Our top ten councils for adult social care analysis was the cover story of the MJ five weeks ago, and despite being somewhat nervous beforehand, I've been really pleased with the response.
We were delighted when the LGA recently announced that six more local organisations have won grants to deliver behavioural science-based trials. In every single case, the winning proposals have demand-led change at their core, meaning that they focus on (a) reducing avoidable demand, and (b) increasing the effectiveness of prevention investments.
As we have shown over the past eight years, it is possible to achieve remarkable results by applying basic behavioural science in public services. Behavioural science is an umbrella term that encompasses psychology, neuroscience, sociology and behavioural economics, and in this context is about designing ways to ‘nudge’ citizens into making decisions that will be the most beneficial for them. IMPOWER has pioneered this area – firstly by establishing demand-led change as a real opportunity for councils, and secondly by harnessing the power of behavioural science to reduce demand at the front line of local services in a practical, no-nonsense way to get results.
On our journey, we have discovered that although behavioural science is finally breaking through into mainstream thinking, it isn’t enough by itself.
It is also clear that councils and health bodies still lack confidence in behavioural science. The fact that the LGA’s modest grants (£25,000) were massively oversubscribed gives you the sense that councils still don’t want to spend their own money on these projects. For now, this seed money from the LGA is critical to keep innovation going. But confidence will grow over time, and the grants should become unnecessary. When done properly, the business case for behavioural science practically writes itself.
In fact, the main challenge isn’t the lack of money. To generate big scale benefits, behavioural science needs to be used as part of a broad suite of tools applied to tackle complex system challenges.
By itself, nudging isn’t close to being enough to really deliver change. The real skill lies in blending tools and techniques from a wide variety of sources, including behavioural science.
For example, at the front line of adult social care, how a social worker greets a client, the order in which they ask questions, the questions they ask, the actual words they use, their body language, and their tone of voice all demonstrably affect the outcome and the cost of the service provided. All of these elements can be changed and informed by behavioural science.
However, the social worker can be let down almost immediately if the reablement worker isn’t also providing consistent messages; or if the person doing the financial assessment cares only about the form being filled in; or if the homecare service isn’t flexible enough, or the person sent in to do the review is having a bad day.
Delivering this consistency, day in and day out across a complex system, is a big ask. Behavioural science can inform some of the key tools – but it takes skilled people on the ground (deploying the emotional labour required over many months) to make it work at scale, case by case and council by council.
Smaller nudges such as reducing missed appointments, or increasing take up rates take care and discipline, but produce results and aren’t difficult to implement. There isn’t really any excuse for any local authority not implementing them.
But applying behavioural insights to adult social care and health, as part of a wider transformation programme, is where the real benefits start to kick in.