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Written by Laura Woodroffe
Housing conditions can have a significant influence on the health of residents. Hackney Council wanted to better support tenants of private rented accommodation, where problems can be more difficult to report.
Hackney Council applied for the Design Council’s Design in the Public Sector programme, funded by the Local Government Association, to find ways to deal with the health challenges some of their residents were facing.
Matt Clack, Head of Services for Public Health, also saw it as an opportunity to experiment with new working methods. “I had always been interested in things like Design Methods and Agile,” he says, “The programme was the perfect way to help me integrate some of that thinking into the design of Public Health Services in Hackney in a concrete way.”
Like many councils, Hackney faces pressure on its social housing. Many people in the borough are renting private accommodation. National figures show that a third of private rented accommodation fails to meet the Decent Homes Standard and, in Hackney, 39% of private tenants were below the poverty line. These facts put Hackney’s private tenants at substantial risk of developing physical or mental health problems as a result of substandard living conditions. But those tenants were often less able to report problems, either because of the lack of a clear way to do so or for fear of retribution from private landlords.
In Hackney, some of the many agencies that looked after renting tenants were making home visits. They were in a position to flag any potential problems with housing to each other, and to services that did not have access to residents’ homes. But, their siloed nature and focus on specific concerns meant this was a missed opportunity, cross-agency communication was not happening.
Hackney Council had a hit list of nineteen of these agencies that they wanted to redesign to provide better support for their residents.
They also wanted to challenge their embedded ways of working. Matt Clack explains: “Public Health was integrated into the council five years previously. At the time it brought with it a new way of designing services. One that was very evidence-based and focused on what the data is telling you rather than policy direction or budget.”
Matt saw the Design in the Public Sector programme as a great extension of this way of working. “I felt it would broaden out our methods of research and collecting feedback from both our residents, and from the services working with them,” he says, “and make the way of working more complementary to the rest of the organisation.” To help make this as transparent as possible Matt wrote blogs about the process on Medium and promoted them to his colleagues at the council.
Before applying for the programme, the team shortlisted six different challenges. They chose this one because it was very immediate. “I wanted to avoid a situation where we were just doing this nice thing on the side,” says Matt. “We needed to be able to apply the learnings directly. It was also specific enough for us to be able to bring together a small team around it.”
What we did
Once they started attending the Design in the Public Sector workshops, the team quickly reassessed the nature of their challenge. They needed to link up the different agencies that were accessing tenants households. So, rather than redesigning a service, they needed to create a network. As a result, they realised that their customers were not the residents, but the staff at the agencies they were trying to connect. They had to build something that worked for them in order for the benefit to be felt by residents.
In Public Health Services it’s about bringing all the different people together, like building a puzzle.Matt Clack, Head of Services, Public Health, Hackney Council
The Design in the Public Sector programme helped the team refine the way that they thought about the people their services touched. “As a function Public Health is very population focused,” says Matt. “That makes it quite difficult to think about behaviours. The workshops helped us to think about lived experience. We also started to incorporate systems thinking - understanding all the different services and pressures that impact on people beyond just their individual choices. We learnt not to put our issue at the heart of the conversation when we went out there to talk to people.”
A network of agencies and services
After spending time with staff from the different agencies, exploring the idea with them using techniques they had learnt on the programme, the team started to create the network. “Using the Design in the Public Sector programme to do this was hugely beneficial,” says Matt. “It gave validation to the fact we were using new methods, permission to do things differently. The techniques we used meant that we were talking directly with people about how to develop the network, rather than simply telling them what we thought was the best way to do it.”
The result is a core group of frontline staff from 15 different agencies who all meet for regular workshops around themes they choose themselves. A further twenty agencies ranging from council services to other public sector agencies such as the fire service, to voluntary and charitable organisations have attended workshops at some point making a total of almost 35 agencies. A newsletter keeps them all up to date, and there is a training programme for members curated from existing provision, such as NHS courses. This interconnected working enables them to share and store information across agencies about the environments their private tenants are living in, so they can act before problems become a crisis.
Chris Garnsworthy is the Community Libraries Service manager and a member of the network. His team deliver books to private renting tenants who are often housebound or disabled. “These tenants’ type of accommodation means they are more likely to be isolated and have issues surrounding their home environment,” he says, “but they are often ‘out of the loop’ when it comes to assistive council and charitable services. For me, being part of the network has given me the opportunity to meet staff, hear about their services and understand how their work could help our housebound and disabled service users so that I can pass that benefit on to them."
The network is already having an impact on the ground, where joint visits to residences are a new way for the agencies to work together to safeguard residents health, and officers already see benefits. Tenants often ask Environmental Health Officers questions about health. With their primary focus on living conditions, they are not equipped to answer. So the network facilitates joint visits with Health Coaches who help create a plan with tenants, to tackle health issues. “This is popular for both service providers,” says Matt. “It gives the Health Coach another access opportunity, and the Environmental Officer does not have to face questions that they are not confident answering. Our Floating Service for mental health has also been taking environmental health officers with them, providing another chance to monitor residences.”
The network is in its early days, but Matt estimates that up to ten joint visits have already taken place and tenants are starting to feel the benefit. In one case a family support worker who was part of the network noticed mould, mouse droppings and excessively cold temperatures in the house of a mother of three children she was supporting. Because of the information the support worker had gained on the network workshops she was able to organise a joint visit from a housing officer, who otherwise would have had no access to the property. After the assessment the private landlord was required to carry out a number of improvements.
Eventually the network will run itself, we won’t need to do anything.Matt Clack, Head of Services, Public Health, Hackney Council
The long-term plan is that the network will become self-sustaining. To get to that point the team are pursuing several aims. “We have a target list of agencies that we want to involve,” says Matt, “and the fire service is at the top. Not just because they do home visits, but because they are the most trusted service.”
The network uses the eyes and minds of people on the ground and what Matt calls their “peripheral vision”. “Take a Health Visitor for example,” he says, “their main concern during a home visit is the health of the newborn child. But, by being in that residence, they also have access to the parents and may spot indications of problems with their mental health. Or they may see problems with the environment.” By sharing these ‘peripheral’ observations, the network can get the right services involved sooner or support tenants to reach out when they need help. The team is building a list of joint ‘red flags’ to assist this process. Red flags are things that each agency would immediately see as a risk in a home, and would escalate. Each agency has its own set of red flags. Bringing them together helps staff on the ground use their peripheral vision to spot issues which they might not otherwise notice.
Funmi Osinowo is a Private Sector Housing Officer who is already seeing benefits from the new system. “I have definitely seen an increase in detailed referrals from staff, who now have a better idea of the red flags they should be looking for and describing,” he says. “And for me, being part of the network has made it much easier to signpost the most appropriate services and share knowledge with my colleagues. The face-to-face interactions at the workshops with staff from other services has made me much more confident doing that.”
Hackney Council have used the Design in the Public Sector programme to successfully tackle what can be an intractable issue at any organisation – a siloed structure. By focusing on networking rather than redesign the team identified the real issue they were facing and were able to create a viable solution.
Design in the Public Sector aims to help local authorities commission and deliver improvements to public health services. The programme builds an understanding of how design practices can enable local government professionals to shape and deliver improved services.
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