Can greater transparency and payment by results transform public services?

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Last week, in his speech to launch the Public Services Reform White Paper, the Prime Minister set out five principles that will guide the government's approach to the reform of public services: choice, decentralisation, diversity of providers, fair access and accountability. These overarching principles sound very laudable, but the real challenge is translating them into practice in public services as diverse as the NHS, policing and education.

The White Paper sets out two ways in which public services will be held to account: firstly through greater transparency of information on the performance of public services and what they spend their money on, and secondly by linking funding to outcomes. These approaches are set to replace the role of targets and top-down performance management – but can transparency alone deliver improvements in care in the NHS?

The government has already published data on rates of criminal activity, such as burglaries, by local areas. Presumably the idea is that if local people are concerned that the police are not doing enough to tackle crime in their neighbourhood they will voice these concerns (rather than move to crime-free areas!)

The Cabinet Office Minister Francis Maude made an announcement last week that got little attention: he committed the government to publishing data by the end of the year on the clinical quality of general practice and prescribing, hospital complaints and staff satisfaction. It is not clear whether the government expects patients to use this information to choose a GP or hospital, or to demand better services from the local NHS.

There is already a wealth of information on NHS Choices and other patient feedback sites, such as Patient Opinion and iWantGreatCare. But our research on patient choice found that as few as 4 per cent of patients who were offered a choice consulted the NHS Choices website. And most people found it very difficult to interpret this information and use it to identify a high-quality hospital.

The previous government was also keen on greater transparency, and introduced a requirement for all providers of NHS-funded care to publish quality accounts. We analysed the first year of quality accounts and found that the information was difficult to interpret and in many cases did not enable people to judge the quality of local services. If the government wants people to act on this information they will need to make sure it is relevant, comparable and easy to interpret.

As we have argued elsewhere, transparency can support accountability but is not entirely sufficient. There must be consequences if care is not of an acceptable standard or does not deliver value for money. The government seems to believe that the consequences for providers are either that patients choose to go elsewhere (and so the provider loses money), or that the public will lobby those who have the power to take action, such as regulators, commissioners and local authorities.

The benefits of greater transparency are unlikely to be delivered through patient choice or public voice. Evidence suggests that the real value of transparency is the effect it has on providers; concerned about their reputation, providers are 'shamed' by coming near the bottom of a league table and this spurs them on to improve. The Prime Minister seems very fond of repeatedly citing economics research showing the positive effects of competition on quality. Perhaps we can yet persuade him that yardstick competition based on comparative performance data is a powerful driver for improving quality.



Comment date
19 July 2011
Public Service Reforms – submission to NCVO

I have raised with NVCO the review and the amounts of cuts HM Government is introducing this year through its budget reduction, these reductions equates to about 9% per annum, year on year, for the next four years.

We requested using the Freedom of Information Act and asked how Local Authorities in London spent these budgets; the findings showed £42 million pounds invested by the Dept. of Health to cover the costs of transformation with personalisation, though just 30,000 people in London qualified. These figures don’t include those who sought support from these organisations and are not covered by the statistics. On average £1,800 was spent per person, based upon the numbers receiving support, yet with a London population of more than 7.5 million people, to reach, such numbers, seems a low return and outcome.

The United Kingdom has some 62 million people, of which about 250,000 receives support through personal budgets. It is HM Government intension to increase this up to a million people.

In the context of openness, transparency and fairness, this information shows us how decisions are made and can look at the effectiveness and equity of such decisions, if the United Kingdom is to address it Roadmap 2025 to Disabled people, poverty, social inclusion to all, with a continued growth of an already 62 million population in the UK, something’s have to change.

Localism is about supporting your community, neighbour, friends and all that which is entangled by the provision of Central Government, Acts of Parliament and the Courts. This structure provides us with the guidance and assurance of what makes us who we are and is law.

These grants resource and fulfil the various needs, conditions and support that affect all of us. Our analysis shows the commitments made and questions the performances and outcomes in reaching the UK’s diverse people and population, all organisations thorough its decisions and to it’s commitments to the people that it represents should relook at their Equality and Impact assessments in responding to its communities and needs. The Equality Duty and other legalisation provide us and its people with provision and should always be considered when making and deciding outcomes that affect the community it serves.

Looking at the social return upon investment, measure and impact of HM Government investment for London, £42 million - Personalisation, £10 million -people living with HIV, £400 million - Supporting People, £44 million - Carers, £32 million - Health, £217 million - the Dept. of Schools and Families and more, is provided through the Area Base Grant, all without being ring-fenced, further adds to the question of responsibility of our councils.

Whilst HM Government through it grants provides employment, support and assistance to those with in the United Kingdom until such time there is more disclosed information and is reported by the voluntary and third sector and Local Authorities within it annual accounts, does the question of social return upon investment and the numbers supported be in question.


Comment date
21 July 2011
One of HM Governement investment program is The Social Enterprise Investment Fund, The Volunteering Fund or the Big Lottery Fund are some of the other alternatives I know of.

John Kapp

Social Enterprise Complementary Therapy Company
Comment date
21 July 2011
Cameron is Thatcher mark 2, making the NHS patient-led, as Thatcher made the nationalised industries consumer-led, rather than provider led. Patients have choice of treatment in the market between conventional (drugs and surgery) and complementary therapy, but only the rich can access the latter, as it is not free at the point of use. This is why we have health inequalities. To reduce them we have to integrate NICE-recommended complementary therapy, as SECTCo seeks to do. If this were done, it would prevent sickness, halve public health statistics, and meet the Nicholson challenge.

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