House of Commons - Public Administration

Select Committee on Public Administration Written Evidence

Memorandum from the New Economics Foundation

PART ONE

Introduction

This response forms part of the response from nef (the new economics foundation) to the Public Administration Select Committee's Issues and Questions Paper "Public services: putting people first?" This response, from the People in Public Services team at nef, focuses on the discussion in the section, "Whose voice?" and to the challenge posed in "Question 6: Should users be more directly involved in service delivery? If so, how can this be achieved?" It complements the response from nef's Measuring What Matters programme which addresses the questions posed in the "Minimum standards for public services" section of the Committee's Issues and Questions Paper.

nef is an independent think-tank that undertakes innovative research and thinking on economic, environmental and social issues. The People in Public Services team at nef seeks to highlight the ways in which local communities, the voluntary and community sector and public services might develop through the medium of co-production: that is, in mutually beneficial ways that acknowledge and reward local "lay" experience while continuing to value professional expertise. The team promotes practical tools, such as timebanking, that acknowledge and reward individual's skills and assets and highlight the often invisible interdependencies upon which successful interventions depend.

The Issues and Questions Paper contains the following reference to co-production in relation to service users:

Government also attempts to improve services by involving users directly in their design and even delivery. This can be achieved through a process of consultation or through direct user representation (or indeed both). Direct user representation is one form of what is sometimes referred to as "co-production" of public services.

In this response we seek to develop and illustrate the potential of "co-production" as more than merely another form of "consultation" (which we recognise as a method only able to gather information, ideas or opinions from public service users) or user "representation" (which we recognise as a method only able to present information, ideas or opinions from public service users). By co-production we mean actively involving those we are trying to help as co-workers. Co-production describes a model where responsibilities and knowledge are shared between professionals and users, and sometimes with the user's family and neighbours.

This response sets out the case that co-production goes beyond consultative or representative approaches, to tap the vast but currently under-engaged assets that surround all public services, the individuals and communities who use them. Co-production is a challenge to the traditional public service delivery model that is detached from the community by the professional nature of the services, the hierarchical structure of the delivery organisations and the increasingly technocratic systems of delivery. nef believes that co-production is the mechanism through which individuals and communities can work alongside "helping professionals" to make public services more effective.

This response is structured in three clear sections: nef's analysis of the problem; our proposed solutions, and recommendations on how these solutions could be applied.

We outline why co-production is vital for the future of public services, include practical examples of co-production already happening, and suggest the actions needed to make this possible across all services.

1. THE PROBLEM

— Public services currently use a deficit based approach, focusing on what people lack or how they fail as a qualifier for access.

— People are being asked to make sense of a greater choice between the services available, rather than being able to develop reciprocal relationships as individuals with service providers.

— Professionals within public services do not seek to develop or create networks of support for individuals or communities.

— Public services do not seem to be effective at progressively making people independent: people still have vast, continuing and undiminished need.

Public services currently use a deficit based approach, focusing on what people lack or how they fail as a qualifier for access: Agencies, both governmental and non-profit, provide help or benefits based on need or problem—a deficit based approach. Having provided that help, the agency says: Case closed. nef's analysis shows that this sends the wrong message. The message is: We (the agency or organization) have something you need (services and support)—but you have nothing we need, want or value. The other implied message may well be: if you want more help and more of our resources, make sure our help failed or come back with another and bigger problem. In effect, the only asset that our organizations are able to recognize within their clients is their ability to have problems. And the more complex, the more intractable, the better. This is hardly the way to create a partnership or enlist collaboration.[23]

People are being asked to make sense of a greater choice between the services available rather than being able to develop reciprocal relationships as individuals with service providers: nef believes that the "Choice" agenda misrepresents people's experiences of public services. Recent work completed by John Clarke at the Open University concludes that "while expectations of what can be delivered are rising, people who use services do not think of themselves as customers or consumers".[24] Instead people want high quality services and relationships with the professionals within them based on values such as "respect" and "partnership".

Professionals within public services do not seek to develop or create networks of support for individuals or communities: the vital importance of social capital in the maintenance of public health, tackling crimes and other social imperatives is supported by a growing volume of literature and increasingly highlighted within public policy initiatives (Our health, our care, our say; strong and prosperous communities; Lyons Review of Local Government). In fact, a vast array of vital civic work and citizen engagement—much of it essential to a democratic society—is undertaken on an unpaid basis, and in many ways the social support provided by families and neighbourhoods underpins everything else in the economy.[25], [26]

Public services do not seem to be effective at progressively making people independent: they still have vast continuing undiminished need: engaging with the assets of our communities is vital to the future of our public services. The two Treasury commissioned reports completed by Sir Derek Wanless into the future of the NHS concluded that the NHS could survive and thrive only if people took more responsibility for their own health. The reports warned that it would cost £80 billion more a year to run the NHS by 2020 if this did not happen[27].

The need for active engagement by people to make society work is particularly relevant for the work of public service professionals. Co-production has emerged as a general description of the process whereby clients work alongside professionals in order to make public services more effective. Co-production—or labour from the consumer—is the missing factor that is needed in every sphere of social endeavour. The danger is that, without engaging this support, modern welfare systems and philanthropic programmes tend to impact more effectively on symptoms than on underlying causes. nef's research shows that without engaging the co-operation and confidence of clients or patients, professionals will tend to create a dependency, convincing clients they have nothing to offer and undermining what systems of local support do still exist[28]. Co-production is designed as an approach that reverses this process and redefines clients as assets, with life experience and the ability to care.

2. THE SOLUTION

The term "co-production" began as a way of describing the critical role that service "consumers" have in making it possible for professionals to make a success of their jobs. It was originally coined at the University of Indiana in the 1970s by Elinor Ostrom and other academic sociologists as a way to explain why neighbourhood crime rates went up in Chicago when police stopped walking the beat and lost their vital connections with the local community[29].

It was also used in the UK in the 1980s by Anna Coote and others at the Institute for Public Policy Research (IPPR) and the King's Fund to describe the reciprocal relationship necessary between professionals and individuals to make positive change concrete[30]. It has been a term that has been applied particularly to the necessity of a two-way relationship between doctors and patients, but applies equally well to other public services.

The concept has been deepened and broadened by US-based civil rights lawyer Edgar Cahn, who emphasises the involvement of the wider neighbourhood of families and communities as well. Cahn has urged that the credibility of co-production depends on the following values;

— Assets: every human being can be a builder and contributor.

— Redefining work: work must be redefined to include whatever it takes to rear healthy children, preserve families, make neighbourhoods safe and vibrant, care for the frail and vulnerable, redress injustice and make democracy work.

— Reciprocity: the impulse to give back is universal. Wherever possible, we must replace one-way acts of largesse in whatever form with two-way transactions between individuals, as well as between people and institutions.

— Social networks: humans require a social infrastructure as essential as roads or bridges. Social networks require ongoing investments of social capital generated by trust, reciprocity and civic engagement.

Co-production requires professionals and service managers to move out of traditional roles as "experts" and "providers" into partnership models that work with "clients" and "communities". This enables them to find a solution together to the complexity of their problem and sometimes requires that the "problem" be redefined. Real and lasting change are possible with approaches that build or strengthen social networks and in turn motivate people to learn about and exercise their powers and their responsibilities as citizens. The elements of this approach are outlined further in appendix B.

In 2003, the Department of Health commissioned a major research programme into patients' involvement in their care entitled Health in Partnership.[31] The programme consisted of 12 separate pieces of research and produced consistent and clear results, which included the following:

— Involvement in decisions about their care, as well as experience in self-managing, significantly increase patients' satisfaction with their experience of interacting with the healthcare system.

— Patient involvement can also be demonstrated to lead to reduced patient anxiety and greater understanding of their healthcare needs.

— The involvement of patients increases clinician satisfaction with their role.

— Both patients and clinicians report an improvement in the relationship between them following greater patient involvement in decision-making and self-management.

— There is evidence that improved health outcomes at the individual level result from patients' involvement in decision-making and in self-management.

These outcomes require more than simply offering services users "choice" between treatments or providers. Barry Schwartz, in "The Tyranny of Choice" highlights that the results of greater choice are not always beneficial. The majority of medical patients do not want the decision authority that the canons of medical ethics have thrust upon them. Responsibility for medical decisions looks better to people in prospect than in actuality: Sixty-five percent of respondents say that if they were to get cancer, they would want to be in charge of treatment decisions, but among those who actually have cancer, only 12 percent want that control and responsibility. It is critical to ensure that the process of choice within public services increases people's well-being and sense of independence rather than adding to people's sense of stress and helplessness.[32]

Research completed by nef in 2006 identified the characteristics and values that projects and services engaged in co-production share. These organisations consistently:

— Provide opportunities for personal growth and development to people who have previously been treated as collective burdens on an overstretched system, rather than as potential assets.

— Invest in strategies that develop the emotional intelligence of people and the capacity of local communities.

— Use peer support networks instead of professionals as the best means of transferring knowledge and capabilities.

— Reduce or blur the distinction between clients and recipients, and between producers and consumers of services, by reconfiguring the way services are developed and delivered. Services seem to be most effective here when people get to act in both roles—as providers as well as recipients.

— Allow public service agencies to become catalysts and facilitators rather than central providers themselves.

— Devolve real responsibility, leadership and authority to "users", and encourage self-organisation rather than direction from above.

Examples of the emerging co-production sector

The past three decades have produced a number of successful examples of co-production in action. The squatter camps of Orangi in Karachi successfully provided themselves with drainage and mains water faster and at a far lower cost than the more accepted top-down method. Habitat for Humanity has made houses more affordable by including work building other people's homes into the mortgage payments. Some programmes—notably the Bolsa Escuela scheme in Brazil, which pays mothers to make sure their children attend school—have made direct payments to clients or their families to recognise the efforts they are making.

The time banks movement in the UK and the time dollar movement in the US are explicitly aiming at a co-production approach by building alliances with local public services. Time banks use a "time credit" system to measure and reward the efforts people make—often very small contributions like phoning neighbours or helping them face-to-face—and gives them limited spending power for what they need. Around the world, these time credits can variously be used to access food, clothing, computers, legal services, health-care services, housing, rides to the shops and even enrolment in college courses.

Many public services are likely to already recognise and hold some of the values identified by the nef work. Crucially, co-producing organisations work to all of them. Within the practical examples outlined in appendix A it is possible to see how a co-productive approach has been able to connect public services, service users, citizens and communities in a variety of settings from primary to specialist health care, in drug rehabilitation, with refugees and asylum seekers, education and working with young people, housing associations and care of the elderly.

3. RECOMMENDATIONS

nef believes that government needs to set the framework that will allow co-production to become mainstream, both in the way it evaluates public services and the way it organises its budgets. This will require the basic task of professional staff to shift from being simply fixers who focus on problems, to catalysers who also focus on abilities. This shift was urged in the Green Paper on social care, Independence, Well-being and Choice: A Vision for Adult Social Care in England.[34]

To this end, nef proposes that government should:

— Set a duty to collaborate between services, their clients and the public—this would mean requiring all bodies responsible for setting standards and auditing or inspecting performance in the public sector to put in place mechanisms to make sure public service organisations engage with their users, and the wider public, in formulating and pursing common objectives and targets.

— Build on its "Together We Can" campaign to promote collaboration between citizens and public services, and introduce a cross-sector award scheme to recognise effective co-production—as Investors in People does now for staff training—and to inject reciprocity into the relationship between professionals and clients.

— Experiment with accounting systems which allow policy makers to see more clearly which interventions save money—in the short term, this will mean giving consideration to the findings and proposals from the research on the evaluation of the costs and benefits of community engagement, commissioned by the Civil Renewal Unit in the Home Office. (See the response from nef's Measuring What Matters programme for a fuller discussion of this.)

— Trust citizens to do more and take more responsibility by tackling directly the culture of risk aversion.

— Set up a Co-Production Fund for public service institutions, which will match their investment in innovative asset-based experiments.

— Enable everyone to give their time to shaping and delivering public outcomes without any financial penalties, especially if they are outside paid work, have mental health difficulties or are excluded in a range of other ways, and make sure that public services provide more opportunities for joint work with citizens.

In order for co-production to take root in public agencies, public service workers will need to be helped to:

— Learn to trust local people.

— Seek out and value contributions from a wider range of local people, clients and patients.

— Help build new social networks that they do not actually control.

The shift within public services to an environment that facilitates and encourages co-production will need to:

— Build on the wealth of experience in public engagement resting in the less visible parts of current public services (eg mental health).

— Rethink financial models to enable the flow of resources of value apart from money (eg time) to enable reciprocity.

"Used positively, co-production can be an opportunity to rethink service provision—a progressive alternative to those who hold out two choices: bureaucratic models of production or individualised consumerism." [37]

nef believes that our response to the Committee's Issues and Questions Paper illustrates the vital importance of co-production within public services in the UK and the multiple positive outcomes that develop as a result of this approach. We recommend that the Committee seek evidence from expert witnesses with experience in developing thinking and practice around co-productive approaches including:

— Edgar Cahn—creator of time banks and founder of the Timedollar Institute. Edgar will be visiting the UK during March 2007.

— Anna Coote, Head of Engaging Patients and the Public, the Healthcare Commission.

— Becky Malby, Director of Centre for Innovation in Health Management, University of Leeds.

— Zoe Reed, Trustee of Timebanks UK, Director of South London and Maudsley NHS Trust.

— David Boyle, nef fellow and originator of timebanking in the UK.

— Timebank members (we would be willing to arrange this for the Committee).

We also suggest that the Committee visit some, or all of the case studies provided, to experience first hand the impact that co-production has on those involved and the flexibility of the approach within a variety of settings and services. We strongly recommend the committee explores the "timebanking" model, a practical tool that enables and records opportunities for co-production within a variety of settings.

Appendix A

CO-PRODUCING ORGANISATIONS ACROSS THE SECTORS

HEALTH

Social Action for Health (SAfH) Health Guides

Cohorts of local people act as health guides within their community in their own language. The aim is to facilitate own-language access for excluded people on information and guidance about health services and health issues; to promote understanding and awareness of self care and self management.

75 local people from Bengali, Somali and Turkish-Kurdish communities in Tower Hamlets, Newham and Hackney went through training programmes which included how to access resources and services, chronic conditions, how to work with groups, how to listen and how to be representatives. The Health Guides work in pairs to deliver sessions in community settings (community centres, schools, mosques, clubs) to groups of people at different times of the day, evenings or weekends as appropriate. The Health Guides also feedback to healthcare professionals about particular issues/ difficulties that the local community raise and help to develop services that respond to these.

Newham Community Care Navigators

The Community Care Navigators (CCN) are a new workforce that proactively engages the community, carrying out very informal assessments of their needs. Once this assessment is completed the individual will be offered a range of support to help them self-manage their condition. A range of advice and help is offered including counseling, complimentary therapies, housing and benefits, nutrition, smoking cessation, support groups and the expert patient programme. Individuals can self refer to this service or be referred by doctors, health visitors, etc. The CCNs encourage the community to self-manage if they have a long term condition and also promote healthy living. The CCNs are mainly recruited from the local community.

South London and Maudsley (Slam) NHS Trust time bank

Time-based currencies value everyone's contributions equally. One hour equals one service credit. In these systems, one person volunteers to work for an hour for another person; thus, they are credited with one hour, which they can redeem for an hour of service from another volunteer. The Slam time bank is based on the wards of this large NHS mental health trust. Individuals experiencing mental ill-health are encouraged to become members of the time bank, which provides an opportunity to reconnect with the local community.

Because time banks are based on people's skills, rather than their needs, mental-health service users can escape the ghettoisation of services that often leads to mental health service users only ever meeting other mental health services users. By supporting time bank members when they are patients on the wards, the time bank maintains social connections that are frequently lost when individuals are hospitalised. Individual skills exchanges and community activity provides opportunities to develop social networks, contributing to well-being and health. Timebank participants are also able to connect to other local community timebanks based across south London, ensuring a social network is in place for individuals on discharge.

Member to Member, Brooklyn

This is an example of how successful mutual patient support schemes can help mainstream health services, in this case a health insurance agency, provide a more effective service. "There is a basic need to feel needed", says co-ordinator Mashi Blech, "we all need opportunities to use our skills and experience to make a difference. We all need to be challenged as lifelong learners. Member to Member brings people together—strangers become neighbours, neighbours become friends, friends become extended family". Member to Member have been so successful that they have now expanded to cover the whole city of New York and members are even offered discounts on their insurance premiums—because participants in the scheme are a much healthier going concern.

The Expert Patient Programme

The Expert Patient programme illustrates the positive outcomes that can result when the relationship between provider and service user is redefined. The programme recruits volunteers who have themselves experience of chronic ill-health to deliver self-management training to others experiencing ill-health through local PCTs. The programme demonstrates that where patients and health professionals act together to co-produce a positive outcome there are long term reciprocal benefits for all. Volunteers are recognised as assets as a result of their experience, participants are more able to live successfully with their conditions and professionals are less likely to deal with problems that are essentially self-managing.

EDUCATION AND CHILDCARE

Scallywags Nursery, East London

This nursery set up to meet the childcare needs of parents in East London. The project has been able to meet dual challenges of providing flexible and affordable childcare and enabling parents to remain engaged in their childs time while at nursery. The nursery employs a qualified nursery nurse and requires every parent to commit one day per month to the nursery. Parents negotiate their shifts to ensure suitable numbers of carers are available on each day. The nursery is able to take a central co-ordinating role whilst also ensuring that the skills and interests of each local parent are engaged in supporting their own and others children. A secondary outcome of the nursery is that in working together many parents develop friendships that they maintain outside the nursery, overcoming the isolation that many new parents experience.

Mitchell High School, Stoke-on-Trent

Mitchell High School is one of the models for the UK Government's "extended schools" programme. Its success is based on the efforts of an innovative headteacher and her team, and their ability to turn to the community for help in regenerating a failing school. The school explicitly reaches out to the neighbourhood, mainly to parents, to use their skills—not just on the governing body or helping out in the classroom but also to achieve major projects, including improving behaviour. Mitchell uses the school as a springboard in order to rebuild the local community through co-production. It may be the fact that this is a school is less important—other local institutions have been used in much the same way—than the underlying purpose behind the project. In fact, the project has been only indirectly about raising educational standards. It has been primarily about building emotional capacity within the community, which the headteacher saw as a prerequisite before academic standards could be raised. The central idea has been that the community is an equal partner.

DRUG REHABILITATION

Basta Arbetskooperativ (Basta), Stockholm, Sweden[38]

Basta is a unique partnership between drug rehabilitators and former drug users to develop community services as equal partners, in a co-operative social enterprise structure. It is an example of how co-production can be embedded as part of the legal structure of an institution, rather than relying on the interests of a handful of professionals who may move on to other positions. Basta gives recovering drug users the option to become a partner in the not-for-profit company. The result is a tough model, which gives away nothing, but where the support is entirely reciprocal and where a great deal is expected of the service users.

ENVIRONMENTAL PROJECTS

Curitiba Recycling Project, Curibita, Brazil[39]

This is a ground breaking attempt by a Brazilian city to pull together underused capacity in the public transport system to solve problems of waste and recycling in slum dwellings, and improve the overall environmental performance of the city. It emerged out of the innovative work of Mayor Jaime Lerner, whose key problem was that the streets in the favelas were too narrow to allow his waste trucks down. As a result, there was a serious problem of informal rubbish heaps, which festered disease and illness and which were affecting the health of the populace. Lerner's successful solution has been to measure and reward the efforts made by ordinary people to tackle this problem with a credit system that allowed them to use public transport.

Appendix B

THE ROLE OF CO-PRODUCTION IN DELIVERING REAL AND LASTING CHANGE

	Conventional delivery approach (e.g. institutional public services)	Generic co-production approach (e.g. conventional voluntary sector)	Institutional co-production approach
People as assets	Community members as patients, students, victims, perpetrators, the problems to be solved Strategy and policy documents and quality standards restrict community members to status of consumers, clients, end or services users Significant status and power/distance differentials Community members may provide user representation on boards, in consultation processes but have little or no real influence over decision making Friends and family networks seen as marginal or, at worst, negative influences	Community members as volunteers usually primary medium of service delivery Community members often describe themselves as "just a volunteer" Volunteers often protected and directed by professional staff Community members have some influence over design and creation of services, often sit on management and partnership boards Often co-delivery of services done by volunteers and direct experience valued	Community members seen both by others and themselves as complementary participants equally responsible for positive/negative outcomes Community members' direct experience seen as integral part of "solution"Networks of friends and families considered positive co-contributors to success Community members meaningfully involved in all stages of service planning, design, creation, delivery and evaluation
	Conventional delivery approach(e.g. institutional public services)	Generic co-production approach(e.g. conventional voluntary sector)	Institutional co-production approach
Work	Community contributions often restricted by regulations and institutional risk management Status and pay accorded by professional skills, qualifications and expertise—specialist knowledge delivered/ transferred to lay recipient Paid with some marginal unpaid contributions in specific areas Unpaid contributions do not figure in targets or evaluation of service effectiveness What constitutes work is pre-determined and regulated	Clear distinctions between roles and responsibilities of paid professionals and community members Some regulations and risk management approaches restrict fully inclusive participation by all community members Community members' contributions recorded only for funding purposes rather than to meet organizational aims Unpaid work valued highly but nature of work tends to be limited by type of organization and strategic aims and objectives	Community members' contribution to strengthening the core economy seen as necessary for achievement of successful outcomes—by both professionals and community members Community contributions form integral part of organizational strategy—they are systematically recorded and used to define organizational mission and meet objectives Nature of work is defined by needs and complementary skills and capacity of both community members and professionals
	Conventional delivery approach(e.g. institutional public services)	Generic co-production approach (eg conventional voluntary sector)	Institutional co-production approach
Reciprocal activity	"Contract" between professionals and community members is implicit with community members required to comply Professionals seen as "authoritative voice" by both paid staff and community Generally one-way transactions from professional/expert to lay person/community member Assumption (implicit) that this is what professionals are paid to do and therefore wouldn't be expected or need to ask for help—nor should community members be expected/required to provide it	Specific reciprocity—tends to take form of one-way transactions between volunteer and beneficiary (individual or organization) for which volunteer may receive acknowledgement in the form of training, work experience, paid expenses, etc Stated motivation for community members' participation often "to give something back" Expectation of getting something back in return often viewed as contradictory to ethos of volunteering Reciprocal benefits increasingly used as "carrot" to incentivise volunteer involvement	Giving and receiving encouraged equally—emphasis on reducing cultural resistance to asking for help (and associated "weakness") Reciprocal transactions take place in both specific (1-2-1) and generalized (one-to-many; many-to-one; many-to-many) ways Asking for help/ contributions is seen as positive and expected Reciprocal actions take place across conventional boundaries—both horizontally and vertically, eg across status divides, interculturally and cross generationally, between organizations
	Conventional delivery approach(eg institutional public services)	Generic co-production approach(eg conventional voluntary sector)	Institutional co-production approach
Social capital and social networks	Generation of social networks and strengthening of both individual and community social capital seen as outside the remit of service delivery	Generation of social networks and strengthening of both individual and community social capital often unintentional by-product of participation, eg self-help groups	Generation of social networks and strengthening of both individual and community social capital is specific and explicit organizational aim
	Professional networks of high status the norm—foster polarization of in-groups/out-groups	Bonding social capital common, some low-level bridging and linking	Both instrumental and transformational networks are actively promoted and supported

	Bonding social capital common—bridging and linking forms are rare		Support and delivery of activities that bring people together and generate positive emotions are an integral part of organizational ethos Bridging, bonding and linking social capital building activities are underpinned by organizational policies and practice

PART TWO

Introduction

This response forms part of the response from nef (the new economics foundation) to the Public Administration Select Committee's Issues and Questions Paper, "Public services: putting people first?". It complements the response from nef's People in Public Services team by specifically addressing the questions posed in the "Minimum standards for public services" section of the Issues and Questions Paper:

— Is it possible to set minimum standards for public services? If so, how is this best done?

— What role do measures of customer satisfaction have in assessing the standards of public services?

nef is an independent think-tank that undertakes innovative research and thinking on economic, environmental and social issues. This part of nef's response was co-ordinated by the Measuring What Matters team within nef. Measuring What Matters is a programme of research that looks at how government policy making could be improved by measuring and valuing what matters most to people, communities, the environment and local economies. It seeks to move away from a culture within government that is short-term and target-driven, towards one that enables government to pursue real social, environmental and economic well-being.

Setting standards for public services

nef believes that the Committee's proposal for minimum standards for public services is an innovative response to some of the problems of designing and delivering effective public services. In particular, it poses a constructive challenge to the narrowly-focused target culture that has dominated public service delivery in recent years. As the Committee noted in its earlier report On Target?,[40] in many instances targets have directly resulted in distorted priorities and behaviour. The secondary effect of this is that often the interests of users are sidelined, as the main focus becomes meeting targets rather than people's needs.

Instituting standards for public services could potentially correct this distortion by equipping service users with a means of ensuring their views and experiences count. In this sense, the purpose of public service standards corresponds with nef's belief that government should measure what actually matters to people.

We would, however, urge that the Committee go beyond minimum standards to include a broader concept of "public service standard" that looks at outcomes for users. We advocate setting public service standards that are based on actual outcomes—rather than outputs, activities or the resources required—because that is how people ultimately understand and experience the provision of public services. (Please refer to the response from nef's People in Public Services team for a fuller discussion of outcome based public services.)

Any process for setting standards for public services should adhere to certain principles to ensure their legitimacy and relevance to users. The principles we suggest for setting service standards, based on those we use to "measure what matters", are as follows:

— Measure outcomes.

with

— Accountability to people.

— Measure assets rather than deficits.

Principle 1: measure outcomes

This principle relates to the form that standards for public services should take. As outlined earlier, we favour standards that are based on outcomes because expressing things in terms of outcomes more clearly brings out the impacts of public service provision on people's lives.Setting standards based on outcomes, however, can be very difficult for a number of reasons:

— It gives rise to problems of demonstrating that a particular standard (ie, the relevant outcome) has been met. This is especially so where an outcome is more or less subjectively experienced; for example, the criminal justice system's aim of protecting and reassuring the public is experienced differently by individuals depending on their attitudes towards crime and community safety.

— There is often a problem of attributing the achievement of an outcome standard to the provision of public services where there are many other factors that affect that outcome. To take a simple example relating to health care, a person's state of physical health depends on numerous factors beyond access to health services, including diet, exercise, lifestyle and genetic conditions or predispositions.

— Practically speaking, setting a standard in terms of a minimum entitlement to public services that users can claim may lend itself more to outputs rather than outcomes (for instance, a standard based on the timeliness and quality of access to medical care rather than the eventual effect on the overall health of a patient).

Despite these complexities, setting public service standards requires an outcome-focused approach. The danger otherwise is that standards may not capture the most important aspects of what users want from public services. In other words, service standards could fall into the same trap as narrowly-focused output targets. Specifically, it could lead to services being distorted towards meeting a prescribed minimum level of provision rather than focusing service delivery on what actually matters to people. Outcome standards set the necessary context for minimum standards, because they express the ultimate impacts on people's lives that effective public service provision should bring about.Evaluating the achievement of outcome standards is equally challenging. One way of doing so is through measuring user satisfaction and attitudes. Taking up the example of public protection mentioned earlier, an outcome standard could be the extent to which people feel safe in their neighbourhoods, as measured by attitudinal surveys, in various scenarios—eg alone or in a group, during the day or at night, and so on. (Corresponding output measures might be the number of prisoner escapes and the amount of time community-based constables spend on the beat.)

As with outcome standards themselves, user accounts of their experiences of public services can be difficult to work with as they are necessarily subjective. Nevertheless they do, at least, provide some means for measuring whether public services are delivering what people want.[41] Outcome standards would also complement other initiatives to increase and improve user feedback on public services, such as Bernard Herdan's recommendation (in his report to the Cabinet Office on the Charter Mark scheme) that more rigorous customer satisfaction measures should be introduced for public services.[42]

Our conclusion is that the Committee should focus on outcome standards as well as minimum standards for public services. We believe that minimum standards are necessary but not sufficient. Having complementary outcome standards would enable users to make the connection between the public services that are provided and the effect the provision of those services has on their lives.

Principle 2: measure with people

Setting meaningful standards that people will relate to means that users must be involved in formulating them. Particularly for outcome standards (as described earlier), it also requires people's participation in determining whether standards have been met. Involving users in setting standards, and in service design more generally, increases the likelihood that public services focus on the public's priorities.

In this way, public service standards have the potential to be a truly "bottom-up" measure of the adequacy of public services—a necessary counterweight to targets, which are often criticised as top-down directives that can distort service provision away from what matters.[43] Public service standards could be bottom-up in two ways:

— through direct user input into the development of standards; and

— through people actively claiming their entitlement to (especially minimum) standards of service where provision falls short.

Much recent thinking on methods for involving people in policy formulation could be applied to the development of standards for public services.[44] The citizens' jury technique, in particular, could be used to set outcome standards that would result from a process of informed deliberation. There are also precedents of user involvement in standard setting and monitoring through the various scrutiny bodies made up of service users, such as the former rail passengers' committees (now Passenger Focus).

Principle 3: accountability to people

This means ensuring government measures embody a degree of public accountability that makes sense and is relevant to people. Public service standards do this by instituting a more direct measure of accountability for the use of public funds. Standards convey to people the connection between the taxes they pay and what they receive in return from public authorities. In this way, standards can encourage user attachment or connectedness to public service provision. This taps into wider debates about reviving and renewing the "civic contract" or social compact between government and citizens.[45] It was, of course, also a key rationale for the original Citizen's Charter, in seeking to set out the levels of service that people depending on public services could expect.In order to function effectively in securing accountability, public service standards must firstly be embedded firmly into government accountability arrangements; and, secondly, must entail a mechanism for users to hold government bodies to account if standards are not met. This issue has been canvassed more fully elsewhere in a discussion of minimum service standards as "public service guarantees".[46]

In order to tie public service standards to existing accountability structures, standards could form part of the public service agreements (PSAs) through which each government department sets out its goals and targets. One of the primary purposes of public service agreements was to more clearly define the obligations of government to its citizens.[47] Incorporating user-oriented public service standards would bring this original intention more sharply back into focus, while at the same time complementing the top-down approach of existing PSA targets.

Potentially, public service standards could bring about much more direct and vivid accountability. This would require public service standards that specify the means of redress that an individual could expect if a standard was not met, and an effective enforcement mechanism (perhaps in the form of an independent adjudicator on public service standards, or through an extension of the Parliamentary Ombudsman's powers).[48] There are many practical questions of implementation that would need to be worked out, but the basic idea of public service standards embodies the prospect of a real and meaningful accountability to the people that use and pay for public services.

Principle 4: measure assets rather than deficits

This underpins a distinct policy approach that focuses on how best to enable people to flourish. It contrasts with the more commonly found approach to policy making that focuses on deficits—what people lack—or why people fail. Instead, it requires decision makers to consider the positive factors contributing to an individual's success, and how policy could encourage individuals to succeed.

For example, in criminal justice the Government's main measures on offender management have for some time largely concerned reoffending rates. Because of the focus on reoffending, measures reflect where policy has failed rather than where it has succeeded in enabling individuals to lead fulfilling, law-abiding lives. An emphasis on success factors could help identify interventions that enable individuals to go and stay straight.

An asset-based approach entails a more complete view of individuals and their needs and is geared towards achieving long-term outcomes. It reinforces our earlier principle of measuring outcomes, and similarly it suggests that minimum standards need to be complemented by outcome-based standards in order to capture what is ultimately important to people.

RECOMMENDATIONS

nef recommends that:

outcomes

— Users should be involved in developing and evaluating public service standards, through appropriate participatory techniques such as citizens' juries.

— The design of public service standards should specify mechanisms that enable users to hold government to account if defined standards are not met.

nef plans to report research findings on how government decision making could "measure what matters" by the end of 2007. Two of the programme's research strands may be of particular interest to the Committee, as they seek to demonstrate how policy makers could refocus their policy approach on outcomes for service users. For each research strand—on women offenders and on children in residential care—we are examining what difference it would make if a user-centred policy approach were to be adopted: to the policy process, policy outcomes, indicators of success, the wider costs and benefits, and ultimately to those people most affected by policy.

We would be happy to discuss progress on the Measuring What Matters research and our eventual findings with the Committee at any appropriate point.

January 2007

23 Cahn, E (2005), Wanted-A Paradigm Shift: From Service Delivery to Co-Production. Back

24 http://www.openac.uk/socialsciences/citizenconsumers/ Back

25 Etzioni, A (1997) The New Golden Rule: Community and Morality in a Democratic Society. New York: Basic Books. Back

26 Cahn, E S (2001) No more Throwaway People: The Co-production Imperative. Washington, DC: Essential Books. Back

27 Boyle D, Ali R, Mulgan G (2006) Life After 60; A National Wellness Service. Back

28 Cahn, E S (2001) No more Throwaway People: The Co-production Imperative. Washington, DC: Essential Books. Back

29 Ostrom, E (1973) Community Organisation and the Provision of Police Services. Beverly Hills, CA: Sage Publications. Back

30 Coote, A (2002) Claiming the Health Dividend. London : King's Fund. Back

31 Farrell, C (2004), Patient and Public Involvement in Health: the evidence for policy implementation, London: Department of Health. Back

32 Schwartz, B (2004) The Tyranny of Choice, The Chronical of Higher Education, January. Back