Britain is the fifth richest country in the world,11 the home of some of the world's leading companies, many creative scientists and many intellectual and cultural figures. In past centuries it was one of the first countries to recognise the need for government to ensure that all citizens could enjoy a decent education, good health and security in times of need. As a country there is no reason why Britain should offer its citizens anything less than the highest quality public services.
Being world class should involve:
- Delivering excellent outcomes, such as high levels of literacy and numeracy, healthy populations and low levels of crime, and constantly striving to improve those outcomes.12
- Offering personalised approaches that are responsive to individual needs13 and delivering basic services to users fairly, swiftly and efficiently, as well as responding quickly if things go wrong. Personalising services involves moving beyond a ‘one size fits all’ approach to offer services that are flexible. It also means always treating people with dignity and respect and recognising the importance of designing services that fit into people's busy lives.14 Wherever appropriate, people should be treated not as the passive recipients of standardised services, but as active partners, able with tailored support to solve many problems themselves.
- Being fair and equitable – not simply delivering excellence for the most assertive citizens or the better off. This involves striving to meet the distinctive needs and aspirations of each individual, family and community – tackling inequality and achieving excellent standards for all.15 World class services promote a fairer society – this means that they actively reach out to all, regardless of wealth, background, gender, ethnicity or assertiveness. A core purpose of world class services should be to reduce inequality; not to tolerate second rate services or significant variations in service quality between different locations – so-called ‘postcode lotteries’.
- Offering good value for money. Public investment is critical to excellent services, but systems that deliver the best outcomes, with the highest levels of satisfaction and equity, need not be the most expensive. World class services achieve value for money by focusing on the productivity of staff and on prevention rather than cure, as well as by carefully allocating resources to people in greatest need and by adopting the most effective approaches.16
Britain's public services today
Looking at the characteristics of the best public services it is clear that most public services in Britain are good, but not yet world class. Last year, for example, 80% of children attained the benchmark level of good English at the end of primary school, compared with 63% in 1997. But recent international assessments ranked the UK as 13th out of 30 OECD countries for reading performance by 15 year-olds – a good performance but there is still scope for significant improvement.17
Reforms such as Children&039;s Centres and neighbourhood policing have extended the range and responsiveness of Britain's public services. NHS Direct enables millions to access healthcare advice and support around the clock, in their own home, over the telephone and via the internet. However, many people still complain of difficulty accessing services. Too many services are still designed around the needs of the service provider rather than the service user. For example, satisfaction with GPs is high and above the European average, but satisfaction with the ease of accessing GP services is still below the European average18 and causes significant resentment, especially for working families.
Some of the most dramatic improvements over the last decade have been in the most disadvantaged areas, helping to create a fairer Britain. Some of the fastest growth in GCSE results can be observed in the most disadvantaged communities19 and there is evidence that the class attainment gap is narrowing.20 However, it is clear that many inequalities have yet to be tackled. For example, only one in five of manual workers' children go into higher education compared with half of non-manual workers' children.21 Any society determined to increase social mobility and achieve equality of opportunity must address these differences.
Over the last 10 years, investment in many services in the UK has been brought up to levels comparable with other developed countries. Investment in education has risen from 4.4% to 5.5% as a proportion of GDP,22 and in health from 5.5% to 7.3% as a proportion of GDP.23 In addition, over the past three years more than £23 billion of efficiency savings have been made and reinvested in services.24 After successive centrally-driven reductions, the number of civil servants in Whitehall is now approaching a post-war low. Truly world class services hardwire such efficiency savings into the system.25 In Canada, for example, the Government Expenditure Management System [External website] provides an ongoing review of existing spending.26 Likewise in Britain, services will need to achieve even greater value for money in the future.
To achieve the next stage of improvement, to deliver quality and fairness for all, a new phase of reform is required. This phase must build on previous success by accelerating and deepening the reforms already in place. Sustaining good funding and using high national minimum standards will remain important in the future, but we need to go further. Services will be provided by a wider range of organisations and offer greater choice which remains a central driver of improved innovation and performance. But government must also adopt new approaches, learning from the experience of the countries with the very best outcomes.
Characteristics of world-class services
Examining the best public services in the world, together with the best public services in the UK, points towards clear lessons for the next stage of reform.27 World class systems put more power in the hands of citizens and public service professionals but they also leave an important role for central government to make sure that the right incentives, behaviours and cultures are in place to ensure that improvement becomes self-sustaining:
- Citizens are empowered to shape the services they receive. Public services should reflect the preferences and needs of those who use them, not those who provide them. In addition, citizens must have the power to work collaboratively with services – parents with schools, patients with doctors, residents with police – rather than passively receiving services. In world class systems citizens have clear information about the performance of services and the power to ensure that their needs and aspirations are met,28 both as individuals and as members of communities.
- Public service professionals act as the catalysts of change. Achieving world class services demands that innovation, consistency, continuous self-improvement and responsiveness are driven from within the public services themselves. This requires services led by skilled and informed professional staff able to respond directly to the needs of the public and compare their performance with their peers. Sometimes in the past our reform programmes have discouraged professionals from developing or sharing new ideas or innovations. Energising the workforce is a key element of the next phase of our reform programme
- Government provides strategic leadership. World class public services depend on governments providing leadership by setting a clear vision, a stable framework, adequate resources, effective incentives, as well as accessible and consistent information on performance. Only government can take this broad overall view. This means rejecting the temptation for government to micro-manage from the centre. It also means rejecting the laissez faire option of an absentee administration, which provides no direction, standards or vision. The health, welfare and education systems which succeed are not those where the government plays a limited role, but rather those where the government's role is strategic and enabling.
Around the world wherever public services are considered excellent these three characteristics are typically present, for instance Swedish health care,29 Danish public services,30 Canadian education (see box) and policing in many American cities.31 The best public services in the UK also reflect these three characteristics, for example the best foundation hospitals, the highest performing schools or the most successful neighbourhood policing initiatives. In addition, many of the most admired private sector companies have long recognised that putting the customer first, unlocking talent and providing clear leadership are critical for success.
These three characteristics – citizen empowerment, new professionalism and strategic leadership – are mutually reinforcing.32 For example, giving users more control over the services they receive requires that public service professionals have the freedom and skills to innovate in order to meet what are likely to be a diverse set of needs and aspirations. Government sets a foundation of high minimum standards on which professionals build such innovation.
Each of the three strands and the way in which they can be achieved are outlined in the following sections. Lessons from the highest performing public services in Britain and around the globe are drawn on throughout.
How Ontario’s schools reach every student
Ontario has one of the highest performing education systems in the world. In the two most recent international reports (based on 2006 data) Ontario was a top performer. For instance, in the PISA results involving 57 countries, Ontario was fourth in reading (behind Korea, Finland, and Hong Kong), fifth in mathematics and third in science, and demonstrated significant gains or continuing high performance since the last assessment in 2003. Similarly, in the PIRLS study of reading results among 9 and 10 year-olds only two countries, out of 45, performed significantly better.
Citizen empowerment: Ontario has an explicit objective to increase public confidence in the education system. A Provincial Parent Board was established in 2007 to ensure parents' views on schooling and education are taken into account. This is in addition to Parent Involvement Committees which give parents a voice on school boards. The Managing Information for Student Achievement (MISA) initiative aims to improve the collection and use of data by regional government, education boards and schools.
New professionalism: The Ontario government has placed specific emphasis on building professional respect and partnership over the past few years. The School Effectiveness Framework was launched in 2007 and is premised on establishing the professional accountability of Ontario's educators for monitoring improvement. Extensive and targeted capacity-building for improving teaching practices, instructional leadership and system improvement have been rolled-out across the system.
Strategic leadership: The government has developed a strong and shared leadership for Ontario's reform agenda. A ‘guiding coalition’ of political and professional leaders has been significant in developing, communicating and continually improving the education strategy. There has also been a focus on minimising distracting initiatives to ensure the delivery of priorities – including labour stability, budget, governance and operational efficiencies. For example, four-year pay agreements have been agreed with teachers.
Reach Every Student: Energizing Ontario Education [External website], Ontario Ministry of Education, Winter 2008
How Finland achieves excellence in health care
In a combined index of satisfaction with health care and social services Finland is ranked 2nd out of 28 European countries. The OECD (2005) reports that the Finnish system is driven by a strong culture of professional self-improvement and collaboration. The system performs excellently against OECD (2007) measures of health care quality such as breast cancer survival rates – which are among the best in the world.
Citizen empowerment: Patient complaints are collected together as part of Finland's national policy of ‘steering by information’. Patients also have a right to information. The most important channel for the public to participate in the health system is the locally elected municipal authorities – and the OECD (2005) reports that local communities can easily exercise preferences over spending priorities.
New professionalism: Finnish health care staff have high levels of skills and training and there is a high quality of technical health procedures. Doctors are trained centrally at one of five medical schools. There is a strong culture of self-improvement, with significant levels of clinical autonomy and a professionally led Clinical Quality Management system which informs the medical profession as a whole.
Strategic leadership: Central government defines general social and health policy and prepares major reforms, however Finland has one of the most decentralised health care systems of its kind. Governance of primary care, hospital care and social services is delegated to more than 400 municipalities.The OECD (2005) reports that bottom-up change is a valuable feature of the Finnish health care system – municipalities can tailor services to meet local demand, based upon local knowledge.
OECD, Reviews of Health Systems: Finland [External website], OECD 2005. European Foundation for the Improvement of Living and Working Conditions [External website] (2004) Health and Care in an Enlarged Europe [External website]. Health at a Glance, OECD, 2007.
Notes
- World Development Indicators Database [External website], World Bank, 2007.
- For example, continuous improvement has been identified by the OECD as embedded within the high performing Finnish healthcare system through a strong culture of professional self-improvement, and high levels of motivation among staff to deliver good quality services (Review of Health Systems: Finland [External website], OECD, 2005).
- For example, the Dutch healthcare system is rated highly by the OECD in terms of the quality of medical procedures and services, but it also performs well in terms of customer service and satisfaction – a Health Consumer Powerhouse, Euro Health Consumer Index [External website] 2007 ranked the Dutch system second in Europe in terms of a number of measures, including customer service.
- Evidence indicates that there is an extremely strong correlation between whether patients consider they are treated with dignity and respect and their overall satisfaction (NHS Acute Trust Inpatient Surveys [External website], DH, 2001/02).
- Nordic countries, such as Finland and Denmark, have some of the highest performing public services in the world and this often includes high levels of fairness and equity by international standards. For example, Knowledge and Skills for Life: First Results for PISA [External website], OECD/PISA, 2001, rated the Finnish education system as ‘high excellence’ and ‘high equity’, while the the UK was rated as ‘high excellence’ and ‘low equity’.
- Delivering our world class ambition will mean doing even more to ensure that delivery is as effective and efficient as possible. That is why the Government has set a target of a further £30 billion of savings over the next three years. Looking forward, the Government will continue to deepen and widen its work on efficiency to ensure policies and ways of working are delivering the best possible deal for the taxpayer.
- PISA 2006 Science Competencies for Tomorrow's World Volume 2 [External website], OECD, 2007.
- Health and Long Term Care in the European Union [External website], Eurobarometer, 2007.
- The percentage of pupils achieving five or more A*-C at GCSE/GNVQ and equivalents in relatively deprived Excellence in Cities Partnership areas increased by around 11 percentage points from 39.8% in 2001 to 50.6% in 2005. The rate of increase in non-EiC schools over the same period was around five percentage points, rising from 52.2% in 2001 to 57.5% in 2005. Excellence in Cities Factsheet [External website], 2008.
- For example, since 2004 gaps have been narrowing between free school meals (FSM) and non-FSM pupils at Key Stages 2, 3 and 4 and the latest data shows there has been a rise in the proportion of people from disadvantaged areas going to university. Source: DCSF.
- Hirsch, D. Chicken and egg: child poverty and educational inequalities [External website], CPAG, 2007.
- UK Education expenditure as a proportion of GDP [External website], DCSF, 2006.
- Public Expenditure Statistical Analyses 2007 [External website], HM Treasury, 2007.
- HM Treasury: 2004 Spending Review: efficiency progress to December 2007 [External website], March 2008.
- Budget 2008 – Stability and opportunity: building a strong sustainable future [External website], HM Treasury, 2008.
- Budget 2008: Responsible Leadership [External website], Canadian Department of Finance, 2008.
- For example, as part of Lord Darzi's NHS Next Stage Review [External website] there has been a far reaching programme of engagement and consultation with those working within the health and social care services.
- For example, school results and inspection reports create public pressure for improvement, and legitimacy for change when things are not good enough.
- The Swedish healthcare system is one of the best in the world – performing very highly on OECD quality measures (see Health at a Glance [External website], OECD, 2007) and levels of patient satisfaction (90% satisfaction rating with quality of hospitals – Health and Long Term Care in the European Union [External website], Eurobarometer, 2007). The system is characterised by high levels of citizen empowerment, for example users have rights to choose where to have treatment, alongside good access to large amounts of information about healthcare. There is also a significant degree of devolution to local/regional government whereby healthcare is organised according to the needs of local residents. These forms of citizen empowerment are combined with a high level of professional autonomy and self-improvement (for example, National Quality Registers, a tool used to disseminate best practice among professionals, are run and owned by professionals themselves) as well as strategic leadership by government –: the government sets overarching expectations which are used by citizens to hold care providers to account (for example national guidelines for waiting time limits). See, for example, Improving the Quality of Health Care Systems [External website], OECD, 2002.
- An additional example is Danish public services, which also perform very well on international measures. In a combined index of satisfaction with healthcare and social services, from 2004, Denmark is ranked 5th out of 28 European countries (European Foundation for the Improvement of Living and Working Conditions, 2004); crime is reported as falling by 11% (International comparisons of criminal justice statistics http://www.homeoffice.gov.uk/rds/pdfs2/hosb1203.pdf [External PDF]) between 1997 and 2001 – the second largest reduction in the EU). The Danish government recognises the strategic role it can play, for example by stimulating innovation – the Ministry of Finance has set up a unit to promote new ideas,with plans such as creating a single account for financial transactions with citizens. The stimulation of innovation is mutually reinforcing increased citizen empowerment – one idea which exemplifies this is the ‘Danmarks Debatten’ project. This is an online discussion forum designed to allow citizens and elected representatives in Denmark to contribute to debates on current topics affecting them locally and nationally. Local authorities and other government bodies can use the system to instigate debates based around a current issue facing citizens in a locality. Citizens are then able to engage in an exchange with their elected representatives by submitting their views through DanmarksDebatten. From summer 2007 the site has been combined with a new web portal for Danish citizens – borger.dk (meaning ‘citizen.dk’) (see Organisational Change for Citizen-Centred Government, 2007).
- For example, the Chicago Community Alternative Policing Strategy was inaugurated in April 1993. The programme was expanded to encompass the entire city after testing in five police districts. In the Chicago Police department, each of the 279 police beat officers and sergeants meet regularly with residents to (a) identify which public safety problems (e.g. a crack house) constitute the most urgent priority, and (b) develop strategies involving both police and civilian action to deal with these problems. These beat meetings are held accountable to the central authorities by requiring them to document their problem solving and by regular checks to ensure that the groups have not been captured by vested interest groups. In Chicago, many categories of crime peaked in 1991 and then declined sharply. Over the 1991-2002 period, violent crime declined significantly, as did property crime and robbery.
- Ideas from systems theory can help us to further elucidate this approach. It has been argued (see, for example, Chapman, J. System Failure: Why Governments Must Learn to Think Differently [External website], 2004) that public services can be described as adaptive systems because they contain many actors whose individual decisions are a function of the decisions made by other actors in the system. The behaviours displayed by such systems are often difficult to predict, meaning the systems cannot be ‘controlled’ in the traditional sense. Instead, improvements will come from effective use of incentives, investment in capability and enabling solutions to be generated from the many interactions in the system.
