Scottish Government public services reforms
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The Scottish Government together with local authorities, partners and stakeholders have initiated reforms in the way in which public services should be provided to achieve ‘a sustainable, person-centred system, achieving outcomes for every citizen and every community’. (Scottish Government 2011a)
It is believed that everyone has to make a contribution. The Government set the aims to the services that should be person-centred, seamless and proactive. Services that would allow everybody to have best quality of life and give the full potential of contribution to the communities people live in. The key aspects involved in the public service provision focus on equality, respect and dignity, support in overcoming inclusion barriers and general positive outcomes and well being. The underlined values relate also to the individualised needs such as religion, culture or ethnic.
Problems such as growth in public spending, social inequalities, poverty, lack of clarity in what lies behind organizations etc. have their origins in the way different services are funded, planned and managed. However, the aim of the Scottish Government remains unchanged and is to reduce the frustration resulting on long standing problems such as inefficiency of the public services, and the gaps that frequently exist within care systems. (Scottish Government Publications 2000).
Researchers investigate what people value most to archive real-life improvements in the social and economic wellbeing of the people and communities. Half of the public finds that the Government’s foreground for service provision should be "what is good for everyone in society as a whole" (Ipsos MORI, 2010). This show that a progress in the development of an integrated public service has already occurred but requires continuation to success.
Reaching an understanding
It needs to be understood that public services and support systems exist for the society that use them. Evidence such as Christie Commission report (Christie, 2011), demonstrate that the needs have not always been central to the planning of services.
The people that use the services often perceive themselves to be not sufficiently informed and not fully able to take part in the growth process of the services.
Some changes in the service provision in relation to ‘shifting the philosophy ’ have already taken place. This makes the service provision more user centred and allows the user to participate actively in the changes and benefit the majority. (Rose, 2003)
Client 'centredness' became the watchword for the twenty-first century; however the progress in the implementation of person-centred planning in practice appears slow.
Since devolution, there has been development, changes and new policies for health care, with reorganisations taking place, that are generally called reforms. These refer mainly to patients' choice; system efficiency; quality of care and accountability acquired through transparency.
In Scotland, for example, the separation of purchasing from provision of health care was abolished (National Health Service and Community Care Act 1990); it is not recommended for the providers to compete; The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations (2011) implemented free drugs prescriptions as well as personal social care for the over-65s (Community Care and Health (Scotland) Act 2002).
Recent changes relate to the abolition of primary care trusts (PCTs) and strategic health authorities (SHAs), new commissioning of clinical groups (CCGs) and Healthwatch England.
Other examples of success relate to improving the quality of services that include smoking ban legislation; lower mortality levels or decrease in heart disease and stroke through a number of governmental initiatives. These changes led Scotland to become a leader in public service reforms and made visible improvements for the Scottish society.
The system’s integration with social services discourages provider competition and encourages patient choice and strong performance management. The Scottish Government's 2020 Vision (Scottish Government (a) 2013) aims to enable everyone to live a life that is longer, healthier; possibly at home or in a homely setting. To achieved that the healthcare system that focuses on prevention and anticipation and on the integration with social care.
Positive changes improving people’s lives do take place at national and local levels. However, studies show that the public are overall more negative about services nationally and show positive stance about local services. This can be reasoned by the affirmative actions in which the public can have a bigger impact on how local services operate and the on the decision making. Public Service Trust states that more than a half (58% ) of the public would like to be actively involved in shaping public services. Although this is more than a half of the public it proves that there is the need for more community and local activity an engagement in relation to the public services in order to reduce and minimise the substantial barriers.(Ipsos MORI 2010)
These are only a few examples of the improvement that has occurred due to the governmental actions focused at partnetships between service providers and investment in people. (Scottish Government (c ) (2013)
New legislation was introduced ( The Scottish Government (c)2013) to improve the integration of health and social care provision to make care for the citizens better. This affects particularly older people - free personal care for them and acknowledging the facts highlighted in the Christie report (Christie, C. 2011) that by 2033, the number of people aged over 75 will increase by 84%.
The report ( Christie, 2011) estimates however that additional demands on social care and justice services will be costly (<£27 billion over the next 15 years) and underlines areas that need improvement such as growing numbers of older people with multiple conditions and complex needs such as dementia or the increasing numbers of prisoners ( 20% by 2020). There is also increasing number of medication prescriptions related to high levels of stress, drug and alcohol problems and its physical symptoms. (The Scottish Government (b) (2013)).
Although there is evidence demonstrating progress especially in implementing diverse and innovative approaches that appeal to healthcare and social care professionals, practitioners and policymakers there are also many challenges of implementing the client-centerness.
Achieving outcomes for every citizen and every community
While many professionals espouse the principles of client-centred practice it seems much more difficult to implement these into everyday practice.
Health care providers, staff and clients must work together to facilitate changes and ensure that each client receives respectful, supportive, coordinated, flexible and individualized service where standards affirm basic ethical principles, beneficence and social justice. This is however a real change, due to many factors including changes in funding, culture and power relations, as well as in approaches to service management and staff supervision.
This is why attention is paid to more openly and transparent performance of the services .This however according to Dr Barry ( Barry, M. 2007) requires comprehensive strategies to ensure fair, good quality but foremost integrated services for people with the knowledge and well structured priorities in relation to their professional and social roles.
Across researchers (Ipsos MORI, 2010), it is to see that not all the issues policymakers find important for reforming public services resonate with the general public at the same levels. The fairness, good quality standards of customer service, local control, accountability, personalisation and choice are seen as public’s key priorities, however the first two aspects seem to be more important to the public. 63% think that standards of public services should be the same for everyone and everywhere in UK and over 47% would prefer greater local decision-making. This could be a consequence of declining trust in politicians. The findings of Ipsos MORI (2008/9) suggest that the citizens would like to feel more welcomed to take a part in an honest debate about the options ahead for public services because information about the scale of the approaching challenges has not reached citizens in a form they understand.
This demonstrates the need of more control and choice in the consumer, and facilitates individualised rather than universal services.
Roles, relationships and responsibilities of partners within an integrated public service.
Many of current public services continue to operate on the basis of the traditional model of service provision. To allow the changes in how resources are managed and allocated to happen there is a growing need for appropriately trained staff and management. However to support the reforming public services change for a well integrated 'multi-agency' working not just at managerial level is needed but a change to the whole culture that governs services.
Collaborative working, partnership and community involvement
Co-operation that would replace competition is required as well as focus on professional responsibility on meeting the increasing complexity. (Royal College of Nursing, 2004). The collaborative work, in practice should involve joint planning between health authorities - both local and national as well as the private and voluntary sectors and education.
Working together includes the whole process of researching, assessing, planning, implementing and evaluation. Balancing power relations in partnership across cultures, ethical, political or religious differences play an important role in promoting appropriate services for the service users. Teamwork and partnership often do not operate in an integrated way where the patient or service user would be seen as the central figure. The users involvement is vital. Working together, joining trade unions, expanding knowledge and engaging with local authorities helps find ways to reach excluded and marginalised groups of a society.(Department of Health 2000 a).
This is already notable in the programs of most of the political parties. The citizens empowerment is seen as a social manner that can influence and shape the public services to suit better the user's need. Giving people a say in the design and delivery of public services.
This is however a social challenge as the public opinion research show a decrease from 58% to 47% in disposition to the interests in decision-making related to the local areas. ( Ipsos MORI 2010).
This is why people should be motivated to get involved in collaboration and partnerships within the public services, they should be offered the chance to share experiences and discuss actions and widen the pool of resources and skills.
The impetus for integration and collaboration has been pointed out in legislations and government policies such as The Vital Connection (Department of Health, 2000a), NHS plan (Department of Health, 2000b) or in the Government's Equality Framework (Department of Health, 2012)
This demonstrates clearly that seamless health and social services provision has been a concern of policy makers for many years and that the UK governments underline the need for collaboration. However when the public was asked about getting personally involved in local decision-making, the commitment to involvement in decisions affecting their local area has dropped to 47% from 56%. (Ipsos MORI (2010). This could be one of the explanations why problems continue to exist.
Service planning, empowerment and engagement
The notion of empowerment is central. This however requires people's engagement. Research shows that people find that vast majority are more interested in having a say (24%) or in knowing more (47%) than actually getting engaged. The service planning should therefore include informative element how the services are delivered and by whom for the users in order to engage them to recreate services they need.
According to the annual Audit of Political Engagement only 11% of adults can be classified as ‘political activists’ and over half the public (51%) have no interests. (Ipsos MORI 2010). It seems that co-making decisions is less important than having the influence to make them.
Managers and frontline workers
Poor image, desinformation and low pay contribute to general feelings of helplessness among many frontline workers that should be involved decision-making and planning processes (Eborall,2003).
Managerial styles need to be empathetic in order for frontline staff to adopt person-centred approaches to their work ( Sherad, D. 2004)
A good style helps demonstrate and articulate the values of the organisation, values personal commitment and relationships with the people it supports. Look for ways to use staff interests and strengths in directly supporting people.
The style shall rather review itself in decision making and in having a clear vision and direction. This encourages new ideas as well as personal involvement and helps to achieve the purpose as a team.
The Government support management and frontline staff in public services by implementing programmes that lead to integration of health and social care. One of the examples is The Public Bodies (Joint Working) (Scotland) Bill. The act underlines the importance of the integrated work for health and social care provision across Scotland.
They both have a key role to play reforming the public services, therefore the reform should involve more educational, council, employer and training bodies to help improve the workforce awareness and leadership development.
Also thethird sector organisations should have access to appropriate skills development opportunities, including leadership development .(The Scottish Government ( 2011 b)
Summarising it needs to be believed that people learn from the past experiences and improve partnership at local and national levels to build a well functioning system that could seamlessly provide care for the whole community, including people with complex care needs because at the end of the day we do it for us.
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