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chapter three: Fundamentals of reform - user focus
15. First and foremost, services must be designed around the needs of service users. Scotland has always valued public services, but there is still a perception that many of these public services reflect a post-war welfare state model, which could be regarded now as paternalistic; where users had little say in what that service should be and the amount and quality of service is strictly rationed.
16. We are moving away from that approach towards more flexible, user centred services, but we must go further. In doing so, we need to learn from other sectors, be it voluntary or private, whilst respecting what is valuable about the public service ethos.
17. Public services can never be wholly identical to private provision - precisely because they are public. They exist to provide the intangibles of safety, community cohesion and law and order; working with communities to achieve a smart successful economy and protect the most vulnerable, delivering social justice and quality of life, and safeguarding the living standards of the generations to come after us.
18. So public bodies have many complex roles (and, with local government the addition of elected status) including direct service delivery, planning and commissioning services, regulating and protecting the public, advocacy, and adjudicating between competing interests. We need to apply the principle of user focus in the right way for each service.
19. Making user focus our primary goal means that we are committed to greater responsiveness to individual needs, lifestyles and work patterns, and:
- Working with service users, and recognising the contribution that they themselves make to outcomes;
- Testing out new ways of delivering services, including through technology;
- Ensuring people have the information and support to access the services that they want and need, and to hold services to account;
- Widening the choice people have over the kind of services that are on offer.
20. The other elements of reform underpin the aim of user focus, through:
- Ensuring consistently high service standards - so service users do not have to seek out adequate services;
- Making the most efficient use of resources - so the quality of frontline services is never compromised;
- Organising services around the needs of users, not institutional silos;
- Strengthening the accountability of services to communities.
User focus and personalisation - how we are delivering
Delivering for Health commits us to a health service where services are provided in partnership with patients and their carers. More services will be delivered locally, and there will be dedicated resources in less well off areas, to reach out and help those at higher risk of ill health. We will expect care to be tailored to the needs of individual patients, and we will increase support for self-care.
The 21st Century Social Work report 'Changing Lives' sets out a vision for social work which engages people as active participants, delivers accessible, responsive services of the highest quality, builds new capacity in individuals, families and communities, and focuses on preventing problems before they damage people's life chances. The review was guided by a diverse, active and valuable panel of users and carers. Their insights and priorities were integral to the review process and underpin the report. The panel is developing the concept of 'Citizen Leadership' which will involve the development of structures for the input of users and carers to the implementation of the review's findings and to the long-term future of social work services at local level.
The Customer First programme is creating a national data sharing infrastructure which will allow local authorities to offer a much more customer focused and efficient service to their citizens.
This infrastructure will support joined up Customer Relationship Management systems, ensuring that at least 75% of service requests can be dealt with at first contact, and a national entitlement card system providing more convenient access to public services.
Choice, voice and personalisation
21. The options for empowering service users are sometimes characterised as 'choice' or 'voice'. We wish to strengthen both in our public services.
22. We want to see more meaningful choice for service users, wherever this is consistent with fairness to others, and in various forms - choice of the type of service that meets the person's needs, and when and how to use it. In some services, this will mean an increased diversity of service providers or public provision itself offering more choice and new ways of meeting the needs of individuals within current delivery frameworks.
23. This is already occurring within our public services. Within NHSScotland there are situations in which a user can choose which hospital they attend for a major operation requiring a significant recovery period enabling them to be close to family and friends that can offer personal support. For example, an older person living in Glasgow can choose to have their major operation in Dundee so that they can be near family and friends and recuperate with them.
24. This choice exists now but we also want to go further - offering users more choice tailored to their needs. For instance, offering services out of hours to fit in with individuals' lives enabling users to get a GP appointment, make a statement at the police station or ask for information at the council office out of hours. This added value to the service will encourage greater participation from citizens in our community facilities securing their sustainability.
25. There has always been a mixed economy of public services in Scotland, with services delivered by public sector bodies, the voluntary sector, private organisations and individuals. For most public services, the most important issue for the user is not who runs the service, but whether it can be accessed locally and how best to secure high quality, efficient services which are accountable to them.
26. "A Vision for the Voluntary Sector - The Next Phase of Our Relationship" 1, emphasised the contribution the sector makes to Scotland including its role in service delivery. The vision discussed ways of assisting the sector to grow this role and we will continue to explore this as part of this strategic discussion on public service reform.
27. We also recognise, though, that user choice cannot be the only solution to improving public services. For some services, a choice of provider is simply impractical, or would require wasteful surplus provision. After all, choice in public services is different from the choice an individual might expect in the private sector where supply outstrips demand, where everything is priced and where the user is constrained by their personal budget. If choice in public services is to be worth anything, it has to make a difference to what the user gets.
28. Our vision is for personalised public services, which not only view service users as consumers, but also as participants and citizens - working with public services to create better lives for themselves and their communities and having responsibility for the choices they make. This will not only help to make services more user focused; it is often more cost-effective, by drawing on the potential and resources of citizens and their knowledge of their own problems and potential solutions.
29. Services must also listen to the concerns of users. Being responsive to feedback and complaints is vital for successful private businesses, and should equally be a mark of good public sector bodies.
30. Strengthening 'voice' means giving all service users the means to speak out about services - not just the articulate and well-informed.
Strengthening 'voice'
The Mental Health (Care and Treatment) Scotland Act is one of the most innovative pieces of mental health legislation in Europe. For the first time it set out a legal principle that the service users views must be taken into account, even when receiving compulsory care, and a statutory duty to provide advocacy services for patients.
The Scottish Schools (Parental Involvement) Bill seeks to encourage parents to be involved in their own child's learning, strengthening the links between parents and schools, and improving parental representation. Research shows that when parents are involved in education, children do better.
31. Where service users are unhappy with their service, the ideal is to resolve the issue locally and informally wherever possible, with simple and easy to access complaints and review procedures, where this is not sufficient. There has been a lot of work done to develop modern responsive complaints systems, but many people still feel intimidated and unsupported by the procedures involved. Improvements could be as simple as the ability to speak to a real person rather than an automated system making all the difference to the user. In addition, complaints systems are still often linked to specific service providers which may not be enough in a world of joined up service delivery.
32. We want to explore what more we can do to strengthen user voice, including the potential benefits of a more unified complaints system across public services. A responsive complaints system should progress in line with people's needs and input giving the user feedback and using complaints to shape future policy and improve service delivery. We also wish to consider how the implementation of Best Value duties 2 can more effectively support our aims for personalised and user focused public services.
Discussion points:
- What more can we do to ensure public services are driven by a desire to create as much user focus as possible?
- What more can we do to ensure that the public are able to make informed choices about the services available to them?
- How can we ensure that complaints relating to public services are resolved at the first point of contact rather than escalating the process?
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