Last updated: 08 December 2009
Excellence and Fairness: key questions for policy makersImplementing the principles of Excellence and Fairness will vary from service to service. However, in developing service improvement policies it will often be useful to consider the questions set out below. Some domestic and international examples of interesting practice are also included.
This policy toolkit includes information and checklists on the following:
| Key questions | Domestic examples | International examples | |
|---|---|---|---|
| Raising skills and increasing consistency in the quality of practice | Can the skills of the workforce be improved? | The National College of School Leadership recently introduced the new Masters for Teaching and Learning [External website] | In Finland all teachers have a Masters degree either in education or in one or two teaching subjects [External website] |
| How does the system ensure that professionals focus on getting the basics consistently right? | The National Institute for Health and Clinical Excellence and National Service Frameworks in health have improved basic practices in the NHS [External website] | The New Zealand Teachers' Council (NZTC) is responsible for developing a framework of competencies for different levels of teachers [External website] | |
| Are performance and information evaluations transparent and widely available? | Information technology now makes it possible to publish, share and search vast quantities of data, e.g. outcome information on individual surgeons | In Sweden, National Quality Registers ensure medical practitioners respond to reliable data and information and help to drive continuous improvement | |
| Are their mechanisms in place for professionals to collaborate and learn from one another? | Rightsnet is a welfare rights website for benefits advisers that provides up-to-date benefit and tax credit information and give advice [External website] | In Victoria, Australia. teachers have access to a knowledge bank to ensure good practice is shared across the system [External website] | |
| Giving high performers greater freedoms | Can individual professionals be given greater freedoms to respond to the needs of those who use the service? | 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 [External website] | In Holland, healthcare professionals have responsibility for quality improvement. They set standards, formulate recommendations and decide on corrective actions. |
| Can high performing organisations be given greater freedoms? | The overall number of crime targets were reduced in 2007 to free up police to focus on the most serious crimes and on local priorities [External website] | In the U.S. Charter Schools fund most reforms and have considerable freedoms. [External website] | |
| Are staff able to establish social enterprises? | Local authority managed leisure services have become independent leisure trusts | ||
| Supporting and encouraging innovation | Are front line professionals/service providers empowered and incentivised to innovate? | The Productive Ward Programme designed by the NHS institute for Innovation and Improvement, empowers nurses to look at how their ward is organised and make changes that allow them to spend more time with patients | Singapore's Public Service for the 21st Century programme seeks to foster a culture in which all the workforce is encouraged to continiously improve services. |
| Can radical innovations be incubated through distinct funding and support? | The NESTA Health Launchpad is an early-stage incubator, which develops promising ideas around long-term conditions into new ventures | ||
| Rewarding success | What incentives can be put in place to encourage the best professionals to work in the most challenging areas? | Teach First has successfully encouraged some of the most talented graduates to teach in inner-city schools. [External website] | Professional Compensation System for Teachers (ProComp) in Denver, Colorado rewards teachers through a variety of different performance-related mechanisms [External website] |
| How does the system deal with those professionals who are poorly performing? | The National Patient Safety Agency helps local organisations manage performance problems with doctors and dentists. [External website] | ||
| Excellent leadership and management | How will the next generation of leaders be developed at every level? | The National College of School Leadership has introduced new qualifications for school leaders and is working with local authorities on succession planning [External website] | New Zealand has a mentoring program for first time principals and a coaching support program for experienced principals [External website] |
| Professionals defining excellence | How can professionals set their own stretch targets? | 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 four hours | In Finnish healthcare there is a strong culture of professional self-improvement, with high levels of motivation amongst staff to deliver good quality services |
| Key questions | Domestic examples | International examples | |
|---|---|---|---|
| Providing vision and direction | Is government providing the necessary vision and direction to the system? | The Next Stage Review of the NHS sets a high level vision without detailed implementation plans which are the responsibility of local SHAs, PCTs and trusts [External website] | Many mayors in US cities put considerable effort into building coalitions of statutory, private and third sector organisations to address local challenges |
| What role should government play in leading changes in people's attitudes and behaviours? | The ‘Think!’ road safety campaign has helped the UK have one of the best road safety records in the world [External website] | In Australian the ‘Slip-Slop-Slap’ campaign from 1981 helped shift attitudes towards using protective measures against harmful radiation from the sun [External website] | |
| How can local government be empowered to lead change in the system? | Local Area Agreement negotiations on local targets and funding have shown that local leaders are well placed to bring services together [External website] | In Finland centralised steering in education was drastically reduced in the 1990s and operational control devolved to 400 municipalities | |
| Do the accountability and management arrangements for services facilate strategic leadership by central government rather than micro-management? | NHS Foundation Trusts have reinforced the accountability of Trust Boards for financial and operational management of hospitals. [External website] | In Sweden, operational management decisions are nearly always the responsibility of arms-length agencies or local authorities, rather than central Government Departments. | |
| Guaranteeing standards and fairness | What are the baseline standards below which service providers cannot fall? | The new NHS Constitution will set out the basic standards that people can expect from their local NHS services [External website] | In Finland the National Board of Education is an expert agency responsible for the development of education aims, content and methods [External website] |
| Is there a clear failure regime for those that fall below minimum standards? | The new National Challenge programme sets out how local authorities will work with schools where attainment is low [External website] | In Victoria, Australia there is systematic intervention in under-performing schools | |
| How will equality of access and power be ensured, particularly for disadvantaged groups? | The recently revised schools admissions code ensures fair access to schools [External website] | In a number of parts of the US children from disadvantaged backgrounds or from underperforming schools are given a wide range of school choices. | |
| Providing stability as a long term investor | Does the funding and management framework provide the stability and incentives required for organisations achieve long term improvements? | Multi-year pay agreements covering over 1.5 million public service employees have recently been negotiated | In Ontario, Canada, four-year pay deals have been agreed with teachers |
| Are incecentives in place to promote continuous improvements in value for money? | The HM Treasury Operational Efficiency Review is exploring how front line leaders can be incentivised to indentify improvements in efficiency and effectiveness in services. [External website] | The Canadian Government has a long-standing programme of continuously identifying efficiencies. | |
| Building service capacity and and connections to bring about change | Is there a process for ensuring sufficient numbers of skilled staff are recruited and developed? | The Training and Development Agency for Schools has increased the routes into teaching and provided greater national support for teacher training and development, alongside successful recruitment campaigns. [External website] | Victoria, Australia has an accelerated development program for high potential leaders |
| Are professionals put at the heart of the policy making process? | Lord Darzi's Next Stage Review engaged clinical groups across the country allowing local clinicians and NHS bodies to produce some of the most radical proposals | ||
| Are opportunities for exploiting new technology being pursued? | In 1997 NHS Direct was a phone-based service, now it receives more visits online than telephone calls [External website] | Service Canada simplifies access to a range of Government services, with a single route for phone, internet and face-to-face inquiries. [External website] | |
| Central Government understanding and capability | Do policy makers understood the variety of factors involved in acheiving outcomes – the ‘overall system’ – and the complex interactions between these factors | The recent Government report Food Matters sought to articulate the complex relationships between consumers, the food chain and public services before developing strategies for achieving individual outcomes | In Finland, the STAKES research agency supports policy makers with independent, expert advise on health and welfare policy. [External website] |
| Does the central Department have sufficient capability to provide strategic leadership to the system? | All UK Government Departments now undertake Capability Reviews, which assess Leadership, Strategy and Delivery capabilities. [External website] | Over recent years the Government of Canada has invested in the capability of Government staff through the creation of the Canada School of Public Service and new responsibilities on managers to promote training. [External website] |