The case for change
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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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Weak markets
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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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New performance management
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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
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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
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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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Wellbeing
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Wellbeing

Wellbeing is a multi-dimensional concept that encompasses social, environmental and economic outcomes. A number of governments are using wellbeing frameworks to measure progress against these outcomes and to guide the development of policy and practice.

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Benefits and challenges of wellbeing frameworks
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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
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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
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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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Can targets be replaced by purpose?
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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.

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