Memorandum from The Work Foundation and
Research Republic
This summary responds to the following broad
questions set by PASC, principally:
— Should users be more involved in
service delivery?
— How does user influence relate to
wider issues of democratic accountability?
PUBLIC VIEWS
OF PUBLIC
SERVICES
1. What do we know about what the public
think? Research shows that satisfaction with public services has
remained static despite service improvements; expectations of
improvement remain low, as does trust in politicians and public
managers to deliver such improvement. Yet the public remains committed
to basic values of universality, equity and accountability even
if they want public services to treat them more like "consumers".
— The public are consistent in their
expectations that services will not improve under the current
government, with the exception of the police and the education
service.
— There is an overwhelming perception
amongst the public that public services need to improve. 90% of
those surveyed in an ICM Poll in July 2004 strongly agreed with
the statement that "we urgently need to improve the quality
of public services". 80% stated that "I will only believe
that public services are improving if I see it with my own eyes."
But perceptions do not match real delivery improvements. Of the
following facts about public services, only:
— 20% agreed that crime is falling.
— 22% that there are thousands more
teachers.
— 36% that there is faster access to
treatment in NHS hospitals (than in previous years).
— Satisfaction with most services has
remained static over the last few years. 84% of recent patients;
58% of crime victims and 84% of parents of primary school children
say they are satisfied with the services they receive from their
GP, the police or their local school. Satisfaction with different
public services is higher locally than nationally for all public
services. In a MORI poll in 2004, 78% of the public were very
or fairly satisfied with their GPs in their local area compared
with 70% in Britain as a whole.
— The public remain committed to the
core values of public services, universality and equity. 85% agree
that public services should be funded by the tax payer and free
at the point of use. Only 34% strongly agree or tend to agree
that what matters is the quality of services in their local area
and that they are not interested in what is happening elsewhere.
60% tend to disagree or strongly disagree with this view.
— The most important drivers of trust
in public services are whether services meet individuals' needs
(55%) and how they are treated by staff (53%). The least important
drivers are "what is said about public services in the media"
(16%) and "what family and friends tell you about the service".
Nevertheless:
— Opinions are formed via a number
of sources. People claimed they got a lot of information about
public services, compared with a little or not at all, from National
TV news (52%) and TV documentaries (49%) compared with relatives/friends
experience (34%) or their own experiences (43%).
— 36% of the public felt that high
profile incidents that raised questions about quality and reliability
of public services undermined their trust in the specific public
services involved, compared with 28% that considered them to be
rare, one off events that did not effect their trust.
— Only 48% of the public trust their
council compared to their local police force (74%) and their hospital
(79%). With regard to individuals, trustworthiness and honesty
are the most highly rated qualities of public officials but only
11% believe that they are actually trustworthy and that they are
honest.
— The public are strongly in favour
of having choice over specific services, principally, a choice
of school for children with special needs (43%) and choice of
support for elderly living in their own home (42%). But most people
are not prepared to pay more for choice. Only 23% said they would
be happy to pay more tax to allow people a greater choice of school
compared with 70% who said they would not.
— The evidence on the demand for greater
voice in public services is mixed, inconsistent or contradictory.
For example, one survey found that only 17% of the public would
help their council plan and deliver its services, whereas another
found that 70% of the public would be likely to get involved in
a meeting where they could set local council budgets with councillors.
Research also concludes that the public say they are keen to participate
in the design and delivery of services but reluctant to do so
through existing mechanisms.
— 42% of the public interviewed in
a MORI poll for BBC Radio 4 agreed that private companies should
not be involved in providing public services under any circumstances
compared to 37% who believe they should. However, 81% wanted public
services to start treating users as consumers and 79% wanted public
services to start treating them as consumers in the same way that
the private sector does.
DELIVERING RESPONSIVENESS
2. The orientation of public services to
the user as "consumer" raises questions about the relationship
between the citizen and the state but also about the mechanisms
for overcoming the "delivery paradox"—where satisfaction
is not rising alongside service improvement—such as choice,
exit, voice and the role of the private sector in service provision.
3. One explanation for this paradox may
be the lack of belief or knowledge amongst the public about objective
service improvements, but this cannot be overcome simply by communicating
these facts better to an unknowing public. How the public evaluates
a public service is determined by their existing knowledge, experience,
perceptions and impressions of local and national services, by
the individuals delivering those services as well as being shaped
by an individual's own values and opinions about government in
general.
4. But policy makers and public managers
should treat this paradox with some caution, before unduly worrying
about why the paradox exists. Firstly, satisfaction as a measure
is not entirely reliable as a driver of service responsiveness
or as an indicator of improvement. There is much evidence to support
this. For example, surveys often focus on how well a service is
received rather than what that service should provide. The characteristics
of a service can affect perceptions of that service, for example,
increased satisfaction does not correlate with improvements in
services that are used frequently by the same users, such as with
public transport. The public can be ostensibly satisfied with
an organisation despite a large number of complaints about the
kinds of public services it provides. Research also shows that
how well people feel informed about an institution is indeed correlated
with higher satisfaction, but this does not say anything about
objective service improvement or effectiveness of the institution.
5. Secondly, satisfaction may be an inappropriate
goal when service reforms are aimed at increasing safety, efficiency
or redistribution, or simply when reforms are unpalatable or seek
to dampen demand, for example, in the case of benefit reform.
Research suggests that it is more appropriate to use satisfaction
data when an organisation seeks to understand user priorities
for improvement of a service, to benchmark performance and to
help set targets. A more subtle, nuanced understanding of satisfaction
is clearly required before public managers sit too comfortably
(or rest uneasily) on satisfaction ratings with a service.
MANAGING PUBLIC
EXPECTATIONS
6. Satisfaction is not the only indicator
of what the public value. Other indicators, such as public expectations
of a service prior to it being delivered, could help public service
providers see where expectations of a service are likely to exceed
available provision and may result in low levels of satisfaction,
or indeed lead to an under supply of that service.
7. Many factors shape an individual's expectation
of what a service should provide including need, previous experience,
values and reputation of a service and government. These are similar
to drivers of satisfaction. However, as indicators of public value,
satisfaction and expectations tend to behave differently as well
as having their own complex inter-relationship.
8. As with satisfaction, managing the public's
expectations of a service can become an agenda all of its own.
For example the reassurance agenda in policing, which seeks to
reduce the fear of crime rather than levels of actual crime. The
context for each situation is crucial when considering the direction
in which expectations need to be managed. If expectations are
too low they can reinforce disillusionment with a service provider,
if they are too high they can be dashed by poor experiences. Service
improvement, satisfaction and expectations and the story they
tell between them, all require a public manager's attention if
they are to be used more effectively to help reform services.
MECHANISMS FOR
RESPONSIVENESS
9. Choice and voice, alongside target setting
and contracting out services to the voluntary or private sector,
are all mechanisms that are currently used to improve public services;
with service improvement, satisfaction and expectations as potential
indicators of their relative success.
10. In theory, choice in public services
should allow users to exert an influence over who, what, when
or how a service is provided and to "exit" if it does
not meet their needs. Examples of choice in operation include
choice based letting, direct payments in social care and the "choose
and book" system for appointments in the NHS. In practice,
choice has to be tightly specified because people are bound by
money, location or information or even their physical or mental
wellbeing, and scarce public resources are unable to meet unlimited
public wants.
11. Improving the opportunities for users
to have a voice in how services are delivered is a further mechanism
for improving services, one that shifts accountability towards
local service providers. Improving voice also helps to reconnect
people with the institutions providing services. Examples of enhanced
voice for users of services include consultation exercises and
forums, for example, community safety forums that work with under-represented
groups, local authorities and the police, workshops with local
communities and user/interest group campaigns, such as the "Putting
Breast Cancer on the Map" campaign that gave women suffering
from breast cancer a voice on the relative neglect of research
into the illness.
CREATING LEGITIMACY
THROUGH PUBLIC
ENGAGEMENT
12. If Public Value is to thrive, service
providers must become more visibly responsive and more participatory
than merely consultative. As Leadbeater has argued, what we need
are more direct, innovative and creative opportunities for users
to participate in the "script" of public services. Users
need to receive services according to their needs, but also to
play a role as "co-designers in the shaping and delivery
of that service."
13. In regard to public perceptions of Public
Value, research by the Audit Commission found that while 80% of
local secondary school users were very or fairly satisfied with
their service, only 30% of the general population shared this
view (Bentley et al, 2004). People thus seem to perceive value
when the gap between them and the reception of service is reduced.
Recent research in the UK found that "faith" in "closer"
relationships (family, friends, work colleagues), rose between
1996 and 2001, while "faith" in larger institutions
(government, media, businesses), has gone down (Bentley et al,
2004).
14. For central government, public involvement
in local decision-making, alongside effective local leadership,
has long been seen as crucial to the attempt to reinvigorate local
democracy and to stimulate improvements to services. The 1998
Local Government White Paper, for example, argues for "fundamental
shift in power and influence towards local people," so that
the public get, "a bigger say and a better deal," (DETR,
1998). The Modernising Government White Paper echoed these themes,
arguing for increased public participation as a means of ensuring
that services meet, "the needs of citizens, not the convenience
of service providers," (Cabinet Office, 1999). Similarly,
the development of the Best Value regime, community strategies,
local public service agreements and local strategic partnerships
have all been driven by the demand for decision-making to be more
relevant to, and more engaged with, local communities.
VOICE: METHODS
OF CONSULTATION
AND FEEDBACK
15. A recurrent difficulty with seeking
to enhance citizen engagement is that of knowing when to do so
and why. Such engagement is clearly important where public support
for services and their funding are required. There is evidence
that when and where this should occur depends on the different
stages of the policy development process, and the distinct functions
citizen participation can perform in each. Curtain (2003) sets
out a helpful table which summarises this work:
REASONS FOR
POLICY MAKERS
TO SEEK
CITIZEN PARTICIPATION
|
| Policy development stages | Reasons to seek citizen participation
|
|
| Define the problem/issue | Discovery role—citizen input can help to define the issue
|
| Identify criteria for decision | Discovery role—citizen input used to identify evaluation criteria or underlying principles of a sound policy
|
| Generate alternative options | Discovery role—citizen input to identify alternative options and/or
Education role—citizens participate by absorbing relevant information and discussing issue and/or proposing alternatives
Legitimate—citizen involvement in consideration of options can be important basis for wider public acceptance of the outcome
|
| Evaluate alternatives | Education role— discuss/debate proposed alternatives and/or
Measure—assess the range of public opinion on a set of options and/or
Legitimate—citizen involvement in consideration of options can be important basis for wider public acceptance of the outcome
|
| Recommend an option | Education role—discuss/debate proposed alternatives and/or
Persuasion role—seek to convince public to accept recommended option or approach
Legitimate—citizen involvement in consideration of options can be important basis for wider public acceptance of the outcome
|
|
| |
Source: Adapted in Curtain, 2003 from Walters, L; Aydelotte,
J; & Miller, J; 2000
16. Though we can identify the need for greater citizen
involvement, and perhaps even state when and where that involvement
is most effective, there is a sense in which this kind of research
amounts to the petulant stamping of feet and a demand for something
that simply cannot be met. Unless practices are available for
citizen engagement, democratic authorisation cannot be fulfilled.
In fact, there is widespread experimentation with practical ways
of achieving citizen engagement, both from the top down and from
the bottom up.
17. Curtain, (2003), drawing on evidence of participatory
methods used by local authorities in England identifies four broad
types of practical initiative to engage citizens, these being:
"traditional," "customer-oriented feedback,"
"participative innovations" and "deliberative methods,"—see
below.
PARTICIPATORY METHODS
USED BY
LOCAL AUTHORITIES
IN ENGLAND
| Form of Public Participation | Used in
2001 (%)
| Form of Public Participation | Used in
2001 (%)
|
| Service Satisfaction Surveys | 92
| Other Opinion Polls | 56 |
| Complaints/Suggestion Schemes | 86
| Question and Answer Sessions | 51
|
| Consultation Documents | 84
| Co-option/Committee Work | 48
|
| Focus Groups | 81 | Issue Forums
| 44 |
| Public Meetings | 78 | Shared Interest Forums
| 38 |
| Service User Forums | 73 |
Visioning Exercises | 38 |
| Citizens' Panels | 71 | User Management of Services
| 18 |
| Area/Neighbourhood Forums | 64
| Referendums | 10 |
| Community Plans/Needs Analysis | 58
| Citizens' Juries | 6 |
| | No of local authorities
| 216 |
Source: Office of the Deputy Prime Minister, 2002.
18. The variety of methods currently being tried, the
survey of participatory methods employed by local authorities
reveals a significant level of activity and a set of well-tried
techniques. It is worth noting that this survey covers only those
methods which are being used by elected officials and policy makers.
19. For the most part, these are top-down techniques,
and still more are available in the fields of planning, international
development and corporate team-building. If we combine these various
top-down methods with participatory activity emanating from the
bottom-up, (such as self-help and community groups, user-led campaign
groups, etc), it begins to appear as though participatory forms
of governance are rather more developed than is commonly supposed.
This conclusion is supported by an Economic and Social Research
Council research programme in political participation, which found
that while voter turnout is indeed decreasing, other forms of
political participation are on the rise (Pattie, Seyd and Whitely,
2004).
20. There has been widespread enthusiasm for the use
of innovative methods of consultation in the UK, prompted by "their
potential to combine citizen deliberation, the interrogation of
specialist evidence, and participatory approaches to problem-solving,"
(Smith & Wales 2000).
21. However, while voice may have democratic validity
in its own right, there are issues with voice as a mechanism for
addressing poor performance. Where voice accords no real power
or weight, such as funding implications, to what users have to
say, it can result in consultation fatigue. Equally, however,
where voice does accord such power and weight, it may result in
unrepresentative groups taking control of the decision making
process. Moreover, improved complaints systems often favour the
educated and articulate and not necessarily those whose complaints
are more serious. Getting right the precise mechanisms that allows
users' voices to be heard and acted upon, can thus be a time consuming
challenge for public managers. As a result, choice increasingly
appears to be the preferred mechanism of the Government for improving
services. Support for deliberative methods such as citizens' juries
have been seen to give rise to very public criticisms of government
policy. As a consequence, Whitehall funding for innovative consultative
techniques have increasingly focused on the "safer, more
controllable methods such as focus groups," (Wakefield, 2002).
22. Moreover, at the local level, where the outcomes
of deliberative initiatives have been received more positively,
what are often "quick and dirty" exercises have been
criticised for an alleged lack of methodological rigour, and the
limited extent to which jurors could express their opinions independently
of the body that had commissioned them to act. Delap (2001) has
suggested that citizens' juries have sometimes been used to substitute
for other established processes that might hold governing bodies
more effectively to account. Interestingly, in Delap's example,
we observe a participatory method used in place of an established
method of accountability. Mechanisms such as citizens juries,
though time consuming, should therefore add to rather than substitute
established accountability processes, but also to make accountability
a democratic process in itself.
23. However, difficult it may be to get the right mechanisms
for citizen voice in place, we argue that the removal of voice
for citizens is likely to cause greater anguish and "civic
frustration" than the removal of choice—which users
of public services do not expect of a public service anyway. The
less than subtle substitution of voice for choice as the preferred
mechanism has serious implications for the quality of democracy,
even if the jury is out over which mechanism leads to improved
public services. A key criteria of an improved public service
should therefore be that the service provider has sufficiently
engaged with the public in a deliberative manner.
PUBLIC VALUE
AND THE
CITIZEN-CONSUMER
24. The report concludes that the delivery paradox between
satisfaction, expectations and performance cannot be explained,
or overcome, by reducing users of services to mere consumers.
The paradox exists because users are also citizens, who derive
value from a service because of how it is being used by others
and how it is provided. A Public Value approach sees these as
key sources of value upon which service reform should be based,
signalling the need for a significant shift away from a narrow
preoccupation with satisfaction ratings, and an embrace of a more
deliberative mechanisms between the state and the citizen about
what it is they value.
January 2007
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