Launched in 2009, the UK Government's Total Place policy is a valuable model of local multi-agency collaboration in an attempt to provide better public services for lower costs. Elizabeth Roe looks back at the policy and the lessons we can learn.
What is Total Place?
In the turbulent aftermath of the 2008 banking crisis, the Labour government at the time launched Total Place, an initiative designed to transform local public service delivery. The national Total Place programme involved 13 pilot areas and aimed to understand how places could provide better, lower-cost public services by eliminating the duplication of work and by breaking down silos among local government and its partners in the public, private and third sectors. Each of the thirteen pilot areas was led by local politicians and senior managers and chose its own focus based on local needs.
The design of Total Place encompassed three complementary strands: counting, culture, and citizen insight.
The counting strand involved deep dives to assess the baseline public service investment, both in individual places and on a national scale. It focused on mapping how much money was spent on what, and how effective that spending was in producing favourable outcomes.
The culture strand focused on identifying and rectifying the system’s cultural barriers that inhibited smooth communication and collaboration among multiagency partners.
The citizen insight strand collected feedback and insight from local communities to shape priorities and boost community engagement and empowerment.
In addition to joining up services, Total Place placed a heavy emphasis on early intervention services, such as early years work and support for former offenders. The aim was to avoid costly and reactive crisis-management spending by proactively investing upfront. Overall, the Secretary of State at the time, John Denham, predicted that a shift towards Total Place could save the UK up to £20bn within ten years.
What happened in pilot areas?
The map below shows the 13 Total Place pilots and their chosen areas of focus.
Map taken from www.leadershipcentre.org.uk
We can better understand how places adapted Total Place principles to fit local needs by looking at two of those pilot areas: Birmingham and Bradford.
Birmingham
The Total Place pilot has succeeded in rigorously testing how more collaborative, personalised and preventative public services can deliver more for less: better supporting key outcomes for Birmingham people, whilst requiring less funding for the public sector.
Representative from Birmingham Total Place pilot
Birmingham’s Total Place pilot’s focus was on early intervention, drugs and alcohol, mental health, learning disability and gangs. Birmingham City Council teamed up with a raft of local partners including NHS Trusts, JobCentre Plus, the Police and Fire Service, housing agencies, Chamber of Commerce, probation services, West Midlands' regional development agency, and community organisations. The pilot looked at how personalisation and coproduction could improve services for learning disabilities and mental health. It also sought to redesign support for individuals during substance addiction recovery, as well as work with families to reduce the likelihood of children becoming engaged in gangs.
As part of the pilot, Birmingham explored a number of “invest to save” programmes, including the Brighter Futures Triple P programme, a public health-focused programme designed to improve children’s behaviour and mental health by teaching parents parenting strategies. Birmingham estimated that £2m investment in this programme over the course of 15 years would reap between £62m and £97m in cashable benefits for the council alone. These savings would come from reductions in youth offending, social exclusion, and the numbers of people requiring intervention and services over time.
Bradford
By looking at service provision through the eyes of the service user rather than our own individual organisations, we have recognised the tremendous potential to simplify, streamline, make a more relevant and focused impact… by adopting the culture of people and place rather than organisation and/or department at a central and local level, we can significantly change the way public services are accessed and delivered.
Representative from Bradford Total Place pilot
Bradford’s theme was 'Gateway to Integrated Services', with focus on supporting ex-prisoners, older adults leaving hospitals/care, and young people transitioning from the care system. Spearheaded by the council, it was run by the 'Bradford District Partnership Board', a multiagency group with representatives from across the city's public, private and third sector. Partners worked to further develop their “Tell Us Once” approach, which upscaled information-sharing across public sector partners to spare service users from the burden of repeatedly reexplaining their circumstances to different people throughout the system.
Bradford sought to provide those transitioning out of hospitals, the social care system and prison with a single point of contact to provide support in finding stable housing and work. During the pilot, Bradford estimated that an investment of c.£1.2m in improving post-discharge support at home, crisis support, and care homes and liaison psychiatry funding would reduce hospital readmissions by 25% and decrease discharges directly into long-term residential care by 50%, producing nearly £2m in savings. Furthermore, by investing £270,000 in hiring six supervisory offender managers and streamlining support, its was estimated that services could save £4.1m in reduced reoffending among adults who had served sentences less than a year. These cost-benefit analyses were essential to show that high-quality public services could be delivered for less.
Three lessons from Total Place
Based on the Government’s Total Place final report, the “Practitioners’ Guide to Doing Things Differently” (a Total Place “how-to” guide co-authored by all pilot areas), and the remaining publicly available reports published by pilot areas, we can gather three lessons to inform today’s debates about public service reform. All three lessons underscore the principle that place-based leadership needs to be a shared endeavour.
1. The accountability structures of Total Place forced areas to understand a place’s services and financial flows.
The Total Place pilot provided places with the structure and accountability to investigate and truly understand public services and how they work, how a place’s money is being spent, and how to foster better cross-system collaboration.
A key aspect of understanding a place comes from Total Place’s required citizen insight strand. By capturing service user input, stakeholders in pilot areas received valuable information about how public services work – or don’t work – for the average resident. With this knowledge, many pilot areas crafted powerful storytelling pieces and customer journey mapping exercises. These methods of presenting service users’ experiences helped to establish common ground and motivate change among stakeholders across the system.
Based on the information collected through the citizen insight strand, it became clear that to the average resident, public services are fragmented, impersonal, and difficult to navigate. Total Place initiatives uncovered the complexity of accessing public services, with users often finding it difficult to navigate multiple programs and funding sources. For example, in Lewisham, over 120 programs from 15 different funding sources were available to support workless and unemployed individuals. This decentralised approach makes it challenging for service users to know where to seek assistance and ultimately discourages people from taking advantage of available resources. Simplifying and streamlining services could enhance accessibility for all.
In addition, the structure of the Total Place pilot program provided built-in accountability for cross-system collaboration and service improvement efforts. While lip service to collaboration is easy, the pilot’s strict deadlines, reporting requirements, and conditional funding held places to a high standard of delivering and evidencing such system transformation. After the pilot, a Warwickshire County Council representative reflected on the strength of the cross-system partnerships developed: “The relationships between the three councils are now better than ever. Our discussions are open, honest, and often challenging. We have achieved an air of mutual support and camaraderie that you would want to bottle.”
Furthermore, the Government-imposed timetable made it easier to maintain momentum, particularly amidst adversity. As such, a key learning point identified by the pilot areas was that, in the absence of an official Government pilot, cross-system commitment and accountability can be better fostered when deadlines are linked to meaningful events, such as budgets or corporate plans.
2. Cross-system collaboration demands buy-in at all strategic and operational levels to thrive.
The pilot areas’ co-authored report cited a common pitfall as neglecting to anticipate how challenging and different Total Place principles are compared to business-as-usual. Without dedicated time and concerted efforts to change system cultures and processes, Total Place will not succeed. As such, the areas identified the critical need for buy-in from partners across both strategic and operational hierarchies.
For instance, executive leadership commitment to Total Place is essential, but it must permeate and filter down through all levels of the system for meaningful change to occur. It is imperative to obtain engagement and input from individuals such as directors and heads of service, who will likely be ultimately responsible for implementing changes on the ground.
Likewise, even if lower- or mid-ranking stakeholders are engaged in Total Place, the absence of executive-level involvement can hinder strategic oversight and create massive barriers to the programme’s successful progress. Upper-level leadership needs to get involved early, openly express enthusiasm for the programme, and work to bring their respective agencies on board with the initiative.
To facilitate inter-agency partnerships, senior leaders from all sectors must form “professional friendships,” which can be developed via workshops, trainings, and community-based activity.
Finally, to further enhance a pilot area’s chances of success, places should involve a “Whitehall champion” who is willing to co-create and support a place’s objectives and correspondence with the Government.
Ultimately, Total Place can only be as strong as the relationships and buy-in among agencies and individuals throughout a system.
3. Preventative services can only function in the context of strong collaboration.
Total Place initiatives highlighted the potential cost savings associated with early intervention and preventative measures. For example, Bournemouth, Poole and Dorset’s estimates suggested that they could reduce hospital admissions by 15% and save £12m by shifting resources away from acute care and towards greater support for older people at home. By prioritising prevention, public services can not only improve outcomes for individuals but also achieve significant cost efficiencies.
Yet, such success can only be realised when cross-system partnerships function properly, leading to mutual motivation and investment to reach shared goals. For example, Birmingham estimated that every £1 of city council investment in early intervention for children and families would translate to £10 saved in the city. Yet, because only a quarter of the money saved would accrue to the council itself, the council is disincentivised from making such investments. The unfortunate result is that such positive, evidence-based interventions often slip through the cracks.
It follows, then, that something needs to change: stakeholders and agencies throughout the system must feel better incentivised to deliver meaningful preventative public services. This can only happen if agencies throughout the system transition to seeing the entire place as a team, where successes and failures are shared among all agencies, resolve their current silo-based working systems and disparate funding streams, and improve their communication with each other about the shared benefits that an initiative may offer to the place and its people. Only then will partners be incentivised to work together to deliver well-functioning public services that mutually benefit both residents and agencies across the system.
Looking Ahead
Over a decade has passed since Total Place ended and, although we have seen marked progress in place-based leadership, the principles still feel relevant. Looking forward, particularly in the context of an upcoming election and constraints on public service budgets, the lessons learned from Total Place may be able to inform decision-making to enhance service delivery in the future.
To read a related article "Could a return of 2009’s Total Place policy be part of the solution to public services’ challenges in 2024?" click here.
To read more about MV's work in place leadership click here.
Note: This article was written based on information available online about Total Place. Only a limited number of documents on the original pilots remain and there is little accesible information on the outcomes or progress of places over time.