More for Less


These case studies aim to improve the quality of public service policy by providing examples of successful reform in practice. Typically they deliver higher performance at reduced cost; in fact, the financial pressure to deliver value for money has been a catalyst for new thinking.

The 39 case studies below should be a powerful resource which gives confidence to UK policy makers as they approach the challenges of public service reform and deficit reduction.

 

Integrating public services in Margate, England

Author: Katy Sawyer, Researcher, Reform
Summary: Many have tried to get multi-agency working right over the years but the Margate Task Force has demonstrated that it can be done, delivering how integrated, innovative responses to changing public demands and rapidly shrinking budgets.

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Care management in Massachusetts, USA

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In Massachusetts any willing providers were invited to organize community services for low income elderly patients. Patient-centred care management replaced uncoordinated services, reducing the number of nursing home admissions by 32-42 per cent.

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Civilianisation at South Wales Police

Author: Will Tanner, Researcher, Reform
Summary: In South Wales, the use of civilian staff in custody roles previously held by warranted officers has streamlined the way the police force operates. The contracting of G4S, a private company, to manage police custody has released 53 officers back to front line duty and saves £1.2 million a year.

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Co-located courts in Warwickshire, England

Author: Will Tanner, Senior Researcher, Reform
Summary: In Warwickshire, the creation of two new “one-stop shop” justice centres has integrated criminal justice delivery and improved services to victims and the community. The Centres has one-off savings of £9.5 million and £800,000 savings on annual running costs.

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Co-produced environmental services in the London Borough of Lewisham

Author: Will Tanner, Researcher, Reform
Summary: The development of LoveCleanStreets, an innovative mobile application and website that allows citizens to report graffiti and street refuse, has improved the council’s clean-up rate by 87 per cent, improved public satisfaction by 18 per cent and generated significant savings.

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Community Justice in Red Hook, New York

Author: Will Tanner, Senior Researcher, Reform
Summary: In New York, the Red Hook Community Justice Center has provided a radically new method of justice and turned around a neighbourhood. Between 1990 and 2010, crime fell by 76 per cent and satisfaction rates have risen significantly.

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Continuous development at Denbigh High School in Luton

Author: Kimberley Trewhitt, Researcher, Reform
Summary: In Luton, Dame Yasmin Bevan, Headteacher of Denbigh High School has applied a continued focus on professional development and high standards of teaching and learning to her school since taking over in 1991. The percentage of pupils achieving five or more A*-C grades at GCSE has risen from 17 per cent in 1993 to 100 per cent in 2010.

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Data-driven policing in Chicago, USA

Author: Will Tanner, Researcher, Reform
Summary: In Chicago, the introduction of a new policing database and reporting system, CLEAR, has transformed the way in which the USA’s second largest police force operates. Since 2000, crime in Chicago has fallen at twice the national rate across all major indicators, and the reduced bureaucracy has allowed the force to re-deploy 90 once desk-bound officers to the front line.

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Data performance management at University Hospitals Birmingham

Author: Thomas Cawston, Senior Researcher, Reform
Summary: Birmingham University Hospitals took the initiative to develop its own IT infrastructure to track medical errors and provide decision support to front line clinicians. Medication errors were cut by 66 per cent and contributed to a 17 per cent drop in 30 day mortality.

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High volume, specialist cardiac care in Bangalore, India

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The Narayana heart hospital in India provides high volume, low cost heart surgery with mortality and complication rates that are among the best in the world. The hospital achieves high productivity through maximising consultant time, greater use of trainees and non-clinical support staff, and making doctors accountable for cost and quality.

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High volume, specialist eye care in India

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The Aravind hospital in South India is the largest and most productive eye care facility in the world, providing 60 per cent of the NHS’s volume of cataract operations at 1 per cent of the cost. Doctors perform 2,600 operations a year, compared to a national average of 400, supported by low cost specialist staff.

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Hospital closure in Ontario, Canada

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In 1996 the Canadian province of Ontario set up an arms-length government body was set up to review hospital services and depoliticise the reconfiguration process. In four years 31 public hospitals and 6 private hospitals closed, and 44 hospitals merged into 14 organisations. The restructuring has led to a dramatic fall in expenditure on hospitals, from 52 per cent of the provincial health budget in 1981 to 37 per cent in 2008.

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Innovation in education at Durand Academy, Lambeth

Author: Will Tanner, Researcher, Reform
Summary: Durand Academy, an inner-city primary in Lambeth, London, has been transformed from a small, failing school in 1988 to a high-performing academy consistently rated “outstanding” by Ofsted. The school has also established a number of commercial ventures, including a health and leisure centre and flats, and plans to open the first completely free state boarding school in 2014.

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Innovative custody at HM Prison Lowdham Grange

Author: Will Tanner, Researcher, Reform
Summary: Despite large operational changes and an extraordinarily challenging prison population at HM Prison Lowdham Grange, private contractor Serco has consistently delivered exceptional performance despite costing over £8,000 less per prisoner place than the national average.

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Integrated care pathways for mental health in Rhode Island, USA

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In Rhode Island, a private company, Beacon Health Strategies, has created an integrated care pathway for mental healthcare services, which were previously highly fragmented.  In one year, the cost of mental healthcare hospitalisations for children was cut by 20 per cent.

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Integrated criminal justice at the Causeway Programme, Northern Ireland

Author: Will Tanner, Researcher, Reform
Summary: In Northern Ireland, the Causeway Programme has integrated the ICT and data systems of the Public Prosecutions, Forensic Science, Courts, Prisons and Police Service for the first time. By joining up criminal justice information and delivery, Causeway has improved efficiency and saved £68 million.

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Integrated emergency services in Gloucestershire

Author: Will Tanner, Senior Researcher, Reform
Summary: In Gloucestershire, fire, ambulance and police services have been successfully integrated to deliver a more seamless emergency service. The service is more coordinated and the region now has a more resilient approach to natural disasters.

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Integrated specialist migraine treatment in Essen, Germany

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In Essen, Germany, a public hospital has brought together different specialists and services under one roof that were previously offered at different sites and not coordinated. The West German Headache Centre provides integrated care for migraine sufferers that costs 25 per cent less than the national average.

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Intelligent neighbourhood policing in Greater Manchester

Author: Will Tanner, Researcher, Reform
Summary: In Manchester, Greater Manchester Police have introduced a ‘New Policing Model’ that includes the creation of an intelligence “hub” in each division to provide police leaders with a comprehensive overview of threats, harm and risks in real-time, as well as helping to streamline response activity. Performance across all key indicators has risen significantly and the changes have returned £20 million in cashable savings.

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Intelligent workforce planning at Birmingham City Council

Author: Will Tanner, Researcher, Reform
Summary: In Birmingham, the City Council has invested in a radical programme of workforce planning and intelligence to manage its 55,000 staff, including the development of an innovative IT solution and the introduction of performance reviews for all staff. The reforms saved £4.4 million in just one year and enabled the council to reduce its workforce by 4,500 without any major compulsory redundancies last year.

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Localism in practice at North Dorset District Council

Author: Will Tanner, Researcher, Reform
Summary: In North Dorset, the move to a devolved model of community partnership and local autonomy has enabled the District Council to make £4 million worth of annual revenue savings while at the same time improving service delivery.

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Low cost, high impact reform at the Serious Organised Crime Agency

Author: Will Tanner, Researcher, Reform
Summary: Of the 38,000 serious organised criminals operating in 6,000 gangs in the UK, the police service is only able to tackle 11 per cent via traditional investigations. With significant budget restraints, the Serious Organised Crime Agency used comprehensive data analysis and disruptive techniques to radically improve results without increasing expenditure.

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Mixed provision in the German healthcare system

Author: Andrew Haldenby, Director, Reform
Summary: In Germany, the rising deficits and debts of regional governments have led to a steady move towards private ownership and a mixed market of provision, with both profit and non-profit providers now outnumbering public counterparts. These profit and non-profit hospitals offer more efficient services for equivalent quality.

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Multi-disciplinary partnership at the Westminster Family Recovery Programme

Author: Will Tanner, Researcher, Reform
Summary: The Family Recovery Programme in Westminster established a practitioner-based multi-disciplinary team to tackle the 600 troubled families in the borough that accounted for 80 per cent of all social care spending. Through a whole family approach and effective partnership working, FRP has reduced suspected offences by 83 per cent and saved £2 million in three years.

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Outsourcing school services in Islington

Author: Andrew Haldenby, Director, Reform
Summary: In Islington, the decision taken by the Secretary of State to contract out the services provided by the failing LEA has radically improved schools in the borough. In ten years, the number of 15-year-olds attaining five good GCSEs has improved by 46 per cent, compared with a national average of 26 per cent.

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Preventative criminal justice in Glasgow, Scotland

Author: Will Tanner, Senior Researcher, Reform
Summary: In Glasgow, the Violence Reduction Unit has put prevention and early intervention at the heart of policing and justice. Violent crime has fallen by 38 per cent, while possession with intent has fallen by 58 per cent.

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Primary care in retail outlets in the USA

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In the United States, MinuteClinic has developed strict protocols for a range of routine services. This has allowed the clinics to use nurses instead of more expensive doctors, enabling them to provide consultations 30-50 per cent cheaper than a visit to a GP.

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Productivity and prevention at Merseyside Fire and Rescue

Author: Will Tanner, Researcher, Reform
Summary: In Liverpool, Merseyside Fire and Rescue moved from a reactive to a preventative model of delivery, installing fire alarms, engaging the public and improving staff productivity. Between 2000 and 2010, the service reduced the number of fire deaths by more than half while simultaneously reducing the number of staff from 1,500 to 880 and saving over £111 million.

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Public-private healthcare partnership in Valencia, Spain

Author: Nick Seddon, Deputy Director, Reform
Summary: In Valencia, the creation of the first public-private investment partnership in the Alzira Health District has transformed acute hospital care. Alzira hospitals have waiting times that are half the national average, are open on weekends, and cost the government 25 per cent less per capita than public sector equivalents.

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Radical school improvement in Northampton

Author: Dale Bassett, Research Director, Reform
Summary: In Northamptonshire, Edison Learning, a private company, has worked directly with teaching staff and schools as part of a range of school improvement services. The policies have transformed classroom teaching and learning, with a 50 per cent rise in the proportion of children achieving five good GCSEs in two years.

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Reducing recidivism in Staffordshire and West Midlands Probation Trust

Author: Will Tanner, Researcher, Reform
Summary: Since the 2010 merger of two relatively poorly performing probation areas, Staffordshire and West Midlands Probation Trust has delivered some of the highest rehabilitation rates in the country while providing value for money to the taxpayer.

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Rehabilitation at HM Prison Doncaster

Author: Will Tanner, Researcher, Reform
Summary: At HMP Doncaster, private contractor Serco has adopted an innovative operational strategy that places reducing the rate of reoffending at the heart of its work with prisoners, both within the prison itself and after release. The prison now records extremely low levels of reoffending while simultaneously reducing the cost per prisoner place by an average of £750 a year.

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Revolutionising rehabilitation at St Giles Trust

Author: Will Tanner, Researcher, Reform
Summary: St Giles Trust, a charity dedicated to breaking the cycle of reoffending, employs ex-offenders to provide rehabilitation services for prisoners and those on release in the community. The approach has been shown to reduce reoffending rates by 40 per cent against the national average, while also saving the taxpayer between £8,616 and £28,722 per client.

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Specialist joint replacement at Coxa Hospital, Finland

Author: Thomas Cawston, Senior Researcher, Reform
Summary: In Finland, the Pirkanmaa region closed joint replacement departments in five hospitals and concentrated care at one specialist hospital.  The new hospital delivered complication rates below 1 per cent compared to an average of up to 12 per cent for general hospitals.

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Specialist maternity care in India

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The Indian specialist maternity hospital LifeSprings has focused on providing a limited number of procedures and used standardised clinical protocols. Doctors’ productivity is four times higher than non-specialist providers and prices are 30-50 per cent of market rates.

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Specialist stroke services in London

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The NHS in London moved emergency stroke care from 34 general hospitals to 8 specialist units with dedicated staff. London now has the highest standards of stroke care of any major international city.

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Transforming clinical outcomes in Cleveland, Ohio, USA

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The Cleveland Clinic in Ohio has published its clinical outcomes and data used by the hospital leaders to manage productivity, benchmark clinicians and improve quality. The hospital is one of the highest ranked in the United States for quality but costs are half those of equivalent providers.

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Transforming policing in West Midlands Police

Author: Will Tanner, Researcher, Reform
Summary: In West Midlands, Operation Paragon restructured the force from 21 Operational Command Units to 10 Local Policing Units based around local authority boundaries. The new model has streamlined delivery, improved outcomes and placed the force on sound financial footing despite budget cuts.

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Workforce reform at NHS North West, England

Author: Thomas Cawston, Senior Researcher, Reform
Summary: The NHS in the North West of England aimed to improve productivity and patient care through introducing new medical roles and changing the skill mix. The North West has been the most innovative and successful region to modernise its workforce, with non-medical consultants, assistant practitioners and advanced practitioners improving patient satisfaction and access.

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Workforce reform at Surrey Police

Author: Will Tanner, Researcher, Reform
Summary: In Surrey, the police force has fundamentally reformed its workforce by introducing mixed workforce teams of officers and civilian staff, streamlining management and aligning resources to demand. The changes have led to greater flexibility, reduced cost and a more effective service to the public.

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