like to unpick a little more the dementia example that Mr Beattie has mentioned a couple of times. From what you have said, you—I cannot remember how you described yourself; you said that you were a civil servant or something similar—the end users and presumably some of the people in the middle such as carers and managers all got around the table or somewhere and talked to each other. Should that sort of thing not be happening anyway without having to get a lab involved?
That is a good question. My experience of the subject is that, when we convened that innovation lab and brought in consultant psychologists, psychiatrists, mental health nurses, occupational therapists and representatives from the voluntary sector—the Alzheimer’s Society and so on—they all came to the event very much in their chimneys, so to speak. They would say, “I’m X, I do this, and this is how we do it in our world.” However, when they all came together and started hearing the stories, the group gelled and began to say, “We need to address some of these problems.”
One of the things that became very clear in Northern Ireland—it might be the same here, but I cannot speak for Scotland—is that how a person with dementia is treated depends on where they are. Indeed, the term “postcode lottery” was used very frequently. In that case, the benefit of the innovation lab was that a group of disparate people with disparate views from different parts of the health sector, the voluntary sector and, indeed, academia corralled around the need to do something about the issue, the need for a regional model for dementia services and the need to support carers 24 hours a day so that they could access help and so on. There were various things that the group agreed needed to be done; we brought those ideas forward, and the NHS started to address some of them.
You might have thought that those conversations were already happening; perhaps they are, and perhaps, having had this experience, I am still speaking as a rank outsider to the health system, but there was a real recognition—I do not want to use the word “shock”—even among the professionals in the room that the current system was not really working and that the situation needed to be addressed and changed. That is my observation of what happened.
My suspicion is that the same is the case in Scotland and that, with certain issues such as dementia, a lot of people might be interested and committed to them but things are not joined up. Is that what the lab is best at? Is it best at bringing together people who do not normally come together?
If that is all we achieve in many cases, that still shows the richness of the approach. In the example that I have given, we had one overnight, and I had dinner with a number of clinical psychologists from different parts of Northern Ireland. Even though Northern Ireland is a small place, none of them had met before, and they began to tee up, they shared ideas and they agreed to meet. I see the innovation lab partly as a gathering point or a collaborative that pulls together people who have an interest in a particular subject and allows them to look at it in a collective way. However, you need the sponsor or decision maker behind it to ensure that the outputs are taken, tested and perhaps implemented.
I take it that, in the case that you have mentioned, there might be more than one implementer. There would be the statutory services and the voluntary sector, both of which would be able to implement things.
The approach that we tend to take in the innovation lab is that we go to the owning department—
Which would be the public sector.
Yes, the public sector and the health service—or, in our case, the Department for Health and Social Services. That is where we find our sponsor, because it ensures that the outputs from the innovation lab are sponsored by the most senior person who owns the policy area in question and that they can start to influence change in the health system.
Thank you.
Dr Sullivan, you have talked about the need to test as well as have ideas. What does that mean in practice?
That is the challenge for us. As our lab has evolved, it has proved to be very good at bringing people together; Malcolm Beattie has already given an example and, indeed, I have been involved in conversations in which people have said to each other, “We should have met before this.” It was the lab that brought them together.
However, if a lab is really going to do what a lab does—in other words, test things out—it should not just come up with recommendations, and some of our early work has involved getting the right people together, making sure that we are dealing with the right problem and then coming up with recommendations. With the memorandum of understanding that we are now developing with the sponsor, we will get permission to test things in the lab, which means that we will go and do something with the group. Of course, it all depends on the circumstances and whether the necessary legislation is in place, but the aim is that, when we hand things back to the sponsor, we give them not just recommendations as the endpoint of the lab but some albeit fairly small-scale and rough-and-ready pilots that can be responded to.
Can you say how that has worked in the dementia example or, if it has not worked so far, how it might work?
It would be about trialling different service provision with dementia sufferers.
Right.
For example, you might use the diagnosis process. In an experiment that is being carried out in Bristol, the diagnosis is not in all circumstances the preserve of a consultant; the people involved are trying to get GPs to do some of that work. The lab might say, “Let’s design a similar trial in Northern Ireland,” and you would go out to the system and say, “Look, we want to test this to see whether it has any value and at whether it speeds up the diagnosis process or helps get people the support that they need.” That is just an example of what we might do and how we might trial things.
Mr McColl, you gave a hospital example. Part of me believes that we should just close down hospitals and put the resources into the community, but there is some resistance to that.
Really?
Aye, there would be. [Laughter.]
You suggested that an elderly person who has had a turn or whatever could be turned away from accident and emergency. Part of me is attracted to that, but part of me says, “What if they have had a stroke or a urinary infection? Surely social services could not cope with that.” How do we get a balance?
The approach in such a case would be that social services would provide somebody to be with the person. If they had had a stroke, the care worker would identify that and have them admitted to hospital.
The reality of hospital care is that there are risks associated with it as well. We underplay those risks and we overplay the risks of care in the community, which you have identified. The approach that we need to take is one that is based on the evidence so that we can identify what would happen in a particular circumstance and the costs for the individual of admission to hospital. For example, how many individuals in hospital get dehydrated, have poor nutrition or pick up hospital-related infections? Admitting someone to hospital is not a guarantee that nothing will go wrong, any more than someone being sent home is a guarantee that things will go wrong.
So it is about a lack of information or, perhaps, understanding on the part of the public. I was interested in what you said in the conclusion to the Nesta written submission:
“By giving people and communities more power over decisions we can move public services to co-production, enhancing their ability to be preventative”.
However, my feeling is that the public want A and E, and hospitals. Is it just that the public do not understand?
I think that what the public want is a guarantee of good care and they see the NHS as a guarantee of good care. I think that in almost every case that is correct. The problem is that the NHS is often not the appropriate destination for an individual. We need to build the case that that is correct and to be able to say to people, “Admission to hospital is not always the best thing for you in every circumstance.”
We have moved from a culture in which people used to go into hospital for long stays to a culture of more day surgery and much shorter stays. We have built an understanding among the public that that is a better way of doing things and that, if they have major surgery, they do not go into hospital for two weeks but go for a much shorter period. That is the circumstance that we need to move to for the hospital admissions that we have been discussing, because people believing erroneously that hospitals are better for them is not good for anyone.
That is very helpful. Thank you.
Thank you very much. That concludes questions from the committee. I thank all our guests for an extremely interesting question and answer session, which has stimulated committee members’ thoughts. However, I would add that shutting down hospitals is not Scottish National Party policy.
Just before that press release goes out.
It has gone—too late.
If there are no further points from the witnesses, we will now go into private session.
12:14 Meeting continued in private until 12:39.