The best systems in the world treat each citizen as a unique individual, with his or her own family's distinct needs, and then tailor the service to meet these personalised requirements. No centrally driven or centrally accountable system can operate in this fine-grained way when confronted with literally millions of different public service users. Nor can it meet an increasing demand for individuals and families to play a greater role in addressing their own needs and aspirations. So public services that aspire to be truly personalised must put the power to shape those services much closer to the individual citizen. Local professionals and managers must have the power to respond to the specific priorities and needs of their own local customer base. And that in turn requires giving local users far more say and influence over the services on which they depend.
As the Government seeks to move the public services forward, the next stage of our reform programme must put power directly into the hands of citizens, driving services to become more responsive and personalised to each individual's needs and aspirations – and provide a strong set of incentives for the system to innovate and improve. As a consequence:
These changes in the way services operate are more important than ever before. People rightly expect that services are able to reflect their own, or their children's, individual needs and aspirations but services are not yet meeting these expectations. People expect the same quality of service from the public sector as they receive from the best in the private sector.33
For example, as working patterns have changed, public services need to be far more flexible in their opening hours if they are to support all users. Extended schools, greater flexibility in pre-school provision, neighbourhood policing teams and the recent extensions of GP opening times are already helping meet this need. Across public services it will be essential to extend hours further over the coming years as well as ensuring that services that can be delivered online and are therefore available to the user – whenever is most convenient for them.
Understanding and meeting the complex needs that hold some groups back is becoming increasingly important as standards improve for the majority.34 A one-to-one relationship between, for example, a teacher and a child learning to read, or a housing officer and family at risk of eviction, can be particularly important in addressing complex needs or preventing problems from occurring in the first place.
There is no one way to achieve these changes that is appropriate to all services. The feature that world class services share is that they are continually asking the simple question ‘how can the users of this service be given more power and control?’ The most important answers include:
For many services, empowerment starts when people are able to make real choices about which services are best suited to them – their lifestyles and their needs. Enhancing and extending the opportunities people have to make choices empowers citizens. It also creates pressure for improvement by rewarding services that offer what people want.
For some services increasing choice is not the only or best course of action to raise performance. Community services such as the police require greater local accountability rather than choice. In other services, providing effective choice is neither practical nor efficient given the excess capacity that would need to be put in place or because users are more interested in a range of other characteristics about the service over and above choice.
However, in the many areas where choice is appropriate, it can drive more responsive services and drive up performance because it fosters an overall cultural change,35 benefitting even those people who do not want to choose anything other than their local hospital or school.
Giving people the opportunity to choose between providers of services can increase contestability between those providers.36 Such contestability has a major role to play in ensuring that managers and professionals give greater attention to the interests of users and is especially important where services have traditionally been inflexible or performance is poor. Wherever it can help deliver our goals of fairness and excellence the Government will therefore continue to expand opportunities for voluntary and community organisations, social enterprises and private businesses to provide services in a range of sectors from childcare to primary health, alternative education, probation and employment services. For example, a national training programme has been launched to help commissioners work more effectively with the third sector. At the same time it will seek to increase contestability within the public sector, for instance enabling high-performing schools or hospitals to play a greater role in raising standards.
Offering more choice between providers is not the only route to ensuring individuals' needs and preferences are met. There also needs to be more choice within institutions. Providing parents with a choice of secondary school is important, but on its own is not enough to ensure that their child's once in a lifetime experience of school meets their educational and social needs.37 Parental choice of school must be supported by information about examinations and test results, and a trusted inspection system that both informs parents and directly holds schools to account. Without information like this, choice is less effective. Children and parents also need and want choice of curriculum and qualifications, more personalised learning and the offer of a far greater range of out of school activities. Similarly, patients should have more, properly informed choice over when their treatment takes place and what their treatment involves, rather than just hich GPor hospital to attend.
Some have argued that choice adversely impacts upon the principles which lie at the heart of Britain's public services - excellence and fairness. Although there are risks, this does not have to be the case. Government, with its democratic legitimacy, can set the overall strategic direction and framework within which choice operates, to ensure the objectives of improving fairness and social mobility are not undermined. For example, where choice is introduced it will be essential for public services to support individuals and families through the process of making choices so that all can benefit and for funding systems to support equitable outcomes. Without support some will be able to make far greater use of choice than others. And it is crucial that choice takes place within a fair set of rules, for example by ensuring that all schools have fair admissions policies.
Wherever it is effective, and supports the overriding objectives of excellence and fairness, the Government will therefore continue to increase choice by:
14-19 Diplomas: Learners able to choose what they study
Diplomas are innovative new qualifications for 14-19 year-olds that have been created to provide additional qualifications for young people. There will be 17 Diploma disciplines by 2011, designed to allow learners and parents to make informed choices about the course best suited and most relevant to them.
Diplomas will combine theoretical and practical learning to equip young people with the skills, knowledge and understanding they need. They will be offered by partnerships of schools, colleges and work-based learning providers, working together to offer a high quality learning experience in a range of settings. The unique mix of learning experiences will also give young people an insight into the world of work, allowing them to make informed choices about their future.
DCSF, What is a Diploma?: Improving Choices; Improving Chances [External website]
A deeper form of user engagement involves transferring control of resources to the service user. For example, individual budgets in social care have shown that when people are given control over the funds to be spent on them, they often make changes that significantly improve the care they receive: bringing support closer to home; fitting services more closely around the needs and resources of their family; and getting better value for money in the services they buy.
The Government will consider introducing personal budgets in new areas where they can empower users without undermining our commitment to equity and universalism. They are already being extended in social care and skills and are being considered in certain parts of health care.
Where personal budgets are not appropriate, there may be ways of incorporating elements of the approach. For example, for the young person with particular needs, such as a disability or learning difficulty, the Government is encouraging the range of local agencies to pool their resources into a single budget, managed by one lead professional such as a children's nurse. Spending priorities can then be agreed in negotiation with the family.
Personal budgets: More responsive services in adult social care
Personal budgets in social care are one of the most promising ways to enhance user independence and control, and to deliver more responsive and better services. On the basis of a professional assessment, resources are allocated to people through a personal budget. Individuals and families are provided with the support necessary to make good use of the budget, but the allocated resources are put to use on the basis that people know best what works for them.
Early evidence indicates that personal budgets of this kind can help people meet their distinctive needs, with wider positive effects for individuals and communities. For example, 63% of respondents in one study said they now took part in and contributed to their communities more.
Personal budgets have also been successfully used in other parts of the world. For example, mental health patients in Florida have used personal budgets to address all facets of their mental health by combining traditional clinical care and non-clinical care and activities.
Leadbeater et al., Making it Personal [External website], Demos, 2008; Hatton, C. et al., A report on In Control's second phase: evaluation and learning 2005-2007 [External website], Florida Peer Network, 2007.
The next phase of improvement in services will also complement greater choice with a wider set of ways to empower citizens.
One of the most practical means by which users of public services can be given a greater collective say over priorities, and of rewarding effective providers, is through effective use of satisfaction and opinion surveys. Over the last 10 to 20 years there has been a huge expansion in the use of tools to understand what people think of services both in the public and private sectors.
World class public services make far greater use of these types of approaches, they actively encourage feedback from the people who use them and then use this feedback in very tangible ways. Once organisations are collecting this data it is possible to give real weight to the views of the parent, patient, student, tenant or victim of crime. For example in schooling, Ofsted inspectors have over the past few years been required to look at how the school is regarded by parents.40 Many national performance agreements with services now explicitly include the citizen's viewpoint as a key indicator of success.41
The internet has given a powerful voice to consumers to give feedback on private sector services – that feedback is now spreading to public services and must be embraced. NHS Choices [External website] is a large scale example of the public sector soliciting feedback on health care, building on the example of websites such as patientopinion.org [External website]. The challenge for public service providers is to listen to and work with websites that provide a rich seam of feedback, even if that feedback makes for uncomfortable reading.
Public services should, however, go further in the next phase of reform. The Government believes that many more public services must now be opened up to more direct forms of accountability and engagement.42
The Government is committed to delivering improved policing that is better suited to the needs of the public and the communities being served. The new neighbourhood policing teams, which were rolled out earlier this year, 43 will be required to give people the opportunity to express their views directly through face-to-face meetings with a ‘contract’ for agreed standards.44 The Government will go further in giving people more local control over policing priorities. It was recently announced that the Government will consult on developing this approach through directly elected representatives on police boards – this will significantly strengthen the voice of local citizens and the local accountability of the police.
There will be new opportunities for local people to demand changes in their communities through petitions and opportunities to participate in deciding how resources are spent locally.45 For example, young people have been given the power to make decisions about what they want for their local area through ‘youth budgets’ – putting more control over services in the hands of the local people who use them.
More generally the Government looks to local political leaders, including directly elected mayors, to play a greater role as the voice of the citizen for their area. We will also support community and voluntary groups to play an active campaigning role.
North Liverpool Community Justice Centre: Offenders repaying their debt to the community
North Liverpool Community Justice Centre works with local people to tackle the causes of antisocial behaviour and crime, as well as the crime itself. It has a traditional courtroom combined with a range of community resources.
A community panel meets bi-monthly at the Centre to represent views of residents. The court focuses on offenders repaying their debt to the community, but it also addresses the underlying issues that may be contributing to their offending. For example, the Centre works with specialists who can provide advice and support to offenders with drug and alcohol problems, as well as housing and debt issues. These services are also available to members of the community, victims and witnesses, with an average of 58 self-referrals a month.
A 2007 evaluation found that cases were dealt with more quickly than the national average:
100% of warrants for non-appearance at court are issued within 24 hours, beating the national target of 90%.
MOJ, Evaluation of the North Liverpool Community Justice Centre, 2007. The Community Justice Centre North Liverpool website [External website]
World class services are characterised not only by collaboration between citizens and public service professionals, but also by empowering people to make a greater contribution to meeting their own needs. This will require more shared responsibility46 as both public service providers and citizens work together to improve health, early years development, education and skills and reduce crime and antisocial behaviour.47 For instance, in helping people who have been on Incapacity Benefits improve their health and find work, the quality of the relationship between the claimant and employment adviser is extremely important. Similarly, the recent Casey Review of Crime and Communities highlights how the police and other front-line organisations must work more closely with local communities to reduce crime further. And in health, the Government has committed to introduce health checks for people aged over 40 which will look for early signs of conditions such as heart disease, strokes and diabetes – the checks will empower clinicians and patients to work together to prevent and manage these conditions.48
The Government will therefore extend opportunities for people to become directly involved in making decisions about the treatment and service they receive – the parent, student, patient, tenant or victim of crime becoming a genuine partner in deciding on the best approach. Parents, for example, will be able to influence and support the education of their children through regular interaction with their school via email and text message, as well as regular parents' meetings and reports.49
These new rights also provide the basis for extending the responsibilities of citizens. Across public services the Government will explore new ways to increase responsibility: those outside the labour market signing up to look for work and undergoing skills audits50 – improving job prospects and the take up of training; patients taking more responsibility for managing their own conditions and maintaining healthy lifestyles; parents getting involved in the education of their children; and across the public services users attending booked appointments and not wasting resources.
At the heart of the Government's vision of personalised public services are strong partnerships between users and professionals: the individual tutor and the child falling behind in maths; the specialist nurse and the patient struggling with diabetes; the youth worker and young person seeking to leave a gang. For those with the most intensive needs, stronger one-to-one relationships with professionals and volunteers should become the norm.
One-to-one in practice
England is now at the forefront of personalising learning in schools. For example, the Making Good Progress pilots provide one-to-one catch-up tuition in mathematics or English, for children who particularly need specialist intervention. By 2011, some 300,000 children will receive up to 10 hours' extra maths tuition and a further 300,000 children a year will receive up to 10 hours of extra English tuition. These programmes offer more tailored and specialist help outside the classroom to those children who are falling behind in lessons so that pupils quickly get into a position to make good progress back in the classroom.
DCSF; Teachernet.gov.uk [External website]
In addition to encouraging collaboration between service users and professionals, networks of users can also provide personalised and ongoing support to an extent which would be impossible if provided by professionals alone. For example, the Expert Patients Programme in the UK enables people with personal experience of managing long term conditions to share their knowledge and expertise with others. This programme will be expanded allowing 100,000 people to benefit.51 This Government will seek to extend this approach, for instance through online self-help communities like the parenting support site NetMums [External website] that is used by over 400,000 parents a month.52
Family-Nurse Partnerships: Stronger relationships between professionals and citizens
A child's experiences during pregnancy and their early years lay the foundations for their future life chances. Family-Nurse Partnerships bring together trained nurses and first-time teenage mothers, in a high quality, high intensity relationship, throughout pregnancy and the first two years of a child's life.
The nurses offer health advice and support, as well as more practical support and coaching. Importantly, the partnerships allow for trusting relationships to be built up between professionals and service users, so that the nurse and individual share the same goals. The emphasis of the partnership is very much on developing the independence and confidence of the mother.
Billingham, K., The Family-Nurse Partnership Programme [External website], Cabinet Office Seminar, 2007.
The whole agenda of reform will rest on improved transparency of information about public services and their performance, as well as transparency about the standards that citizens should be able to expect. Effective empowerment rests on good information.
Ten years ago it was seen as a major innovation that government collected and published information on schools or local authority services and used it centrally to assess the quality of services on behalf of citizens. While this role will continue, new technologies provide the opportunity to improve the availability and timeliness of far more information giving citizens and communities far greater direct power than before. Together with better collection and analysis of performance information, this enables comparisons of local services with those provided elsewhere. World class public services are information-rich, driving changes in the relationships between users and providers of services.
By making government information easily accessible to third parties, data can be combined with other information and republished in new and innovative formats. This can stimulate new non-governmental networks that share advice, provide mutual support and lobby government for change. UK examples include FixMyStreet.com [External website], which highlights local environmental problems, or Dr Foster [External website], which provides information on hospital performance.
The next stage in the transparency revolution rests on ensuring the information held by services is more available for re-use by citizens and civic organisations (while also protecting the privacy of citizens). For instance, the NHS Information Centre [External website] and two local authorities (Essex [External website] and Worcestershire County Councils [External website]) have committed to make their information freely available for re-use by the public.
Central government is therefore committed to ensuring that, as a matter of course, public services make non-personal information available for re-use. This will include the provision of frequent, comparative and tailored performance data about services at a local level. For example, NHS Trusts are increasingly looking to capture real-time patient feedback. As was recently announced, indicators are already being devised that will assess not only the effectiveness and safety of nursing care in the NHS, but also how compassionately care has been delivered.53 Local crime information will be made regularly available to every household, including through local crime maps. Parents will have full and better access to school performance data. The Government will ensure these approaches become the norm across our public services.54
New York school report cards
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 and giving the school an overall grade. The reports give each school a letter grade-A, B, C, D or F-based on the academic achievement and progress of students as well as the results of surveys taken by parents, students, and teachers. These Progress Reports are the centrepiece of the City's effort to arm educators with the information and authority they need to lead their schools and to hold them accountable for student outcomes. The reports also provide parents with detailed information about school performance, both to hold their schools accountable and to inform family decisions.
Each school's grade is based on its score in three categories: school environment, student performance and student progress, with schools that do an exemplary job in closing the achievement gap being able to earn additional credit.
See www.nystart.gov/publicweb/ [External website]
The underlying quality of public services is better than ever before. The challenge now is to ensure the development of more personalised and responsive, as well as fair and equitable services. Alongside the extension of choice in health and other services, there must be a deepening of user involvement through new forms of individual and community control. The exact mechanism will vary from service to service, but the aspiration will be the same: enabling more personalised services by giving citizens the information and power to shape services around their needs and aspirations, rather than by assuming that someone in the Government knows best.