Public Service Reform Kevin McLean

2 Public service reform Introduction 3 stages of public service reform Better outcomes Improved, but not yet world class Long term challenges A new approach to Public Service Reform Lessons from the last 10 years

3 Since 1997, there have been three stages of reform in public services Choice and contestability Minimum standards Major Investment Quality Below averageAbove average World class Public Service Reform Improving Stage 1: Stage 2: Stage 3:

4 Stage 1: Establishing minimum standards Significant increases in funding after the first 2 years Increased numbers of doctors, teachers, nurses Creation of central targets to drive improvement Tougher intervention in failing organisations: schools, hospitals, and local authorities Setting high minimum standards in health, education and social care Unravelling the internal Market in the NHS

5 Stage 2: introducing choice and contestability Extension of quasi-markets in health, education, social care, social housing and offender management Increased diversity of provision in education through more specialist schools, faith schools, independent academies and encouragement for new entrants Creation of NHS Trusts and Foundation Trusts, creating more independence and autonomy in the NHS Increased role for commissioning of services in criminal justice, education, childrens services and health & social care

6 Stage 3: Achieving world class public services Citizen empowerment New Professionalism Strategic leadership from government

7 These reforms have had significant impact on performance

8 Public services have improved significantly, although many are not yet world class, and we face some long term challenges

9 Performance Students achieving level 4 or above at KS2 (%) For example, in education, investment and reform over the last 10 years have delivered significant improvements English Mathematics Science target Education Investment + Significant extra investment Government expenditure on education has increased rapidly (CAGR of 8.3% between 1998 and 2004) and is growing faster than in many of the largest OECD economies Significant new investment in school buildings and equipment Radical reforms National Strategies for literacy and numeracy Specialist schools and academies Choice and flexibility of curriculum pathways in agenda Every Child Matters agenda etc. Current performance around average in international league tables

10 However, despite these improvements public services are still not world class (1) England Scotland Education The latest worldwide league table of child reading achievement puts England in 19 th and Scotland in 26 th place. Source: PIRLS 2006 International Report Singapore New Zealand Northern European Childrens achievement in reading

11 Despite these improvements public services are still not world class (2) Health & social care In a combined index of satisfaction with health care and social services, from 2004, the UK is ranked 10th out of 28 European countries. Source: EFILWC Health and care in an enlarged Europe 2004 UK Eastern European countries Spain, Ireland, Italy Northern European countries Index of satisfaction with health and social care services

12 Despite these improvements public services are still not world class (3) Justice Victim satisfaction with police response in the UK is just above the European average. Source: EUICS 2005 Burden of crime in the EU UK Measure of victim satisfaction with policing Average Denmark

13 Public services face a number of long term challenges. Trends in long term conditions and obesity will increase pressures on health employment and welfare services

14 Public services will continue to strive to meet rising public expectations about customer experience, access to services and how services adapt to their needs

15 Public services will face simultaneous pressure for greater productivity/efficiency, and improved quality of service

16 Public services also face immediate challenges created by the credit crunch, the recession, and the pressure on public finances Speed of change Volume challenge Contradictions Confidence

17 In response to these challenges, the government set out a set of principles for public service reform, published in Excellence and fairness in 2008 Citizen empowerment New professionalism Strategic leadership Excellence and fairness

18 In response to these challenges, the government set out a set of principles for public service reform, published in Excellence and fairness in 2008 Citizen empowerment New professionalism Strategic leadership Excellence and fairness Personalising the relationships between citizens and frontline professionals

19 In response to these challenges, the government set out a set of principles for public service reform, published in Excellence and fairness Citizen empowerment New professionalism Strategic leadership Excellence and fairness Personalising the relationships between citizens and frontline professionals Giving citizens more control means that risk and responsibility are shared

20 In response to these challenges, the government set out a set of principles for public service reform, published in Excellence and fairness Citizen empowerment New professionalism Strategic leadership Excellence and fairness Personalising the relationships between citizens and frontline professionals Giving citizens more control means that risk and responsibility are shared Increasing autonomy from the frontline, greater accountability to the user, and responsibility for efficiency/productivity

Translating the principles into policies and system reforms Citizen empowerment New professionalism Strategic leadership Excellence and fairness Individual budgets The power of information Peer support, mutual aid and self help Recruiting the brightest and the best Bottom up efficiency programmes Funding and support for innovators Optimise preventative spending

22 The Excellence and fairness approach to improving public services is being implemented in a range of different government strategies The NHS Next Stage Review put professionals at the heart of the policy- making process From the Neighbourhood to the National, a Green Paper on policing, contains proposals to empower citizens to hold their local Police to account Communities in Control sets out new duties to involve users of services and help them shape services No One Written Off, the welfare Green Paper includes proposals to modernise the provision of training and welfare and devolve more decision making Childrens Plan: One year on, outlining policies for 2009 which will provide every child & young person with the best start in life.

23 The lessons of public service reform Targets and command and control can produce short term improvements, but reduces the capacity of systems to continuously improve Targets can create perverse incentives Targets and prescription undermine local innovation and leadership and reduce local discretion of professionals Too many targets too many initiatives We have learned effectively from other OECD countries including Sweden, Australia and the US Choice can be introduced in ways that enhance rather than exacerbate inequality Choice has been seen as an attack on professionals and local leaders Choice is not the only way to empower citizens - greater control and stronger partnerships with staff are equally important There are limits to the benefits of individual choices and plenty of examples of the need for collective choice

Questions? 24

25 There are many innovations that demonstrate that personalised public services can deliver better productivity and value for money

26 Personalised public services are an essential resource for meeting Britains long term strategic challenges Bullets