Wemi:City of Milan is going to re-think Care Services in order to create a new Community Welfare

The Challenge: 

The Question: 

City of Milan services define in an implicit way their target

The Problem: 

How could we change welfare and transform the welfare system from a welfare for poor to a welfare for all?

The Solution: 

Create new spaces in order to promote sharing relations among citizens, to create a dialogue between traditional and new actors of welfare

Channels: 

Context

In recent years Milan citizens have developed needs that the City of milan is no longer able to cope with. Available data tell us that welfare services are directed to a minority of citizens, creating a gap with all the others.

But what are the main changes taking place?

- The aging population;
- The reduction in resources due to the economic and financial crisis;
- The changing role of the family, its components and its characteristics;
- The question of the role of youth in society;
- The increasing multiculturalism.

In particular in Milan:

SENIOR CITIZENS

In Milan, the ultra elderly residents aged over 60 are 394 673 (about 30%), mostly women (233,863). Of these 25% are people alone, who then often they face the last part of life in solitude.

Among these are the "very elderly" (over 80) are 94,330.

The elderly non self-sufficient are about 40,000 and they have a lot of care needs and the main caregivers are  familiars (usually sons) and health and social services.

These numbers also explain the growing significance of the phenomenon of the informal care market, the caregivers for elderly people.

The phenomenon is significant in Milan if you consider that in the city are estimated around 32,000 caregivers, both legal and illegal.

It 'also important to note that only 25% of the 39,000 non self sufficient elderly people living in Milan receive formal care provided by Municipality.

WHERE ARE THE OTHERS?

THE ROLE OF WOMEN

The role of women/ mother in Milan  is increasingly complex. Just think that in Milan, in 2011, appear to be residents 383,221 women aged between 25 and 65 years and that the female employment rate in the city is 62.70%.

The above described demographic change also determines a situation where women who are 40 years old today can expect to share about 22 years of their lives with at least one elderly parent, 4 years longer than those born in 1960 and 10 years more than women born in 1940.

The Milanese women are, therefore, for most working women, whose problems of conciliation between family and work are even more marked than women of other cities of Italy.

Children in Milan between 0 and 6 years old are 83,605 of which only 6,902 are enrolled in pre-schools or nurseries and only 5,600 are enrolled in pre-school services and after-school primary school.

WHERE ARE THE OTHERS?

FRAGMENTATION OF RESOURCES

We also found a strong fragmentation between public funds used for care and a  lack of coordination. 43% of these resources comes from the State, Region, Municipality and Local Public Health Agency,  the other part are cash resources that come from INPS (National Insurance Contributions).

The project “Welfare of all”

The idea is to create the conditions to make sure that everyone has access to opportunities provided by the welfare, regardless of economic conditions, and that anyone can have an active role  in the welfare and thus responsible for the improvement of society. Therefore the name of the project: Welfare of all.

This approach seems to us really innovative. Adolfo Ceretti and Roberto Cornelli (partner of our project with the National Centre for Prevention and Social Defence) told us: "The claim of recognition of civil and social rights, after having supported the gradual expansion of the Western democracies, becomes more and more an individual claim that tends to exclude, in the name of "my own right", those of others. "My" right to public housing, the provision of "my" child daycare, and even the right to receive adequate medical care is seen in contrast with the rights of others. We prefer to support the removal from the list of those who "are not as much citizen as I am "- rather than to claim services that reach everyone.

In a context where human relationships are more rarefied, the solidaristic relations are weak, the gap between social segments is dangerously exploding. Insecurity and uncertainty have made the idea of ​​community something relative and fragile. "

Wemi is developing an online platform that enables simple access to home care services of the City, making it possible for citizens to request new services, or in different ways, creating new solutions together, giving you the chance to find personalized answers.

http://wemi.milano.it/

We realized also two territorial platforms, ie two listening spaces for citizens in the aim to promote the sharing of offers and needs among citizens. The territorial platforms perform the same function of the digital platform but in three different physical locations.

In these spaces people are helped to find the services they need, but also they are encouraged to share needs and services between groups of citizens, in the aim to aggregate the needs and provide shared answers . These services then work directly with families and traditional third sector associations.

Online and physical platforms are innovative tools because they force the entire system to rethink: the City of Milan has to change its vision of citizens and the world of the third sector needs to open up to new citizens and think again an adequate business model.

Finally thanks to some ideas  received during some design sessions WEMI is implementing two pilot projects: “Apartment Block Welfare”, with apartment block caregivers/home helps, and “School Welfare”, working with local schools, with a view to better integrating welfare provision.

Apartment Block Welfare

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Financial education for social operators

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Which are the main difficulties that we found?

We found different kind of difficulties.

From the point of view of the City of Milan we’re working with new tools that are very different from the typical ones. For example, we had to think about a new way to communicate services to citizens, trying to build a new visual identity system with the Department of Design at the Politecnico. Moreover we need to build a new language with the traditional actors (cooperatives, NGOs..) that can be understood by citizens  (not technical language).

Another difficulty has been to help no profit organizations to think new kind of products, beyond their traditional services in order to be able to answer to new and different needs.  

So the biggest challenge is to get out from traditional logic, in relation to how we think, how we communicate and we distribute services.

We believe that this new way of thinking services might lead to great opportunities, but we still need to prove that this idea is true. So we need to be brave and really believe and work on this idea.

In this sense the role of the Municipality is important because only Municipality can take the risk of innovation and make an investment that the private social agencies alone could not do, as they are forced to face objective difficulties also linked to a long economical crisis.

What do you think? Do you know similar projects? Do you have suggestions for us?

All comments will be useful for building together this difficult road of Welfare innovation.

Comments

Sostenere i "devianti positivi"?

Alberto's picture

Interessante, @Emanuela – soprattutto la parte sui problemi incontrati. Purtroppo non capisco cosa vuol dire "esplodere le potenzialità delle linee di prodotto del Sistema della Domiciliarità relative agli interventi educativi e assistenziali". Preparati a dare qualche spiegazione se cerchiamo di suscitare dibattito internazionale su questi punti! 

Fare cambiare le logiche a soggetti che hanno già le loro è sempre difficile. Nello spirito di opencare, mi viene da suggerire che potreste pensare di appoggiarvi a soggetti diversi, che hanno già le logiche "sharing" che vi interessano. In pratica, questo significa cercare e sostenere i cosiddetti devianti positivi (https://en.wikipedia.org/wiki/Positive_deviance), cioè gente che ha già cominciato a sviluppare soluzioni come quelle che vorreste promuovere.

Mi ricordo che qualche anno fa leggevo di un caso a Firenze: una signora immigrata, con molto tempo, amante dei bambini, avevo montato un servizio in cui i genitori le lasciavano i loro bambini, e lei li faceva giocare, faceva con loro piccole attività, etc. Sembrave una buona idea: in Italia le scuole per l'infanzia servono solo una parte piccola della popolazione, e sono molto care. In Emilia il costo pieno (senza profitto) è stimato a 700 EUR al mese per bambino. E invece, le cooperative sociali che in Toscana gestiscono questi servizi l'hanno denunciata e fatta chiudere: mancato rispetto delle normative regionali. Un approccio basato sui devianti positivi avrebbe invece concluso che a Firenze servono scuole dell'infanzia basic, e creato uno spazio per la signora e per le altre persone come lei. 

La metodologia di opencare è molto adatta a trovare i devianti positivi. Si tratterebbe di fare un affondo su Milano, cercando le iniziative su cui la gente si sta automobilitando; queste sono le cose che servono davvero. E il bello dei devianti positivi è che, per definizione, sono già nelle logiche che vi interessano. 

Ultima cosa: c'è un numero chiaramente sbagliato nel post: 383.221 donne, di cui 372.998 divorziate? Impossibile. Il totale delle donne dovrebbe essere sul mezzo milione abbondante, a spanna. 

How is the City and private social agencies working together?

Noemi's picture

Hi @Emanuela , I don't think we have met yet? I'm a community manager here, and working with @Rossana Torri and @Franca , among others. Nice to meet you and thank you for the post.

I'm glad there is a version in English too, thank you to the person who translated from Italian.

My question is related to the challenges you mention - needing to present the program online and in a more accessible language and so on. How do you work with the private actors? Ok, the city is the only one to finance this innovation, but does it accept consultancy or how are social agencies involved?

display_matching_funding_services

Matteo's picture

Hi @Noemi,

for as much as I know primarily WEMI is matching a number of services available among the city organizations (providers) with citizens' needs. Provider organizations are those listed in the Register of the City of Milan, therefore they are previously assessed and qualified. Citizens are whoever need services. The matching happens mainly online. Secondarily, City of Milan subsidizes up to 1,500 euros each to less affluent users (some 3mln euros have been pladged for 2017) to access services provided through the platform. Seems to me that the most (creative) interactions can happen in WEMI physical places, that are open to citizens and associations (not only providers).

By April 19th, 2016 Opencare local team met up in the WEMI space in Corso San Gottardo. That was an opportunity to engage representatives of “San Gottardo Social Street” that gathers neighbors in order to build relationships, to share expertise and knowledges, and to implement common ideas. @Rossana Torri might want to add something 

No doubts on some private actors using the programme..

Noemi's picture

Thanks @Matteo , it surely makes sense. Where I was going is seeing if there is openness to include these actors to actually shape and improve the programme - for example if the programme needs better promotion or communication to reach more of those less affluent users; or better, non-jargon copy on the website etc. Is there outsourcing happening, or effective feedback gathering channels? And so on.. I think to me this would be a step towards the open policy making vision which @Franca mentioned here. 

Register?

Alberto's picture

Hello @Matteo , what is this "Register of the City of Milano"? How is it compiled?

Accreditation

Matteo's picture

Hi @Alberto, WeMi basically lists a catalogue of services (currently 300) to several (potential) users. Providers have to be accredited (authorized), on the basis of their competences, to display their services on the portal. City of Milan, whether covering the costs for who is entitled or just matching supply and demand, is competing on a (growing) market. As a quasi-market operator therefore CoM is trying to keep service quality at a standard and keep citizens away from "underground" economy. Does it make sense?. 

Dark side

Alberto's picture

@Matteo it makes plenty of sense. Also, it has a potential dark side: it could easily turn into a barrier to entry. I know this administration is very open, no doubt about that. So was the one before it. But structurally, quality control is always half a step away to turn into supply restriction. In Italy, as we Italians know well, the professional orders are defended in terms of quality control – but they also make some services, from taxi driving to notaries, muach more expensive than elsewhere, and not that much better. Even in OpenCare, we pick up this connection between existing systems failure and legality / regulation that tells you a clear story. The story is: sometimes trying to help is illegal. Sometimes the legitimate operators are those who are better at paperwork, not at care. 

Quality control is an important function of government. You guys have to do it, of course. But certification of entities is not necessarily the best instrument to do it. For sure it is not particularly innovative: medieval Guilds already used them. It is not even particularly successful: it did not stop corruption and abuse, even in care. The Mafia Capitale scandal that emerged in 2014 involved certified social cooperatives like 29 giugno, La cascina, Domus Caritatis (source). Formal control end up emphasizing formality. Can we do better? 

Agreed (in principle)

Matteo's picture

I totally agree with you @Alberto. Too much control, paper work and red tape would make any policy selective, expensive and would weaken mutual trust between government and citizens. On the contrary, as far as I know, WeMe aims at providing Care solution to the largest audience, opening to new actors. A minimum level of control is needed to keep the programme fair,  transparent and accountabile. I'm sure @Rossana Torri and @Lucia would be more precise on this topic.

Do new care providers register or are able to deliver services?

Noemi's picture

This is interesting, so if you want to rethink relationships in care provision and there is a formalized understanding of who providers of care are, and who beneficiaries are, how do you expect innovation to happen? Is it mainly through the technology and methodology (the platform matching), or is it also through the appearance and registration of (until now) unregistered and informal providers? Did you see an increase in the Registry numbers, or signs that there are new actors delivering innovative services?  Thanks Matteo, maybe some other people involved in the programme might also want to join the discussion.

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