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Last updated: 08 December 2009
The next stage of public service reform will involve unlocking the creativity and ambition of public sector workers55 and establishing new relationships between the Government and professionals.56 Around the developed world, the last 30 years have brought challenges for those working in the public services. Old conceptions of deference are fading and users of services have greater knowledge. Accepted good practice is changing rapidly as evaluation improves and technologies are transforming public sector provision, as they have already transformed many businesses.57 The centrally-led standards and tougher targets necessary to turn some services around over the last decade or more have inevitably created tensions between the Government and some professions.
Yet once core standards have been reached, international evidence shows that to continue to improve, services need to unleash the creativity of those who work at the front line, from the hospital doctor to the classroom assistant to the adviser at the Jobcentre.58 Services are unlikely to be highly responsive and innovative without the commitment and enterprise of the workforce who deliver them.59 They are unlikely to truly empower citizens unless front-line staff feel pride, enthusiasm and commitment to doing so. They will be unable to meet new strategic needs identified by the Government or work more effectively with other services without excellent skills and flexibility.
This new professionalism is the only way to achieve the high quality, responsive and innovative services that citizens want:
New professionalism does not mean reducing the accountability of those who work in public services or allowing provider capture. On the contrary, accountability is strengthened both through citizen empowerment, far greater transparency of performance information and professional groups setting their own challenging performance goals.62 Central government retains a role in setting direction, maintaining national minimum standards and ensuring that underperformance is dealt with, wherever it is found.
New professionalism means:
To achieve this, professional groups and public service trade unions will be vital in developing a culture of professionalism that includes skill development, innovation, leadership and a desire to achieve world class standards.
Raising skills and increasing consistency in the quality of practice
A more flexible, higher skilled workforce forms the basis of new professionalism.65 For example, no education system can be better than the calibre of its teachers – and no school will have higher aspirations than those of its head teacher.66 As new technologies develop, professionals require new skills and new ways of working.
Working in public services can be incredibly rewarding for individuals and benefit the whole of society. The Government recognises the importance of a strong public service ethos which has increased over the last 10 years, and is committed to continuing to foster and develop this.67 Therefore it will seek to expand programmes which recruit the most talented and committed people into key public services. In the 1980s and 1990s, for example, not enough of the most able graduates went into teaching, and schools in more challenging areas suffered particularly. It is now critical to better connect leading universities, and their best graduates, with the state school system and, having recruited more of the brightest and best into teaching, accelerate them as rapidly through the profession as their talent permits. That is why, for instance, the Government is such a strong supporter of Teach First, the business-led organisation which recruits from the most able graduates straight from university, training them on its own account and organising two-year group placements for them in lower-attaining schools in London and other major cities. Over the next four years, the Government will work with Teach First [External website] to double the number on these programmes. Likewise, the government will remove the barriers that discourage the best clinicians from becoming NHS managers.
Across the entire public service workforce, the Government will renew its efforts to improve skills, provide clearer routes to progression and encourage the expansion of opportunities such as public sector apprenticeships. These measures will increase opportunities for progression, with clear career ladders, such as for teaching and nursing assistants, in order to develop a world class workforce. The Government will support this by ensuring that all who work in public services have good numeracy and literacy skills and by recruiting specialist technicians where appropriate, such as those responsible for health diagnosis services.
Even excellent teachers, doctors, police officers and welfare advisers need to continuously update their skills. The best public service systems invest in continuous, regular, near real-time feedback, often through mentoring or coaching relationships, as well more formal training programmes. For example the most successful education systems in the world are characterised by high levels of lesson observation and ongoing, regular, performance management. The effective use of classroom formative assessment, with a short cycle of feedback into training, approximately doubles the rate of pupil progress.68 Yet the General Teaching Council recently found that professional development in English schools is insufficiently personalised or connected to the performance management of teachers.69 As this example demonstrates, far from being an easy answer for public services, a new professionalism capable of driving world-class improvement is likely to represent a challenge to many established ways of working.
Regular feedback also ensures that professionals get the basics right. Innovation is only possible from a platform of consistent quality and too often our public services have suffered from wide variations in the quality of basic processes. Over the last few years, there have been improvements in practices including the introduction of the National Institute for Health and Clinical Excellence and National Service Frameworks in health and better evidence on teaching of numeracy and literacy in education.70 Going forward it will be important that further development is led by dialogue with and feedback from professionals.
Underpinning the entire new professionalism agenda is increased transparency of performance information throughout the system. Poor performing services should no longer be able to hide unacceptable results, hoping that nobody will notice. Information technology now makes it possible to publish, share and search vast quantities of data, and the public increasingly expects to be able to learn about the services they may use. Raising standards to the best in the world demands a new openness, often driven by the professionals themselves.
Technology is now also providing totally new and powerful ways for professionals to collaborate and learn from one another. For example, there is already a massive growth in websites which bring together professionals and public sector volunteers, such as school governors, online.71 The Government will continue to support such developments while bearing in mind that their success is often attributed to their independence.
Rightsnet.org: Benefits advisers sharing best practice
Rightsnet is a welfare rights website for benefits advisors, that provides access to the most up-to-date benefit and tax credit information. The site has around 3,500 members and was set up by a small group of benefits advisers who wished to share their professional knowledge and experience with colleagues across the UK. The site makes it possible to share best practice and learn from the experience of colleagues in an effective and efficient way. Exchanging information and guidance, such as advice on specific entitlements and ways to access those entitlements, improves outcomes for their clients.
Visit site at www.rightsnet.org.uk [External website]
Greater freedoms for high performers
New professionalism requires high performers to have the freedoms and flexibilities to respond to the needs of those who use the service and to drive innovation and higher standards. For example, modern matrons are already showing how strengthened professional leadership can improve standards within hospital wards; and neighbourhood policing teams are providing police officers with the dedicated resources and freedom to innovate required to address the particular concerns of local residents.
This freedom starts at the organisational level. Alongside a much smaller set of national targets, public services are moving to a model of presumed autonomy in which, for those organisations that are high performing, there will be less inspection and central control.72 For example, in October 2007, the Government announced a reduction in the overall number of crime targets, designed to free up the police to focus on the most serious crimes and on local priorities, with the emphasis on minimum standards to allow greater flexibility for professionals at the front line. The Government is implementing the recent recommendations of Sir Ronnie Flanagan aimed at reducing bureaucracy in the police service, but further steps are required to free up high performers so they can excel on the front line.73 Central government will break down the barriers that prevent well performing institutions from expanding, such as with the establishment of Foundation Trusts, which develop new services to take over underperforming hospitals and begin to provide primary care services.
Professionals, in turn, are given much greater freedoms to run their own services. In the NHS, for instance, this approach has the potential to deliver real benefits for patients.74 Foundation Trusts are now beginning to pass their autonomy down from their management boards to the clinicians who deliver front-line services.75 The ‘productive ward’ programme, available across England, asks every ward team, including nurses, health care assistants and others, to take responsibility for the services delivered on their ward. Early indications show a significant increase in the time spent with patients where staff have been empowered in this way.76
Modern matrons: Ward-level leadership
In 2001, as part of the NHS Plan, modern matrons were introduced to provide strong leadership on wards and be highly visible and accessible to patients.
Modern matrons lead by example in driving up standards of clinical care and empowering nurses to take on a greater range of clinical tasks to help improve patient care. Crucially, they have been given the authority to get the basics right for patients – clean wards, good food, quality care.
One study found that the introduction of modern matrons in 2002 led, in some instances, to an 11% reduction in cases of MRSA in the following year.
There are now more than 5,500 modern matrons working in the NHS.
Dealey et al. Auditing the Impact of Implementing the Modern Matron Role in an Acute Teaching Trust, Journal of Nursing Management, 2007
In welfare, more people will be helped back to work by allowing front-line professionals to make decisions and give advice based upon the particular circumstances of each individual. So where a claimant has a temporary health problem, the doctor and employment adviser will be able to decide what treatment and support they need and when they should be reassessed; where they have poor skills, they will be offered a tailored training programme; and where they have a drug addiction problem they will be referred to a treatment course.
The opportunities to drive more personalised, more effective services by asking professionals to run and manage them themselves is one of the reasons why social enterprises and other third sector organisations have such potential to deliver public services, alongside more empowered public sector providers. And it is why innovations such as Foundation Hospitals and City Academies and Trust Schools are so important. Over time the Government is keen to see far wider development of these sorts of organisations, run at arm's length from government, not for profit, with significant scope for staff and professionals to run services directly responding to users and commissioners. Indeed, one of the best ways that government can promote a new professionalism is by enabling more of these organisations and ensuring their governance arrangements provide professional staff with a major role in management and service delivery. This is one reason why, for example, from 2010 all Probation Boards will be replaced by Probation Trusts.77
Greater diversity of provision, whether through social enterprise or foundation or academy status, or a private company, should never be a race to the bottom on costs or quality, but rather a way to encourage greater innovation and harness the dynamism of professional staff. That is why the Government is committed to ensuring that the terms and conditions of staff are protected if the management of services changes.
Nurses take control
Central Surrey Health was created by nurses in 2005, when the Primary Care Trust was separating its community nursing service from its commissioning responsibilities. Director of Nursing Jo Prichard and her colleagues came up with an alternative to splitting the service between several practices. The 700 nurses and other staff created a new not for profit social enterprise, in which all surpluses are reinvested in care and all workers own an equal penny share. The consequence has been an improvement in overall performance, a host of professionally led innovations in how to work with patients and a better work-life balance owing to greater control over shifts and timetabling.
More information can be found at www.centralsurreyhealth.nhs.uk [External website]
Rewarding success
Services will also need to encourage the best professionals to work in the most challenging areas and recognise those that deliver the most outstanding results. Too often the incentives work in the opposite direction. For example, the best schools find it easy to attract high quality teachers whereas the schools in the most disadvantaged areas can struggle to attract applicants. In addition, public service leaders will be increasingly judged by their contribution to the skills and motivation of their workforce, how they encourage innovation and how they bring on talent.
At the same time, the Government will look to professional leaders and managers to take more responsibility themselves for dealing with those who are not up to the job. In the best systems, not only is there continuous improvement but also the professions themselves set high standards and ensure they are consistently met. In future, those professionals who are struggling must be better helped to improve, while those who still do not match up to acceptable standards should be moved out of the profession.
Rewarding success
In Denver, Colorado, the Professional Compensation System for Teachers (ProComp) is the product of a seven-year collaboration among the teachers' union, the district and city hall. The scheme rewards teachers through a variety of different performance-related mechanisms both at the individual and school level.
For example, a maths teacher in a struggling city school is rewarded if she and her school meet all their goals, including: if students in her school exceed expectations on the state exams; if she meets professional academic objectives she helped set in the beginning of the year; if she earns a good evaluation from her principal; and if her school is judged to be a ‘distinguished school’, on the basis of a mix of criteria that includes parent satisfaction.
Half of Denver's 4,555 teachers voluntarily signed up to the scheme in its first year.
See www.denverprocomp.org [External website] for more details
Maths teacher example taken from Wallis C, How to Make Great Teachers [External website], TIME magazine, 13 February 2008
Excellent leadership and management
Excellent leadership and management are central to the quality of public services. A recent study of NHS hospitals found a strong link between better management practices and external performance indicators such as clinical quality and financial and operational performance.78
In every service, the Government and professions collectively have a responsibility to grow the next generation of leaders. Services must build on the success of organisations like the National College of School Leadership [External website], which is widely regarded as world-leading, to ensure the highest quality leadership development and support is available to all our future and current public service leaders. For example, in September 2007 the Principals' Qualifying Programme for further education was introduced and, more recently, a new Masters in Learning and Teaching is being established, both of which should become benchmark teaching qualifications in years ahead.79 In health, the NHS will ensure that more clinicians are supported to take up management positions. In police, the Home Office is working with the National Police Improvement Agency [External website] to significantly strengthen the training of future leaders. Across leadership training programmes, the Government will encourage services to work more closely together, pooling resources, sharing experience and enabling future leaders to learn from the experience of those in a range of services.
Operation QUEST: Police leadership and management
The Police Service and the Home Office have demonstrated tangible success through Operation QUEST, which mirrors the best management practices developed in the United States, Japan and Europe. There are three central strands to Operation QUEST:
The police have been able to achieve substantial improvements in performance, particularly in customer service, while also reducing unit costs. For example, in its Northern Division, Lancashire Constabulary reduced the number of pending ‘open’ incidents by 91% and saved the equivalent of £420,000 a year of police officer time; and in Bristol West, Avon and Somerset Constabulary, the average speed of victim contact was reduced from 8.5 days to 0.5 days for actual bodily harm.
Excellent school leadership
Excellent leadership in schools makes a difference to children's lives and the overall success of educational institutions. Ofsted reports that there is a close link between the overall effectiveness of schools of all types and the quality of their leadership and management.
The guiding principle of the National College of School Leadership (NCSL), which was established in 2000, is to transform children's achievement and well-being through excellent school leadership, both now and in the future, so that they can have a positive impact within and beyond their schools. The NCSL runs a wide range of programmes for professionals, including the flagship National Professional Qualification for Headship, which has more than 30,000 graduates. A ground-breaking Leadership Network of over 5,500 school leaders has also been set up to represent the profession in the drive for transformation.
Ofsted, Excellence in Cities: Managing associated initiatives to raise standards [External website], 2005, Ref HMI 2595.
DfES, Leadership Incentive Grant Guidance [External website], 03/2003, Ref: DfES/0139/2003
Professionals defining excellence
The final element of new professionalism involves professionals themselves defining what ‘excellence’ constitutes and how it can be achieved, complementing the work of government in setting high minimum performance standards.
Professionals have much of the knowledge, understanding and experience to know what works in the present and what is achievable in the future. These invaluable resources must increasingly be drawn upon by individuals and networks of professionals in setting high but achievable objectives, sharing best practice, improving cost-effectiveness and tackling underperformance. The Government's aim is that professionals are even more active in defining the standards expected in world class services.80 For example, in the NHS, a clinician-driven process in the South West has produced plans for improving access to local services which include a local maximum A&E waiting time of two hours and local plans to further reduce waiting times for surgical procedures.
This approach to a new professionalism will extend to more strategic influence over the future of services.
The right approach to issues of strategic planning is to make far greater use of professionals and expert evidence. This will allow public services to move from a system in which professionals are consulted to one in which their views are at the heart of designing the approaches which will deliver world class outcomes.
An example of this has been Lord Darzi's Next Stage Review of the NHS [External website]. Rather than seek to design a Whitehall national blueprint for services, he has instead sought to empower clinical groups in every area of the country to review existing practice and draw up recommendations for change, putting clinical decision-making at the heart of the NHS. This has simultaneously allowed local clinicians and NHS bodies to produce some of the most radical proposals for improving services to world class levels in the history of the NHS and given a greater confidence to patients and public that these changes are not driven by anything other than the quest for quality.
This requires a fundamentally different approach from government. As with the NHS, it requires the centre to find the right structures to empower professionals, as expert partners. In key sectors the Government will work with public sector leaders to create forums in which world-class standards can be identified, debated and agreed. Building on the Darzi report in health and the Children's Plan in education and children's policy,81 government departments will ensure that leading professionals are right at the heart of the drive to improve services.
New professionalism is about a shared commitment between the Government and public professionals to create world class performance right across the country. This represents a major strengthening of the Government's approach to enabling high quality services. It means maintaining high standards of service and performance, and strengthening user choices and voice, but at the same time providing space for the best professionals to manage and run their own services. It will require a constant dialogue between government and professional staff on how to achieve the world class standards people want.
New professionalism also rests on redefining the relationship between professionals and citizens. Professionals are no longer simply accountable to their managers or to the Government. Users of public services and other citizens should have the primary role, empowered to demand service improvements where performance falls below expectations and bring more of their own expertise, time and energy to solving problems collaboratively with professionals.
Government will look to professionals to challenge each other, share knowledge and learn from one another to continuously drive up performance. The Government will now expect professionals themselves to take the lead in addressing underperformance and to ensure they have the skills necessary to meet people's needs and aspirations. Where high minimum standards are met they will have the freedoms to innovate and strive for world class outcomes.