Managing Demand – a collaborative approach Dr Henry 20 Nov 2015, CIPFA Annual North East Conference

Context: why are we talking about managing demand?

The Groucho Marx challenge for public services

What do we mean by managing demand?

Before we go further…five inconvenient truths? 1.We can’t manage what we don’t understand! 2.Demand isn’t always bad… 1.Effective delivery is vital, but it needs to be collaborative 2.Nudging is not enough 3.Devo won’t stick without building readiness…

Types of demand - a ready reckoner Is demand rising as a result of public service failure or poor design? Is service demand arising from certain behaviours that could be changed? Is the state providing more than is needed, or inadvertently creating demand through dependency? Are there opportunities to provide services that are a better fit with what is actually needed by citizens? Are citizens accessing services they don’t strictly need? To what extent is demand arising from causes which could have been addressed earlier? To what extent is demand unintentionally reinforced by service dependence?

Excess Demand Is the state providing too much? Are citizens accessing what they don’t need Are we inadvertently creating demand through dependency?

Avoidable Demand Is demand arising from behaviours that could be influenced or changed? Do we have the right level of insight about why this might be the case?

Failure Demand Is demand arising as a result of service failure? Are we creating demand through poor service design? Are we experiencing demand through creating market failure?

Preventable Demand Is demand arising from problems that could have been prevented earlier? Do we contribute to demand through misunderstanding the root causes? Are shunting demand through addressing symptom not cause?

Co-Dependent Demand Is long-term demand being entrenched through service dependence? Do we create demand through poor relationships between front line workers and service users? Do we sustain demand through poor understanding of what communities can do?

Ways to Manage Demand - some organisational levers Better use of data Hard levers e.g. enforcement, compliance Comms & ‘nudge’ New behavioura l insight Commissioning & procurement PayMechs, co- payment Co-design with citizens

Apply : What levers do we have or need to shape demand Group 1:Levers in ASC/Health Lever Describe e xisting lever Is it working? Y/N Is it working? Y/N Existing lever but new to us Lever we need to develop Y Y N N Y Y Y Y N N What other levers could we use? What levers need developing? For ‘N’ levers, how improve?

From emerging science to whole system, whole place: a long term approach Costs Current Demand ‘Real’ Demand Other ways of meeting demand Future demand Eliminate excess demand Redesign services w customers Early intervention, prevention, resilience PPayback Short term Medium term Long term System change

Re-shaping the system – what will it take?

But remember: behaviour, culture & relationships drive delivery… “Read my Lips: no new legislative and policy frameworks…” “It’s the behaviours, stupid….”

Building readiness – what happens next?

Collaboration: no pain, no gain?