8. KEY ELEMENTS OF A REFORM PROGRAMME
8.1 In this final chapter, we summarise what we see as the key elements of the programme of reform which should now be taken forward. We also comment on specific areas of reform highlighted in our remit.
8.2 The Scottish Government, local government and other partners and stakeholders should now work together in urgent, sustained and coherent programme to reform and improve Scotland's public services.
The key objectives of the reform programme must be to ensure that:
- public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience;
- public service organisations work together effectively to achieve outcomes - specifically, by delivering integrated services which help to secure improvements in the quality of life, and the social and economic wellbeing, of the people and communities of Scotland;
- public service organisations prioritise prevention, reduce inequalities and promote equality; and
- all public services constantly seek to improve performance and reduce costs, and are open, transparent and accountable.
SERVICES BUILT AROUND PEOPLE AND COMMUNITIES
8.3 In developing new patterns of service provision, public service organisations should increasingly develop and adopt positive approaches which build services around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience.
8.4 The Scottish Government should explore the potential of the proposed Community Empowerment and Renewal Bill to promote a significant improvement in the quality of community participation in the design and delivery of public services.
8.5 Managers and leaders within public service organisations should develop and extend the empowerment of front-line staff, to support their engagement with people and communities. The Scottish Government, local government and relevant organisations should develop a systematic and coordinated approach to workforce development.
WORKING TOGETHER TO ACHIEVE OUTCOMES
8.6 Public service organisations should work to extend and deepen a local partnership approach, building on but going well beyond the current community planning partnership model. In particular, there should be a much stronger focus on engaging with people and communities in partnership processes, including the design and development of a pattern of integrated service provision.
8.7 To ensure its continued development, the current outcomes-based approach should be underpinned by a revamped political agreement between national and local government, as currently expressed in the Concordat. It should be a mutual requirement of this agreement that, alongside the single outcome agreement, each community planning partnership develops and agrees with the Scottish Government a clear plan setting out how partner organisations will pursue local service integration to achieve outcomes.
8.8 Community planning partners should develop and extend arrangements at a more local level (that is, more local than the local authority area) which facilitate public engagement and participation in shaping priorities, and in the design and delivery of services; and should establish arrangements to enable all parties to each single outcome agreement to account to the public for their contribution to the achievement of outcomes in those areas.
8.9 The Scottish Government should work with local government and other partners to devise and put in place an appropriate set of common powers and duties for public service organisations.
8.10 The Scottish Government and local government should review jointly the current arrangements for funding public service organisations, to increase flexibility. The Scottish Government should develop and extend the use of funding models which expressly require integrated provision of services - for example, through a 'change fund' scheme.
8.11 All relevant public bodies should participate in the preparation of a joint long-term asset management plan under the aegis of each local community planning partnership, based on a shared assessment of the current condition of their assets.
PRIORITISING PREVENTION, REDUCING INEQUALITIES AND PROMOTING EQUALITY
8.12 All parties must prioritise and build in action which has the effect of reducing demand for services in the longer run. The common powers and duties proposed in Chapter 5 should include a specific presumption in favour of prioritising preventative action, and action to tackle inequalities.
8.13 Competence for job search and support should be fully devolved to the Scottish Parliament, to achieve the integration of service provision in the area of employability.
8.14 The Scottish Government, local government and other partners must work together as a priority to develop specific public service approaches targeted on the needs of deprived communities.
8.15 The Scottish Government should work with the Equality and Human Rights Commission and other stakeholders to identify the key equality gaps in Scotland, and address these gaps through further development of the outcomes and indicators contained within the National Performance Framework; and to produce guidance on how the public sector equality duty can best be expressed in the context of partnership working.
IMPROVING PERFORMANCE AND REDUCING COSTS
8.16 All public service providers should be required to demonstrate clearly how their expenditure is driving the achievement of better outcomes through coordinated, collaborative working; and to undertake regular benchmarking against comparable services, and report publicly on outcomes achieved and financial performance.
8.17 Audit Scotland should be given a stronger and more proactive role in improving performance and reducing costs across all public service organisations. In particular, this should include:
- oversight of the collective performance of public services in achieving outcomes around a common set of powers and duties;
- promoting better, more consistent and transparent use of data, including benchmarking to support continuous improvement by individual organisations and partnerships;
- certifying information on performance, costs, budget assumptions and projections of future demand (based on prevailing delivery models and national entitlements);
- driving the integration and better presentation of financial and performance information within business plans and accountability systems;
- identifying opportunities for improvement through streamlining functions, simplifying governance and accountability arrangements, changes to organisational structures and boundaries, sharing services and other initiatives such as co-location; and
- having the power to initiate reviews in support of its functions and to require joint work between organisations.
8.18 The Scottish Government and local government should seek to amalgamate the functions of the Auditor General and the Accounts Commission, to support an integrated approach to oversight.
8.19 The Scottish Government, local government and partners should take forward a rolling programme of bottom-up, outcomes-based reviews across service areas, to improve performance and reduce costs. Projected cost savings should be assessed and verified by the Auditor General and the Accounts Commission.
8.20 There should be a rebalancing of procurement and commissioning from cost efficiency towards effectiveness, with contracts focussing on promoting positive outcomes. There should be a requirement of competitive neutrality between all potential suppliers of public services, through a consistent and transparent application of commissioning standards to all providers, including in-house bids from public bodies.
CRITERIA FOR THE REFORM OF PUBLIC SERVICES
8.21 Proposals for the reform of public services should be assessed against the following criteria.
Proposals for the reform of public services should:
Specific reform initiatives
8.22 Our remit asked us "to have clear regard to joint work already underway to take forward the increasing integration of health and social care, and to develop sustainable police and fire services for the future" ( Annex C). Our consideration of these areas has helped to inform the conclusions and recommendations we have set out in this report. We also wish to make some specific comments on these areas of reform, reflecting the approach to reform we set out above.
8.23 We have received information on the Scottish Government's consultation exercises on the reform of police services and fire and rescue services , including the consultation papers issued in February 2011. We have discussed these issues with a number of interested organisations, as listed in Annex E. The summaries of responses to these consultation exercises were not, however, published in time to be considered by the Commission.
8.24 In our view a number of questions remain to be addressed as these proposals are considered further. In particular, and in line with the criteria for reform set out above, it remains to be made clear whether any new arrangements can:
- be shown to lead to the achievement of better outcomes for the people and communities of Scotland;
- ensure that services are required to account to the people and communities of Scotland, both directly and through their democratically elected representatives, so that public confidence in and support for the delivery of services can be maintained; and
- support the local integration of service provision.
8.25 We call on the Scottish Government and other partners to address these issues in further discussion of the reform of police and fire and rescue services; and to give an account of how any specific proposals for reform can meet these criteria.
8.26 We also note that work is currently underway, by the Scottish Government and others, to explore options for the integration of health and social care services. We are aware of and have discussed with the partners involved the current proposals for 'lead commissioning' arrangements in the Highlands, as well as the integrated approach being pursued by West Lothian Community Health and Care Partnership.
8.27 We agree with the widely held view that this is an area in which both substantial savings and an improvement in outcomes can be secured, by achieving greater integration of services - for example, to reduce the number and cost of unplanned admissions of older people to hospital. It is right, therefore, that this area should be a priority for service reform.
8.28 We therefore call on the Scottish Government and other partners to continue to take this work forward as a priority, with a view to developing arrangements which support the integrated provision of health and social care services, in particular for older people. Specific proposals which emerge from this work should be assessed against the criteria set out above.
8.29 We now call on the Scottish Government and local authorities together with all partners and stakeholders to initiate these reforms. The goal must be nothing less than a substantial transformation of our public services. The prize is a sustainable, person-centred system, achieving outcomes for every citizen and every community.