3. REFORMING OUR PUBLIC SERVICES
3.1 As demonstrated earlier, Scotland's public services face a lengthy period of tight financial constraint against a backdrop of mounting demand and cost pressures. So, how well-placed are our public services to respond to a harsher environment and what aspects need reformed?
3.2 The scale and duration of the emerging challenges demand careful financial management and continuous improvements in service productivity, but it would be wrong to let the financial situation dominate our thinking. The issues are not confined solely to operational questions of efficiency, effectiveness and value for money.
3.3 We believe the debate must be broader, encompassing deeper questions about the design and delivery of public services, their values and ethos. We need to consider the responsibilities of individuals and communities alongside organisational cultures. We need to embed openness and democratic accountability and examine the means of control and authority. We believe these broader themes are at the heart of how the future delivery of public services can be improved.
MAKING THE CASE FOR CHANGE
3.4 The evidence we received makes the case for far-reaching transformation of public services and highlights clearly several areas for positive change:
Rather than repeat the mistakes of our recent history, we need to steer a different course towards holistic public service reform, which is driven by values, which is evidence based, and importantly, which is unapologetic in its ambition to improve outcomes.
Convention of Scottish Local Authorities ( COSLA)
One of the most important issues to be addressed in reforming Scotland's public services is a need to achieve greater simplicity through improved integration and coordination than exists at present.
Society of Local Authority Chief Executives
( SOLACE Scotland)
It is important to set out the direction and the roles and responsibilities of partner agencies and how performance will be assessed, and to ensure that partnership arrangements, and their governance and accountability arrangements, are fit for purpose and support effective decision making.
The big issue is that partners generally have a lack of visibility of how the totality of their spend (including use of assets) does, will and could affect their priority outcomes and key client groups.
The current system creates a bias towards institutional spend in hospitals rather than health improvement, in care homes rather than home care, in prisons rather than reoffending.
National Community Planning Group
3.5 We have seen many innovative and positive approaches but also heard a range of concerns about the current arrangements. Our work as a Commission has highlighted a range of key shortcomings which undermine the capacity of public services to produce better outcomes.
Fragmentation and complexity
- Scotland's patchwork of strategic authorities delivering public services is a complex product of its political and social history, having evolved piecemeal over many decades in response to society's changing needs and demands.
- This complexity is reflected in inadequate strategic coordination between public service organisations that work routinely to different objectives, with separate budgets and processes for accountability.
- Operational duplication is rife between different services.
- Points of authority and control are dispersed widely among varied public bodies, making joint-working and reform difficult. Collaboration often relies on the persistence and flexibility of individual front-line workers and leaders.
- Post-devolution, divided responsibilities and policy disconnects between the UK and Scottish Governments are evident and impact on users' needs for coordinated services.
- Government remains the dominant architect and provider of public services. This often results in 'top-down', producer- and institution-focussed approaches where the interests of organisations and professional groups come before those of the public.
- Contributions from other sources are under developed. Individuals, communities, businesses, voluntary organisations, social enterprises and charities all have resources and capacities that could be utilised more fully.
Outdated attitudes and approaches
- The philosophy and attitudes underpinning the design and delivery of public services have changed little since the birth of the welfare state. Services are provided to individuals rather than designed for and with them.
- Models of provision fail to empower and enable people and communities sufficiently to achieve positive outcomes in their own lives. Services often impair individual incentives and foster dependencies that create demand.
- A culture of professional dominance in public bodies has made them unresponsive to changing needs and risk-averse about innovation.
- Procurement is often taken forward on a scale that discriminates against smaller providers and person-centred approaches.
Poor transparency and accountability for outcomes
- Accountability for performance is often unclear and useful comparators unavailable due to a lack of data, weakening opportunities for improvement.
- Public services lack the transparency and representation of users' experiences necessary for full and effective accountability to the public. This can make it difficult to sustain popular support, especially for hard choices.
- Public bodies collect insufficient data to meet their equality duties. There is not enough information about either users or non-users of services to make informed assessments about the equity of outcomes.
- Public services find great difficulty in prioritising preventative approaches to reduce long-term future demand. Services often tackle symptoms not causes, leading to 'failure demand' and worsening inequalities.
- Many services maintain dependency and fail to build personal capacity or support independent living - in part, because of the statutory duty of care.
- The political cycle has hampered efforts at long-term reform in the past, even where a broad political consensus for change has existed.
3.6 In summary, we believe that substantial reform of how we deliver our public services is required - both in terms of the general approach taken to the provision of services, and to the wider governance and organisation of public services.
APPROACH TO REFORM
3.7 The need for reform is now urgent. If it is not substantially achieved in this Parliament, the chance to fashion an effective, sustainable and valued form of delivering public services for the future may be lost. We cannot allow the obstacles that have hampered reform in the past to thwart the action that is now required.
3.8 It is our view as a Commission that there is a way forward available to Scotland's public services to enable us to achieve this goal. The positive vision of effective, sustainable and valued public services set out in the remit given to this Commission is achievable .
3.9 In our view, it is essential to the future success of Scotland's public services that all stakeholders now work together in an urgent, sustained and coherent programme of reform of how Scotland delivers public services. Outcome-focussed transformation requires strong leadership, the resources of all stakeholders and a reasoned understanding of how outcomes are achieved. The design of roles and structures should be founded on this principle - in other words, form should follow function .
3.10 Our evidence demonstrates the need for public services to become outcome-focussed, integrated and collaborative. They must become transparent, community-driven and designed around users' needs. They should focus on prevention and early intervention. Therefore, we believe reform objectives involve :
Engagement, empowerment and enablement
- That public service organisations engage with people and communities directly, acknowledging their ultimate authority in the interests of fairness and legitimacy.
- That they work more closely with individuals and communities to understand their circumstances, needs and aspirations and enhance self-reliance and community resilience.
- That they mobilise a wider range of Scotland's talents and resources in response to society's needs.
Better coordination and integration
- Fragmentation and complexity in the design of public services must be tackled by improving coherence, collaboration and integrated service provision between agencies.
Reduction in persistent problems and demand
- All public services need to reduce demand in the system through prevention and early intervention to tackle the root causes of problems and negative outcomes.
- This means tackling persistent problems of social and economic inequality and inter-generational cycles of deprivation and disadvantage.
Performance improvement and transparency
- Public services must improve transparency and accountability focussing strongly on value for money and positive outcomes for individuals and communities.
- Governance and accountability must be simplified, streamlined and coordinated emphasising the assessment of costs and performance.
- Services must be open to independent oversight and challenge, including benchmarked comparisons, and state clearly how they are improving outcomes and efficiency.
3.11 Based on all of the above, we have identified four key objectives which must shape a programme of reform.
The key objectives of the reform programme must be to ensure that:
- public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience;
- public service organisations work together effectively to achieve outcomes;
- public service organisations prioritise prevention, reducing inequalities and promoting equality; and
- all public services constantly seek to improve performance and reduce costs, and are open, transparent and accountable.
3.12 In the following chapters, we discuss each of these four key objectives in turn, and make a number of specific recommendations for reform that we consider essential to their achievement.