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Image: small strategy unit logo Excellence and Fairness: key questions for policy makers

Implementing 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:

Citizen empowerment

Citizen empowerment
 Key questionsDomestic examplesInternational examples
Giving people choice and control over services Can service users be given more control over resources? Individual budgets empower users of social care by giving them a far greater say over how those resources are used [External website] Personal budgets are used by mental health patients in Florida. Individuals are able to combine clinical with non-clincal care so that patients can address all facets of their mental health [External website]
Can users of public services be offered more choice? - either between service providers or within institutions Academy and Trust schools have expanded opportunities for altenative providers of education to offer services. Diploma qualifications have given service users more choice over what to study without having to move to a new school [External website] In Sweden patients are free to choose the health centre, hospital or family doctor anywhere in the country. The state reimburses patients for travel costs to and from hospitals/clinics [External website]
Will people have access to information and advice to support them in making choices? NHS Choices provides a wide range of information about hospital services (including the opinions of other patients) [External website] Schools in New York City are now issued with annual ‘report cards’ setting out the performance of the school on a variety of key indicators [External website]
Ensuring individual citizens and communities have a greater say in local services Can feedback from service users be brought to bear on service providers? Many national performance agreements with services now explicitly include the citizen's viewpoint as a key indicator of success (e.g. PSA includes a measure of public confidence in local agencies to deal with anti-social behaviour [External PDF] Patient complaints are collected as part of Finland's national policy of ‘steering by information’ [External website]
Can technology be deployed to provide new opportunities for service users to share their views? PatientOpinion.org encourages the public to provide feedback on the healthcare services they receive, which is widely available to others [External website]  
Can the service be opened up to more direct forms of accountability and engagement? Neighbourhood policing teams now give people the opportunity to express their views directly through face-to-face meetings or through a direct phone line [External website] In Ontario a Provincial Parent Board was established in 2007 to ensure parents' views on schooling and education are represented [External website]
Strengthening partnerships between users and professionals In what ways can people be empowered to contribute their own time, energy and will power? Health and social care users have been empowered to develop their own care plans which recognise the value of self-care and self-referral (NHS Next Stage Review) In the Netherlands schools usually develop personalised learning plans that recognise and aim to meet each child's needs
What new opportunities are there for people to become directly involved in making decisions about the services they receive? The Youth Opportunity Fund (YOF) provides discrete budgets for young people to control and decide how money should be spent on positive activities in their area. The YOF aims to increase young people's engagement with their services and participation in postive activities [External website] In France, patient associations have formed a collective unit (CISS) increasing pressure to accommodate the interests of health care users [External website]
In what ways can services users support one another? Face to face and online communities, such as NetMums and patient support groups provide peer-support on everything from ‘parenthood’ to rare medical conditions [External website] In Denmark, pharmacists run support groups which aim to work with people who are obese/overweight to help improve their lifestyle, the group interventions are backed up by individual counselling sessions [External website]
Should citizen responsibilities be balanced against new rights? Those outside the labour market signing up to look for work and undergoing skills audits as part of new welfare and ‘back to work’ measures The Danish Government has adopted a range of measures to encourage parental responsibility for postive child development, including powers to instruct parents to attend courses/workshops and the ability to withold family allowance
Enhancing transparancy: Radically improving the quality and availability of information What useful, local performance information that isn't already in the public domain can now be published and benchmarked? Local crime information will be made regularly available to every household, including through local crime maps [External website] New information systems and computerised crime mapping capabilities are used in Chicago to deliver timely information to police teams and data terminals have been installed in patrol cars [External website]
Is all published information easily accessible to third parties allowing data to be republished where appropriate? Some parts of the NHS are now committing to making their information freely available for re-use by the public In France, hospital rankings published by the popular press on the basis of basic indicators

New professionalism

New professionalism
 Key questionsDomestic examplesInternational 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

Strategic leadership

Strategic leadership
 Key questionsDomestic examplesInternational 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]