NES/11/72. The Christie Commission on the Future Delivery of Public Services (the Christie Commission)

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1 NES Item 8a August 2011 NES/11/72 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper The Christie Commission on the Future Delivery of Public Services (the Christie Commission) 2. Author(s) of Paper Donald Cameron - Head of Planning and Performance Management. 3. Purpose of Paper To provide the Board with the key points and an analysis of the Christie Commission report. 4. Key Issues The Christie Commission was published on 29 th June It states that public services are facing serious challenges brought about by an ageing population, long term health problems and a persistent failure to tackle inequalities. The report argues that these drivers of demand will require huge investment if we do not change now and it recommends that the Scottish Government takes immediate action on major public service reform. If the Christie Commission report acts as the cue to put in place a detailed plan for radical reform, it may have wide ranging implications for all public sector organisations. However the report is not specific in its recommendations and the implications for public service organisations such as NES will remain unclear until the Scottish Government formulates its response. The Christie Commission report makes specific mention of education, training and workforce development, which further reinforces the integration theme running throughout the report and which is of particular interest to NES. It calls for a systematic and coordinated approach to workforce development across the public sector and makes the following specific recommendations; a coordinated educational infrastructure across the public service a single public sector leadership and management development programme a competency framework for all public service workers a set of generic modules in all professional training for public service 5. Educational Implications This paper describes in summary the potential implications of the Christie Commission highlighting the sections on education, training and workforce development.

2 6. Financial Implications None at present. 7. Which NES Strategic Objective(s) does this align to? This paper is relevant to all the six strategic themes and ten objectives within the NES strategic framework approved by the Board on 18 th November Relevance to Better Health, Better Care This paper reflects the current Scottish healthcare policy framework. 9. Key Risks and Proposals to Mitigate the Risks Some of the challenges facing our future planning priorities are as follows: financial resourcing issues organisational culture, capacity and capability Policy analysis is an on-going feature of the planning process along with strong feedback from stakeholder engagement. We are also now engaged in planning and delivering a range of service improvement programmes which are designed to reduce our costs and improve integration and efficiency as one of the key objectives within our strategic framework for Equality and Diversity Impact Assessment Not required. 11. Communications Plan A communications plan has been implemented and a copy sent to the Head of Communications for information and retention: Yes No x 5. Recommendation(s) for Decision This paper is for information and discussion.

3 The Christie Commission on the Future Delivery of Public Services. 1. Background and summary In late 2010 the Scottish Government established the Christie Commission, and on 29 th June 2011 it reported to a much changed political landscape in Scotland as a result of the SNP s majority at the elections. The commission had a broad remit to make recommendations for the future of public services in Scotland and was expected to further push shared services, and potentially changes to the landscape of public services key elements of reform. What the Christie Commission actually said is that there is an urgent need for immediate and radical reform to respond to a rapid growth in demand, particularly for older people s services. The report challenges the Scottish Government to transform our public services in the face of demographic changes, persistent inequalities and shrinking budgets. It outlines four key objectives as follows; community involvement in service design and delivery integrated and more collaborative services prevention of negative social outcomes efficiency achieving more with less If the Scottish Government uses this report as a cue to take forward a detailed plan for radical reform, it will undoubtedly have wide ranging implications for public sector organisations. However while there seems to be broad agreement with what the Christie Commission says, there has initially been a mixed reaction to how it has presented its findings. Many prominent public service organisations have welcomed the message of radical reform, as it adds to the evidence base for change and potentially provides the Scottish Government with a platform for action. These commentators strongly support the prevention based approach to public services, designed with and for local communities and delivered through better integration and collaboration between organisations. However there has also been criticism of the report s perceived lack of detailed recommendations, with some observers stating that its non specific nature does not provide an effective catalyst for action. There has also been comment that the issue of where cuts should be made, or whether we have too many institutions, has been avoided. 2. Christie s key objectives The Christie Commission argues that public services are facing their most serious challenges since the creation of the UK welfare state. In particular the report picks out our ageing population, long term health problems and a failure to tackle inequalities, as drivers of demand which will require huge resources 1

4 if we do not change now. The report challenges the Scottish Government to take an immediate lead on a major programme of public service reform. The report suggests that inequalities are driving the increasing demand for public services and that prevention must therefore be a reform priority along with tackling fragmented, complex, opaque and top down systems which do not effectively work with local communities. The report describes a patchwork public sector hampered by poor coordination and duplication. It argues that Government is dominant which results in services provided to individuals rather than designed for and with them, so serving the interests of existing institutions and professions. It also describes a risk averse culture where accountability for performance is unclear and poor data means benchmarking is difficult and information cannot be used to drive change. It states that services tackle symptoms not causes, maintain dependency and fail to build personal capacity or support for independent living. All this is described as being delivered within a political cycle which hampers long-term reform. The Christie Commission describes four key objectives for a reform programme. In outlining these objectives the report includes a number of examples of joint working between third sector, local authority and NHS organisations, in partnership with the local community, which have delivered positive outcomes locally. These serve as potential good practice models to build on for the future. The key objectives are summarised below along with the associated recommendations from the report; KEY OBJECTIVE 1 PUBLIC SERVICES - are built around people and communities build services around people and communities and work to build up their autonomy and resilience a Community Empowerment and Renewal Bill to improve participation a systematic and coordinated approach to workforce development across public services to empower staff in community involvement KEY OBJECTIVE 2 PUBLIC SERVICES - work together to achieve outcomes a local partnership (beyond the current) to involve communities and a political agreement and plan for how partners will achieve integration and outcomes local participation (i.e. more than the local authority area) and an agreement which enables all partner organisations to account for their contribution to outcomes a set of common powers and duties for organisations review funding to increase flexibility and to develop models which require integrated provision of services a joint long-term asset management plan for the local partnership. 2

5 KEY OBJECTIVE 3 PUBLIC SERVICES - prioritise prevention, reducing inequalities and promoting equality action to reduce demand for services with the common powers and duties prioritising prevention and inequalities job search and support fully devolved to the Scottish Parliament, to achieve integration of service provision in the area of employability partners develop public service approaches for deprived communities identify equality gaps and further develop outcomes and indicators within the National Performance Framework KEY OBJECTIVE 4 PUBLIC SERVICES - seek to improve performance and reduce costs demonstrate how expenditure is driving better outcomes through integration and benchmarking and reporting on outcomes achieved and financial performance a stronger and more proactive role for Audit Scotland in improving performance and reducing costs amalgamate the functions of the Auditor General and the Accounts Commission, to support an integrated approach to oversight a rolling programme of outcomes-based reviews across service areas, to improve performance and reduce costs procurement and commissioning moving from cost efficiency towards effectiveness and outcomes Of particular interest is the inclusion under key objective 1 of an ambition to develop a systematic and coordinated approach to workforce development. This is supported by specific recommendations for; a coordinated educational infrastructure across the public service a single public sector leadership and management development programme a competency framework for all public service workers a set of generic modules in all professional training for public service 4. Conclusions and implications for NES The Christie Commission report undoubtedly challenges public services to change and the Scottish Government s response will be crucial to understanding what it means for individual organisations. If the report acts as a cue to take forward a detailed plan for radical reform it will undoubtedly have a wide ranging impact, however the report is not specific enough to make the implications for the institutions that deliver public services clear at this stage. There are also important questions to be answered, such as how radical public sector reform can be delivered within a commitment to no compulsory redundancies, or how better community involvement will not merely result in preserving current models of service provision. For NES the recommendations on workforce development clearly have potential implications and we are in a good position to play a wider role across the public sector in partnership with other organisations. We should therefore 3

6 be prepared to build on our already successful joint working initiatives to help achieve the systematic and coordinated approach to workforce development outlined in the report. For example NES is well placed to support the development of a single public sector leadership and management development programme through the national leadership function that we already provide for the health service. It is also important that we continue to build our partnership working with social services by investing in our range of online resources for health and social care through the Knowledge Network, working with the Scottish Social Services Council (SSSC) and the Institute for Research and Innovation in Social Services on older people s services and implementation of Scotland's dementia strategy; and supporting health and social care professionals who work with older people and children and young people. We also need to be aware of emerging approaches to health and community care which aim to realign resources to support new service models and improved outcomes (the Integrated Resource Framework). The Christie Commission report further reinforces the view that public service organisations will be expected to deliver better outcomes through shared service arrangements and partnership working. We must expect to operate with a reduced budget and to drive quality improvement within our organisation through areas such as our property strategy, activity based costing and LEAN, as well as better integration of information communication technology (ICT) and less duplication in our support services. We need to build on the work already done to integrate our ICT and workforce (AIM) functions and to look at new leadership approaches and an education strategy which joins up areas such as quality of the learning environment, assessment, educational supervision, continuing professional development and practice education. To do these things we will need to develop a more flexible workforce with a better mix of skills and to use tools to redeploy staff into other areas of our business. This approach will help us to deliver more with the same, the same with less or indeed more with less. APPENDIX - Sources of Information 1. The Commission on the Future Delivery of Public Services. 2. Unison Scotland Policy Briefing number 5 Future Delivery of Public Services. 3. Holyrood Magazine June 29 th Article Christie Urges Radical Reform of Public Services. 4. The Scotsman June 30 th Article Radical Change Requires Courage, not Committees. 5. The Herald June 30 th Article - Christie Gives a Lead on Reform of Public Services. 4