John Swinney has chosen an interesting word to describe his ambition for Scotland’s public services: “rewiring”.
It is an important distinction. Reorganising changes the structure. Rewiring should change how the system actually works.
That means changing how information is shared, where decisions are taken, how money is allocated and, ultimately, what people experience when they need help.
Scotland has had plenty of reorganisation. We have created and abolished bodies, changed boundaries, reconfigured governance and moved responsibilities between institutions. Yet for many people trying to navigate public services, remarkably little has changed.
So I agree with the First Minister that Scotland needs radical reform. But I am less interested in the architecture of reform than in what happens beneath it.
The proposed NHS restructuring is a useful test. Reducing fourteen territorial health boards to two would be a significant change. But the question that matters is whether the patient notices.
Does it release money for frontline care? Are decisions made closer to communities? Does information move more effectively between services? Is duplication reduced? And can the system intervene before a problem becomes a crisis?
If the answer to those questions is unclear, then we have undertaken a reorganisation, not a rewiring.
This matters particularly because prevention and early intervention sit at the heart of the Government’s reform agenda.
The principle is hard to argue with. The difficulty is turning it into the way public services operate.
At the Wise Group, our experience has led us to a fairly simple conclusion – the starting point should be the person, not the service.
We do not begin by asking which part of the system someone belongs to. We try to understand what is happening in their life.
That distinction is important because people’s problems do not respect the boundaries of government.
Someone struggling to find work may also be dealing with debt, poor health, insecure housing, family pressures or the consequences of involvement with the criminal justice system. These are not five separate lives. They are one life.
Yet the public system is often organised around those separate categories.
The consequence is that the individual is left to join the dots.
They may be passed between housing, health, employability, benefits and justice services, with each organisation doing its part but nobody necessarily taking responsibility for the whole picture.
At the Wise Group, we have been testing what it looks like to organise support differently – starting with the person, understanding the whole picture and then bringing the right support around them.
That means using information properly, intervening earlier where we can and, importantly, judging success by outcomes rather than activity.
A referral is not an outcome.
An assessment is not an outcome.
A programme being delivered is not an outcome.
The question is whether someone is housed, in work, financially more secure, healthier or less likely to return to prison.
That sounds obvious. But it represents a significant change in the way public services are designed and held accountable.
Scotland already has much of the information required to make this shift. Increasingly, we can identify patterns of need and risk across health, housing, employment and justice.
The problem is that we are often better at collecting information than using it.
There is an uncomfortable truth here – we can know more about someone’s circumstances than we are prepared to act on.
If prevention is genuinely to become the organising principle of public services, that has to change.
Prevention cannot simply become another programme added to an already crowded system. Resources have to move upstream. Data has to be used to anticipate need rather than simply record what has already happened. Professionals need the freedom to work across organisational boundaries. And governments have to be willing to judge services by whether people’s lives improve.
There is another, more difficult, implication.
If we are serious about prevention, we also have to decide what we will stop doing.
A system under pressure cannot endlessly absorb new priorities, new initiatives and new commitments. Every pound and every hour devoted to one activity is unavailable for another.
That is where the language of “rewiring” becomes meaningful.
The recent evaluation of the Upstream Homelessness Prevention Fund offers an example of what earlier intervention can achieve, with 662 households in the pilot avoiding homelessness.
The question for government is whether evidence like this remains confined to individual projects, or whether it begins to shape the way the wider public system operates.
This is why I welcome the ambition behind the First Minister’s reform agenda.
It’s also where organisations like the Wise Group can help.
Through our work across employment, household finances, housing and justice, we see where the boundaries between services create friction – and we have the delivery experience and data to understand what happens when those boundaries are removed.
That gives us something practical to bring to reform – identifying where earlier intervention could prevent demand, testing more integrated approaches and measuring whether they improve outcomes.
I would like to see government use the next phase of reform to create more space for that kind of practical collaboration – bringing public services, the third sector and communities together to test what works, follow the evidence and have the confidence to scale it.
But I would judge it by a different set of measures than the number of organisations merged or boards abolished.
Show us that resources are moving towards prevention.
Show us that information can move across institutional boundaries.
Show us that frontline professionals have greater ability to act.
Show us that accountability is focused on outcomes rather than activity.
And, perhaps most importantly, show us what has been stopped to make those changes possible.
Because the ultimate test of public service reform is whether the experience of the person has changed.
Scotland does not need another generation of reform in which the architecture looks different but the citizen still has to navigate the same maze.
If “rewiring” really means changing the way the system operates around people’s lives, rather than simply rearranging its institutions, it is an ambition worth pursuing.
And we should not wait for every organisational change to be completed before beginning.
Start with the person. Build the system around them.
That is where genuine public service reform should begin.
Sean Duffy is Chief Executive of the Wise Group