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Last updated: 08 December 2009
1. The need for public services to innovate rapidly in order to match the best services around the world has never been greater. The United States, for example, had one of the highest rates of university education for much of the 20th century, but in the last 15 years the rate has remained relatively stable while countries such as Poland, Denmark and the Netherlands have significantly surpassed it.1 Health systems that have been world leaders in treating acute illnesses and injuries, such as the French system, are by no means certain to be the best at supporting the rapidly rising number of people with chronic health conditions. The nimble development of online services is allowing ‘leapfrogging’ in the provision of high-quality transactional services. South Korea, for example, has moved quickly to develop one of the best public internet-based job searching systems in the world.
2. Examples such as these demonstrate two lessons. Firstly, that public services cannot stand still if Britain is to compete with the rest of the world - continuous improvement and innovation are needed. Secondly, looking at leading-edge practice across the world should spark our thinking about how public services should develop - there is much we can learn from others. This study, drawing on examples from around the world, therefore highlights some of the innovations and thinking that could keep Britain at the forefront of service improvement.
‘In fast-moving areas like education, if a country stands still on reform for a decade, it is almost impossible for it to recover.’
3. Britain is facing the current global economic downturn with public services in better shape than ever before. Sustained investment and reform have given communities in England, for example, access to Children’s Centres with the flexibility to respond to their changing family needs, as well as schools with better teachers, their own neighbourhood policing teams, hospitals with the shortest waiting times in history and far more personal support and advice for those seeking work.
4. How should services develop further in the years ahead? Overall, the importance of public services is likely to grow rather than diminish. For example, sources of increasing wealth creation - such as the emerging low-carbon, life science and pharmaceutical, and digital industries - will create new opportunities. But every person, and the country as a whole, will only have the potential to benefit fully if they have access to excellent schools, training and employment services. As the baby boom generation ages, they have the opportunity for far more active retirements than their parents’ generation, but this potential will only be fully achieved if they have access to world-class health and social care.
5. Such benefits of excellent services are the reason why the Government is continuing to invest in them. The Government’s strategy for Building Britain’s Future affirms the importance of public services in delivering fairness and prosperity, and sets out new pledges on and entitlements to better health, education, training and policing.
6. Services are, however, likely to find delivering further improvement in the years to come more challenging than over the last decade. The combination of responding to new economic opportunities, serving a significantly larger older population and tackling the potential legacies of the current global recession will put pressure on many services. Progress has already been made in delivering many of the ‘easy wins’ in service improvement, such as tackling the worst-performing schools and hospitals.
7. Above all, the rate of growth of public spending is set to be lower than in the decade that has passed.2 This will require stepping up the drive to improve value for money by taking hard decisions on priorities as needs change, redesigning services, sharing assets better and cutting bureaucracy.3 Identifying and delivering such value will need to be a shared endeavour between central government, local government and services, front-line professionals and citizens.
8. An acceleration of innovation will therefore be required across public services.
‘Developed countries around the world have entered a new period governed by two big facts:
- Many people face hard times and uncertainty, when the support and security provided by public services is more, not less, important.
- For everyone, including governments, using financial resources carefully and doing more with less matters more than ever.’
Tom Bentley, Policy Director for the Deputy Prime Minister of Australia
9. This paper aims to contribute to thinking about such innovation. We draw on nearly 50 interviews with leading experts in public service reform from around the world, in which we probed specific elements of service innovation and wider lessons for service management.
10. The analysis is not intended to be exhaustive. Equally valuable lessons will come from recent service innovations in Britain and from the insights of service users and those who work on the front line.4 Our services are often already ahead of those in other countries, but we have not usually sought to highlight domestic innovations in this paper. Nor could all the innovations be replicated in the UK; many arise from different structures of public service provision, cultural norms, local conditions and financial constraints.5 In considering lessons, it is also important to recognise that the public services that are covered in this study are delivered by the Devolved Administrations of Scotland, Wales and Northern Ireland and by local authorities. It will be for these bodies to consider the most appropriate insights. At a time of necessary innovation, however, the best organisations look outward - for practices which can be replicated and to spark new ideas and challenge existing ways of thinking.
11. The source of much improvement in public services around the world over the last 30 years has been better management. Services have been set clearer objectives. Accountability has been clarified. Scrutiny has been formalised.
12. Britain has often been at the forefront of these changes. The Government’s 30 Public Service Agreements (PSAs), for example, have provided a clear set of medium-term goals around which service strategies and targets are developed. Comparative information about the performance of schools, hospitals and local authorities has challenged these services to raise their quality. Over the past decade this has been supported by historically high levels of investment in public services.
13. However, to respond to the challenges services face, this approach needs to be built upon. Our work highlights the way in which the drive for innovation and improvement in the best services is increasingly coming from a new relationship between citizens and services.
14. To address effectively major needs in society, such as those arising from chronic health conditions, inadequate child wellbeing and antisocial behaviour, it is necessary to give citizens and communities a greater role, enabling them to bring their own insights, time and energy to meeting their own needs in partnership with services.
15. Achieving not merely adequate standards in services, but high-quality, personalised responses to the aspirations of millions of citizens, rests on ensuring that people can better direct services themselves. At the same time, front-line professionals need enhanced freedoms, skills and links to their local communities, in order to respond better to service users.
16. Enabling a new relationship between citizens and professionals requires a change in the way government operates. It involves stepping back from day-to-day management while providing strong leadership on strategic issues such as promoting fairness, building service capacity, and establishing a framework for services and citizens to drive improvement themselves (see box on page 9).
17. This is why over recent years the Government has been streamlining targets, giving more weight to citizen perceptions, increasing the role of local government and the autonomy of service leaders, and focusing direct intervention on services that fail to meet reasonable standards.6
18. It is why a greater diversity of public service providers has been encouraged, for example through the voluntary sector and social enterprises, to match the heterogeneity of people's needs and aspirations. It is why the Government has continued a long-term investment strategy in services and is building the capacity of those who work in them.
19. These wider issues of governance and management are essential elements of further reform. This study, however, has a more specific focus. It examines some of the changes that will be most important at the interface of front-line professionals and the citizens they serve. We consider insights from around the world - which we hope will help to foster further innovation in service provision - on five specific elements of this new relationship with citizens:
Achieving ‘excellence and fairness’ in public services
Over the last year, the Government has established a new framework for improving public services in Britain. Building on previous phases of reform - including better performance management and greater choice and contestability - further improvement will rest on better empowering citizens, fostering a new professionalism and government providing more strategic leadership. This vision was recently strengthened in Building Britain’s Future, which sets out how citizens will be given greater power, particularly through new entitlements such as those for patients to be treated rapidly by the health service and that for pupils falling behind at school to be given one-to-one support. This study builds on this framework, focusing on the relationship between citizens and professionals.
Sources: Excellence and fairness: Achieving world class public services, Cabinet Office, 2008; Working together: Public services on your side, HM Government, 2009; Building Britain’s Future, HM Government, 2009
20. In the best public services, strong entitlements embed, and extend to all, key standards of access and quality to core services. It is from this foundation of fairness and security that greater personalisation, professionalism and innovation develop. The most successful approaches to strengthening entitlements:
21. A revolution in the use and re-use of information on public services is being stimulated by new online technologies, giving the potential to empower citizens to hold services to account far more easily than in the past. The leading-edge systems, such as StateoftheUSA.org and data.gov, are not only disseminating information rapidly. They are also breaking down government monopolies on information presentation and use by making it easy for people to analyse information themselves. At the same time, blogs, wikis and other web 2.0 tools are enabling citizens to get more deeply involved in validating information and collectively making decisions. In Cologne, for example, participatory budgeting uses new technology to give citizens a stronger voice over how public money is spent.
22. The shift required for governments to enable such changes is cultural as much as technical. It is no coincidence that American public services have been at the forefront of these changes, for they already had an understanding that all government information should be in the public domain. Government should, however, do more than just liberate information. The global leaders will be those who invest in ensuring that information is high-quality and balanced, can be shared through common standards and facilitates joint working by professionals and citizens.
23. Service Canada gives people access to nearly 80 government services, and the choice of accessing online, in person or by post. Wraparound Milwaukee, in the USA, provides a single system of tailored care for children with serious emotional disturbance, with a lead professional responsible for each child. These are just two examples of how services designed around the needs of the person, as opposed to traditional organisational structures, are delivering better outcomes and, in the process, building stronger relationships with citizens.
24. As service budgets get tighter around the world, people are asking whether personalisation is affordable. We highlight how the integration and tailoring of services can save money, by reducing unnecessary activity, exploiting a second generation of e-government, and using lead professionals better. Service Canada, for example, saved C$292 million in the first year. Several thousand dollars per child are typically saved by Wraparound Milwaukee as it keeps more children out of hospital.
25. Underlying these specific personalisation practices, the best services are giving people greater control. Rather than just providing one-off choices between services, such as a single choice between schools, they are providing people with continuous opportunities to control services. For example, personal budgets for jobseekers in Australia and for those with mental health needs in Oregon are giving people the opportunity to shape every element of the service they receive.
26. Innovative services are not just investing in programmes which support healthy living, chronic disease management, children’s early years development and preventing reoffending. They also deliver these measures in far more collaborative partnerships with citizens than do traditional services. They are releasing the motivation, insights and resources of citizens themselves. In particular, they are:
27. Finally, a more productive relationship between citizens and services relies on better unlocking the creativity and motivation of front-line professionals. High professional standards are the starting point for such developments. Teachers in Singapore and doctors in New York achieve these not just through good selection and training, but by frequent benchmarking of performance against their peers. The best systems successfully combine such benchmarking processes with a high degree of professional ownership of processes for improving quality. For example, in Sweden clinicians own and contribute to data held on National Healthcare Quality Registries, which then informs developments in practice.
28. We also find that the best systems are bringing professionals more closely together through chains of providers, such as among some schools in the USA, so that new knowledge and practice are rapidly disseminated. They do this while remaining strongly embedded in their local communities through the involvement of users and volunteers and by working closely with other local providers. For example, large third sector organisations in Germany provide excellent public services nationwide by combining local responsiveness, which encourages local innovation among professionals and volunteers, with channels to disseminate best practice across the country systematically.
29. The insights from international examples such as those detailed in this paper, together with innovation and learning within services, will help inform the work of HM Treasury, the Cabinet Office and other government departments in considering ways of delivering better services for the user and driving greater value for money for the taxpayer. In the coming months, for example, departments will be setting out more details about the development of entitlements in health and education in England. Across services, the Government will be looking to increase transparency.7 Within services, major programmes are under way to personalise and simplify the support provided to citizens. From services, the Government is seeking to understand better the challenges professionals face and the proposals they have for improvement. Through such measures, we are confident that the improvements in public services which have characterised the last decade will be accelerated in the years ahead.