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The case for change
Our public services are under ever increasing pressure. Demand is rising at the same time as budgets are decreasing. The NHS faces a funding gap of £22 billion and social care faces one of up to £2.7 billion by 2020. At the same time, people feel they have little influence over the public services that they receive.
Locality and others have argued that the method by which our public services are commissioned and procured is at fault. That large scale, price based competitive tendering is failing to meet people’s needs. What is more, there is no clear cut link between competitive tendering and customer satisfaction.
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Centralised decisions are damaging
Centralised decisions made by groups of people in isolation from society are damaging.
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Weak markets
Some have argued that public services are in crisis because they are inherently weak markets. Traditional competitive tendering can make it difficult for small scale, specialist providers to compete. This can be problematic for smaller, voluntary sector providers who can offer benefits in terms of flexibility, innovation, partnership working and local accountability.
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Decentralised models have advantages
Decentralised models of decision making have a number of advantages over centralised models.
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Arguments for retaining centralised models
There are a number of arguments for retaining centralised models of decision making.
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Obstacles to decentralised decision making
There are a number of obstacles to overcome to achieve a model that allows for decentralised decision making.
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Models which encourage participation
Despite the difficulties, alternative models of decision making which encourage greater citizen participation are gaining traction.
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Unintended consequences
There are some unintended consequences of localised decision making processes.
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Examples of localised decision making
Small-scale localised decision making initiatives have been occurring in the UK.
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Criticisms of participatory budgeting
Many participatory budgeting initiatives in the UK have been criticised for being piecemeal and marginal.
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International experience of larger scale initiatives
Much larger scale localised decision making processes have been occurring internationally.
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New performance management
Over the last 20 years governments across the UK and beyond have sought to improve public service performance by introducing an array of targets, league tables and performance information.
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Performance targets
Whilst the introduction of performance targets has certainly improved performance in specific areas (e.g. NHS waiting times in England) experts have also pointed to a number of problems with this type of approach including ‘gaming’.
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Outcomes based management
Partly in response to some of the challenges associated with targets based ‘New Public Management’ there has, in the last few decades been a growing international interest in outcomes based performance management that more closely align measures of public service performance with the experience of users.
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Benefits and challenges of wellbeing frameworks
Wellbeing frameworks and outcomes based approaches can offer a number of benefits including more joined up approaches to government and citizen engagement but outcomes are not immune to gaming and there are challenges regarding attribution, impact and measurement.
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Human rights approaches
In their paper Being Human: A Human Rights Based Approach to Health and Social Care in Scotland the Alliance argue that a Human Rights based approach to health and Social Care that supports people to be independent, active citizens as well as have good health could offer the basis for high quality social care.
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Camphill Village Trust
John Seddon, in his book ‘The Whitehall Effect’ argues that a whole system change is required moving away from targets, regulation and compliance altogether.
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Giving customers what they need
The secret of a good service Seddon argues, is to focus on giving customers what they need.
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Can targets be replaced by purpose?
There is however significant evidence against Seddon’s approach. There is for example, good evidence to suggest targets can also improve outcomes particularly when it comes to raising minimum standards and that politicians may find it difficult to limit themselves to defining purpose only.