User surveys
198. There are a variety of ways in which those who
provide services can discover the detailed views of service users.
These can include: customer surveys, focus groups; and suggestion
boxes or forms. Although there is no doubt that effective examples
of all these exist in the public sector, they seem to have been
neglected in the current debate on the public services.
199. It is true that, in recent speeches, the Mr
Alan Milburn has suggested that there are benefits in asking users
directly for their opinions on services. He told the Social Market
Foundation "Satisfaction levels with policing in the North
West, for example, rose only after services in both Blackburn
and Liverpool began to elicit public views on how performance
could be improved. Many health and local authorities are finding
the same. There are enormous gains to be made from bringing the
public inside the decision-making tent".[150]
200. Mr Milburn's view was echoed by Ms Palmer-Fagan,
Birmingham City Council, who told us that "As a district
housing manager, I would not like to make any decisions in my
district about changing that service without engaging and involving
the people who I provider those services for".[151]
The South Birmingham Primary Care Trust also carries out "regular
satisfaction surveys, focus groups, and patient forums with our
service users" and felt that they "have made quite a
lot of significant improvements in the services as a direct result
of people saying 'we would like things to be done this way, rather
than this way". [152]
201. Whilst in Birmingham we also heard from Vic
Smith, a tenants' representative, that the transfer ballot appears
to have prompted the Council to redouble its efforts to bring
tenants into the decision-making process. Mr Smith told us that
"we have been involved more since [the stock transfer ballot]
than we ever were before
The tenants have the chance to
come and say what they want".[153]
202. Schools operate a variety of "voice"
mechanisms. Parents have a say through representatives on governing
bodies and complaints systems. Parents are also often surveyed
on proposed changes to schools such as the introduction of uniforms,
and as part of OFSTED inspections. Pupils may have a voice through
school councils. Martin Ward of the Secondary Head Teachers Association
suggested to the Committee that an extension of pupil voice might
be appropriate:
"It is possible to survey pupils and ask
them whether they are content with their education. To move on
from asking them about the dinners and state of the toilets to
asking them about the lessons and the education process is a step
that we are beginning to take now and we are beginning to see
things like student governors and students involved in the appointment
of teachers, for example".[154]
203. When we considered the Ombudsman's concerns
about the new arrangements for the NHS complaints system last
session, Sir Ian Kennedy, chair of the Healthcare Commission,
told us:
"I would say that, in concentrating on complaints,
we forget that there are perhaps other interactions. I often talk
about, if I may say so, the three Cs: compliments, comments and
complaintsthis is terribly rudimentaryand they are
all part of one big C, which is communication".[155]
204. In a subsequent memorandum, Sarah Mullally,
the then Chief Nursing Officer, explained that
"The development of model patient comment
cards was
raised in
"NHS complaints reformMaking
things right". This was published in March last year
and follows our commitment in the NHS Plan that "all patients
will be given the opportunity to record their views about the
standards of care they have received...". The development
of patient comment cards is part of a broad range of initiatives
discussed in "Making things right" to encourage
more positive relationships between patients and healthcare professionals
by both providing greater information to patients and actively
seeking feedback from them.
we have worked
to develop a model
comment card and supporting guidelines.
The comment card is seen as a means of collecting
patient views, to ensure that NHS organisations can continually
improve services using more immediate feedback, alongside information
already obtained through the patient surveys and complaints. The
comment cards will allow patients to say what was good or not
so good about their treatment and make suggestions about what
might be done to improve services".[156]
205. We commend comment cards as a straightforward
but effective means for establishing user experiences from which
the providers can learn and improve their service.
206. The value of regular consultation of service
users about their experiences and expectations of service delivery
is clearly shown in Canada, where a biennial survey of 9,000 users
across the provinces and territories is carried out by the Institute
for Citizen-Centred Service (ICCS). The survey examines key "drivers"
of satisfaction with services: timeliness; knowledgeable staff
who go the extra mile to help clients, fair treatment; and a successful
outcome. The 2002 survey found that timeliness, by a slight margin,
was the lowest scoring in terms of satisfaction, but that it had
the strongest impact on satisfaction, which suggests that in Canada
improving timeliness presents the single biggest opportunity for
service improvement. The same survey also examined the link between
good services and confidence in government institutions, finding
that "Good service not only makes citizens happy, it strengthens
the institutions of government".[157]
207. The ICCS also provides measures by which public
satisfaction with individual services can be assessed. It is the
custodian of a series of Common Measurement Tools which services
can adapt and use in order to carry out individual surveys. The
evidence from Canada is also becoming more widely known. When
we visited that country in 2003 we were impressed by the commitment
at both federal and provincial level to asking consumers what
they needed and wanted from public servicesand to making
sure lessons were learnt to make sure they were improved (including
targets for improved satisfaction levels over time). Writing in
2004 Mary Tetlow, principal adviser at the Office for Public Service
Reform in this country, said that "The OPSR is now considering
whether we should develop some aspects of the Canadian model here"
as, although public service customer surveys are carried out in
the UK, the UK lacks a common measurement tool. Ms Tetlow continued:
"Without [a common measurement tool] it
is hard to gain a definitive picture of how well government is
responding to the needs of customers across the whole public sector.
What we need is a clear understanding of what matters to citizens
about how public services are delivered and the key factors that
will ensure that users of public services are satisfied with the
experience
".[158]
208. The National Council for Voluntary Organisations
(NCVO), representing the voluntary and not-for-profit sector,
made a valuable point when it told us that "consultation
should be about those things that the individual or the community
really can have a say over. And it should include a feedback process
to ensure that those consulted know the outcome of the consultation
and the reasons for decisions".[159]
There is a great deal of scope for innovation in the area of feedback
about user preferences and levels of satisfaction with public
services, and the Government should do more to encourage such
innovation.
209. We believe that there should be a more concerted
approach to the measurement of public satisfaction with public
services. The Canadian experience has shown that such an approach
can be very useful in ensuring that lessons are learned and services
improved along the lines that consumers require. Consideration
should therefore be given to the development of a Public Satisfaction
Index (PSI) which would be used to measure satisfaction with individual
services. This should play a part in performance assessment and
should be rigorously audited by an independent body such as the
National Audit Office or Audit Commission.
210. The machinery to allow service users to contact
government departments and to communicate what they require is
itself complex and variable in quality. It was found in March
2005 that there were no fewer than 198 call centres for central
government alone.[160]
As The Guardian commented "Does the DWP really believe that
the public's best interests are served by having 10 different
contact centres for pension matters? Surely one would suffice?"
In this area, choice does not seem likely to be what the public
want of their public services. In France, there is a move to introduce
a single access gateway, called 'Allo Service Public'. The scheme
aims to answer citizen's administrative queries, satisfying 70%
of requests straight away so users do not have to go elsewhere.
The objective is to give a human and friendly service, as well
as a modern image to public services. The development of a similar
access gateway in the UK could help to make it easier for users
to negotiate an increasingly complex world of public service delivery.
Building on the success of NHS Direct, we believe the trial
of a Public Services Direct would be a valuable addition to the
voice mechanisms available to users.
A FAILURE TO LISTEN TO THE VOICES
OF USERS
211. We have identified shortcomings in the design
and operation of the mechanisms which are supposed to give users
a say in the direction of services. Neither complaints systems,
representative bodies nor user surveys are sufficiently well developed
or sensitive to the needs of the people who use services. One
of the concerns raised by the Government about voice mechanisms
is one which can also be levelled against choice-based systemsthat
they favour the "educated and articulate".[161]
It is ironic, and significant, that those who might be most disadvantaged
by provider choicethe poor and the inarticulateare
often those who are also least able to take advantage of the "voice"
they are given through the (often ineffective) representative
bodies that currently exist. Their voices are rarely being heard.
212. It is therefore disappointing that the Government
memorandum to the Committee, while acknowledging these difficulties,
fails to offer any proposals for overcoming them. It appears that,
within Government, policy development on choice has been given
priority over policy development on voice, and that some important
issues have been neglected. We hope that the recent initiatives
from ODPM might help to overcome this deficit, but there is clearly
much work still to do.
213. We recognise that, just as there are constraints
on choice, there are constraints on voice, whether expressed in
representative bodies or through complaints systems and user surveys.
More careful and imaginative consideration needs to be given to
making voice mechanisms effective. The problems being encountered
by the Parliamentary Ombudsman in gaining active and practical
Government support for modernisation is one example of the current
difficulties. Together, choice and voice can contribute to making
public services responsive and giving more power and control to
those that use them, but they must be treated with equal seriousness
by the Government.
133 CVP 14 Back
134
Q 293 Back
135
CVP 12, para 86.2 Back
136
CVP 04 Back
137
CVP 24a, para 25 Back
138
Q 474 Back
139
Guardian Society, 19 January 2005 Back
140
CVP 24, para 3.3.6 Back
141
CVP 24, para 3.3.7 Back
142
Q 479 Back
143
Q 125 Back
144
CVP 24, para 3.3.9 Back
145
OMB 01 Back
146
HC (2004-05) 50-i, Q 27 Back
147
Ibid., Q 28 Back
148
Ibid., Q 23 Back
149
Ibid., Q 25 Back
150
Speech by Rt Hon Alan Milburn MP, 8 December 2004. Back
151
Q 271 Back
152
Q 374 Back
153
Q 270 Back
154
Q 266 Back
155
HC (2003-04) 41-iii, Q 249 Back
156
OW 10 Back
157
ICCS, Citizens First 3, Summary Report, Institute of Public
Administration of Canada, January 2003 Back
158
"The Canadian Experience", Public Finance, January
2004 Back
159
CVP 07, para 4.17 Back
160
"Calling out around the world" Public, The Guardian,
March 2005. The National Audit Office conducted a survey of government
call centres in 2002: HC (2002-03) 134 Back
161
CVP 24, para 3.3.9 Back