Below is my Guardian Society article about what we can learn from the power shift now underway in the best public services around the world. My argument is simple. If we want better public services in the future, and believe public spending growth is slower, then we need to be more innovative in the way services are delivered. But if we want to ‘free up the system’ and devolve power – and preserve equity – then giving people rights and entitlements to services is crucial. Alongside this, you need better use of information, a shift to personalisation and prevention, and you need to ask the frontline to lead the charge for service improvement – not dictate or demand it from Whitehall. Text of Guardian article below, or link here. http://tinyurl.com/ljzm9w
One of the great joys of my job is my Friday school-gate surgery in Birmingham. I descend on a different school each time with my constituency team to listen to parents and headteachers, and chat about things that are going on – and going wrong – in the local area.
A few months ago, I was in the cafe at Bordesley Green school, where outreach workers told me they had been finding low literacy rates among Bangladeshi boys. So, the school’s family support workers began inviting Bangladeshi parents into the cafe for a chat and, soon, for literacy classes. A year later, Bangladeshi boys were topping the school’s results.
Every week I hear fantastic stories like this. Stories about how public services are transforming the lives of people from some of the poorest communities. I’ve heard it from community nurses, doctors, heads and teaching assistants, jobcentre managers and probation officers.
It is this simple story that sits at the heart of Building Britain’s Future, the government’s prospectus for the future launched last month by the prime minister. In tough times, it is unashamedly upbeat about our future. It argues that if we make the right investments now, we can grow our economy for the years to come.
But if we want to open these new opportunities to the many and not the few we have to have first-class public services. Public services that serve communities like mine (a community with the fourth highest unemployment in Britain) are simply essential if we want a more socially mobile and more equal society in the decades ahead.
We are not intimidated by the prospect of slower rates of public spending growth in the years ahead. You can’t carry on growing public service investment at the pace of the last decade without public services soon consuming the entirety of the economy. Our job in the last decade was to deliver change. But also to correct the historic investment gap in public services between us and other modern economies. That gap is largely fixed now. But it doesn’t mean you stop work. Not if you believe in public services as the vital motor that will keep society mobile for the years to come.
Two relationships are key: the relationship between state and citizen – and the relationship between the centre, in Westminster and Whitehall, and the frontline.
In Building Britain’s Future, we said the key to changing both was to move away from targets and stocktakes and change driven from the centre, towards rights and entitlements for citizens. This is a new field, and getting change right will take some debate. So, last week we published Power in People’s Hands, a study of the leading public service innovators from around the world.
Five changes stand out from the report. The first is the use of entitlements to guarantee a core level of service quality. In the 1990s, Finland, which has one of the most highly regarded health systems in the world, introduced the world’s first patients’ rights legislation, guaranteeing access to high-quality care. Entitlements include maximum waiting times, personalised care plans and good information. These have been implemented while Finland has kept its health costs lower than almost any other country’s.
Critically, systems of entitlements allow those who use the service to hold it to account for performance, rather than relying on central targets. In Sweden and Canada, patients who do not receive treatment within minimum waiting times can have it done in another area, often including the option to be treated privately and to have travel costs met.
Second, online performance information is used to allow people to hold services to account and contribute to the way they develop. Take the US federal government website, Data.gov, which offers a wide range of information, from spending by different government agencies to levels of pollution. People can download and analyse the data themselves.
Such open-book government is generating pressure for both better services and greater value for money. US cities, such as New York, Washington and Baltimore, which have been pioneering these approaches, have demonstrated improvements in policing and healthcare, as well as saving hundreds of millions of dollars.
Third, good services are personal services. We’ve been at this for a while in the UK. But others are showing it can be done without adding costs. Innovative services, such as Wraparound Milwaukee, care for children with serious emotional disturbances by using a single lead professional working with a pooled budget.
Fourth, the best services prevent problems starting in the first place. In Chicago, very accurate, rapidly updated online crime maps help local communities and the police to work together to tackle local increases in crime before they get established. In the Netherlands, Germany and a number of other countries, technology helping those with diabetes to stay in daily contact with their doctor is cutting hospital admissions by more than half.
Finally, we saw professionals being asked to lead innovation themselves, much like former minister Lord Darzi in the NHS. In Alberta, for example, teachers have been systematically supported to innovate, with over 1,700 projects initiated in the last few years. Those schools that have been most involved are now demonstrating better exam results.
Much of this kind of work is under way in the UK. But what is striking about the best practice around the world is that it shows that you can be radical about power and realistic about value for money.