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Transforming Public Services – The next phase of reform

Citizen perspectives on Transforming Public Services: the next phase of reform Part of the dialogue on public service reform that took place across Scotland between June 2006 and February 2007. Published March 2007.

The views expressed in the report are those of the author(s) and do not necessarily reflect those of the Scottish Executive or any other organisation(s) by which the author(s) is/are employed.

The Scottish Executive is making this research report available on-line in order to provide access to its contents for those interested in the subject. The Executive commissioned the research but has not exercised editorial control over the report.

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PUBLIC SERVICE REFORM

CITIZEN PERSPECTIVES ON “TRANSFORMING PUBLIC SERVICES: THE NEXT PHASE OF REFORM”

Jim McCormick, Linda Boyes, Deirdre Elrick, Andrew Harris, Nicole Hastings and Marco Pisano

Scottish Council Foundation

Scottish Executive (2007)

Social Research Report

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ACKNOWLEDGEMENTS Members of the Scottish Council Foundation research team would like to express our thanks to participants in the five deliberative workshops held across Scotland in September 2006. Their willingness to address some of the key challenges for public services across the course of a day’s discussion is a further encouraging sign of the citizen interest in public service reform. We would like to express out thanks, as well, to Catherine Bromley (Project Manager) and her colleagues Pauline Davidson and Colin McKay in the Public Service Reform Development Division (Finance and Central Services Department) of the Scottish Executive. December 2006

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CONTENTS EXECUTIVE SUMMARY 6 User-focus and personalisation 6 Quality and innovation 7 Efficiency and productivity 8 Joining-up and minimising separation 8 Strengthening accountability 9 CHAPTER ONE BACKGROUND AND CONTEXT 10 Research methods 10 Format of events 12 Priority and significant themes 13 Report structure 14 CHAPTER TWO USER-FOCUS AND PERSONALISATION 15 Scottish Executive goals 15 One size fits all? Personalisation and choice in public services 15 Responses to personalised care vignettes 16 Public involvement: upstream and localised 17 The views of public service leaders 20 Summary of main points 20 CHAPTER THREE QUALITY AND INNOVATION 21 Scottish Executive goals 21 Trends and satisfaction with service standards 21 Consistently high standards between areas 25 Innovation: new and adapted services 27 Customer care and communication 28 The views of public service leaders 28 Locating Responsibility 29 Summary of main points 29 CHAPTER FOUR EFFICIENCY AND PRODUCTIVITY 31 Scottish Executive goals 31 Efficiency, priorities and assessing risk 31 Waste, value for money and focus 32 Diverse providers? 32 The views of public service leaders 33 Summary of main points 34 CHAPTER FIVE JOINING-UP AND MINIMISING SEPARATION 35 Scottish Executive goals 35 Defining joining-up 35 Responses to ‘joining-up’ vignette 35 Better sign-posting 36 Communication and planning between services 36 The views of public service leaders 37 Summary of main points 38 CHAPTER SIX STRENGTHENING ACCOUNTABILITY 39 Scottish Executive goals 39 Responsibility and responsiveness 39 Giving an account and holding to account 41 Two-way accountability 42 Independent not vested interests 43

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Authentic performance measures 44 More autonomous, more accountable? 45 Be accountable for actions not just plans 46 Accountable leaders 46 Summary of main points 47 CHAPTER SEVEN CONCLUSION: TEN PROPOSITIONS ON PUBLIC SERVICE REFORM 48 Improve the quality of feedback 48 Be clear on priorities and expectations 48 Devolve powers as they are earned to strengthen accountability 48 Adapt services and skills to serve a more diverse population 49 Reforms need to connect more clearly with public concerns about reducing waste and improving efficiency 49 How services are funded and delivered may be more important that who delivers them 49 Pursue two-way and ‘long-run’ accountability 50 Local and virtual accessibility 51 Expertise and independence 51 Move further towards joining-up and ‘single gateway’ approaches 51 REFERENCES 52 ANNEX 1 SUMMARY OF LITERATURE REVIEW 54 ANNEX 2 TABLES 58 ANNEX 3 VIGNETTE RESPONSES 62 ANNEX 4 FIELDWORK DOCUMENTS 65 Recruitment questionnaire 65 Pre- and post-event surveys 71 Thematic guide for group discussions 81 Vignettes 82

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EXECUTIVE SUMMARY Introduction In June 2006, the Scottish Executive published Transforming Public Services: The next phase of reform. The report set out five fundamental principles around which reform should be organised:

• User focus and personalisation • Driving up quality and enhancing innovation • Greater efficiency and productivity • Joining up and minimising separation • Strengthening accountability

Research Methods To test these principles in more detail, the Scottish Executive has undertaken a number of activities, including a series of dialogue events with public service leaders in nine areas across Scotland. The Scottish Council Foundation designed and facilitated a smaller series of public involvement groups in five locations across Scotland during September 2006. This report presents the main findings of those groups. User focus and personalisation By ‘personalised’ services, participants tended to refer to localised face-to-face contact with people they could identify – such as a local police station rather than a call centre – and to associate ‘personal’ with services promoting independence and dignity, especially care services to help elderly people stay at home for as long as possible. The idea of ‘topping-up’ as a means of limited personalisation over and above universal standards was also considered. Where a clear view was expressed, most participants supported improving the quality of universal services, accessible to all. Greater personalisation was considered by some to bring a risk of favouring those with better communication skills. Responding to case study ‘vignettes’, participants expressed a strong commitment to helping people live independently for as long as possible, with more intensive personal support and adapted accommodation where appropriate. Individual involvement in meetings with advocates and family members was expected with no prior assumptions made about individual capacity to take part in decision-making. Greater awareness and training for frontline staff were proposed in order to enhance professional skills and communication abilities. The need to take concerns seriously, rather than dismissing them on the grounds that ‘the expert knows better’, was also emphasised. Participants placed a high value on personalised response, speed, and excellent communications skills among service providers towards users (and their families), as well as between providers. There was a common expectation that staff and budgets would be brought together to respond to individual needs and that individuals would be fully involved (with extra support provided if necessary) in decisions made.

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A need for the public to play a more active role at the planning stage of decisions was identified, rather than leaving it only to elected representatives to mediate public views. Better systems for ‘advance warning’ were proposed, including public meetings at times people would be willing to attend and more prominent use of local newspapers. While there was near unanimous support for greater public involvement in all stages of decision-making, there was much less discussion on methods of involvement that would work best. The case for holding a referendum on major developments was made in one area (e.g. railway extension) and the option of paying citizens for at least some public involvement activities was suggested in another. Quality and innovation Participants living in diverse areas across Scotland expressed consistently positive satisfaction ratings with most services. Nonetheless, it is notable that residents of the most disadvantaged neighbourhood appeared to be more satisfied than those living in more settled and affluent areas. A contrast between urban and rural areas was also evident: while residents of one central city area rated public transport second highest in terms of satisfaction, participants from both rural groups scored public transport lowest. And while all three urban groups rated Maintenance services lowest, both rural groups expressed most satisfaction with these services. No group offered a negative rating on ‘good quality services’ delivered by their council, but four of the five groups did so on the issue of making ‘best use of the budget’ and those in the most disadvantaged did the same for ‘local focus on quality of life’. Improvements to the local environment were identified as a step forward in most areas, with participants noting it has become easier to recycle household waste than in the past. However, deteriorating standards were identified in the three urban groups related to an overall sense of ‘the visible signs getting worse’, especially litter, refuse/cleansing services and road maintenance. Concerns were raised about reduced primary care coverage out-of-hours and a clear preference was expressed for face-to-face contact rather than using NHS 24. Potential risks to local health service availability in future were identified in both urban and rural neighbourhoods. There was some recognition that the actual or proposed centralisation of key services like these would lead to winners and losers in terms of accessibility. Insufficient funding for bus routes and a restriction of early evening services was also raised as a main concern. In terms of increased service provision in future, participants placed a high priority on greater policing presence especially at night, and (for towns and cities) in places where violence and anti-social behaviour associated with binge drinking was more likely to occur. Practical ways to extend existing services were identified, e.g. doorstep collection of household waste and heavy goods for recycling; extended opening hours in primary care services to better meet the diverse needs of the workforce; and greater use of Community Wardens. In the larger cities, participants placed a high value on equity considerations as well, but they took differing views on the nature of existing variations in standards. Residents of the most disadvantaged neighbourhood wished to know more about service standards across the city, with many believing better-off areas enjoyed better public services. In the most affluent area,

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residents believed some of their public services were poorer due to greater targeting of resources in low-income neighbourhoods. In the most remote location, participants felt they did not receive an adequate level of basic services like water/sewerage and bus links. Most participants recognised there is currently a trade-off between high quality but uneven public services and less good but universal services available in all places. They supported greater consistency in quality standards across their authority, with proper monitoring and enforcement of standards, as well as clearer comparisons between different parts of the public sector and different authorities. Participants expected public services to become more adaptive and responsive services as user expectations and needs change. Participants emphasised the role of good customer care and the importance of clear communication. They noted that migrant workers in front-line service roles should be given language training to ensure their communication skills are good enough.

The possible consequences of demographic trends were considered. Participants identified a need to invest more to support ‘independent living’ and intermediate options like sheltered housing; and supported much greater choice over when and how to retire from work and better options for drawing upon the experience of the retired population. Some emerging social and health needs were felt to be poorly addressed by services currently. Support for parenting and promotion of healthy life-styles (diet and responsible drinking) was expressed.

Efficiency and productivity Waste and duplication were considered to be a legitimate target because they prevent public services being delivered effectively. Participants put an emphasis on ‘wiser spending’ by setting priorities the public felt were more in line with their own. While replacing older buildings with fewer, modern buildings might bring important service benefits, participants felt that options to retain the status quo (or intermediate options) might be worth considering. Some considered that localised services with ‘less than best’ infrastructure might, occasionally, be preferred to centralised services in modern settings. Joining-up and minimising separation One practical consequence of participants’ views on the issue of joining-up is to consider greater use of ‘single gateway’ models, where frontline staff act as a broker between various other agencies on behalf of the user.

Participants in two locations identified a clear need for better communication and joint planning across sectors, not just between public sector agencies. This was considered to be especially important in the case of services like public transport which often combine funding/strategic planning from the public sector with private providers operating on a franchise basis. Participants living in the most remote area stressed that all service provision planning needs to consider the implications of transport if services are to become more accessible.

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Strengthening accountability Participants in all of the public groups expressed strong support for localisation of services, including face-to-face contact with staff who have authority to make decisions and deploy resources. Further ‘downstream’, participants only felt able to hold decision-makers to account if they were given a better account of why decisions have been made, especially where the reasons appear difficult to understand, or changes are unpopular. There was recognition in most groups that decisions might go against what the majority wants, or that some areas may benefit more than others. The common view was that people in positions of authority should be more willing to communicate their reasons openly and take responsibility for their decisions. ‘Long-run accountability’ concerns the timescales for spending allocated budgets, and making sure that they are realistic. In the case of large Public Private Partnerships where actual costs do not become apparent for some years, participants were unclear how councillors and service leaders could be held to account for decisions made largely by their predecessors. ‘Two-way accountability’ describes a process of more active communication, engagement, responsiveness and feedback between service providers and users. Possible ways to change the ‘terms of engagement’ included ‘stakeholder citizen’ and ‘shareholder citizen’ concepts. Linked to this is the concept of co-production between service providers and users, as developed in areas as diverse as personal care for adults with disabilities and community safety. A high value was placed on independent sources of information about service performance. This was influenced by a perceived lack of information sharing by some councils. Participants in the two rural areas proposed a stronger role for community councils, greater expertise through professional advisers playing a role similar to Audit Scotland locally and the idea of ‘professional’ councillors. Participants in most groups took a sceptical view towards a continuing role for party politics in local government. It was felt that what gets measured and reported on may not be the most useful indicators of service priority and standards. How we go about monitoring performance may also need to change. Each group considered the issue of ‘vital signs’ that would persuade them significant improvements to public services were being achieved in their area. While it was considered important to have access to information that carried public trust, participants made clear they would prefer to ‘see with their own eyes’ the evidence of progress. Greater financial autonomy for local councils was proposed as a potential route to stronger accountability. It was felt that councils deserved to have more autonomy in order to test whether this would lead to a more genuine debate about priorities and greater local responsibility for their decisions. Participants wanted to hold their elected representatives to account for what they actually achieve, not good intentions expressed in strategy documents.

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CHAPTER ONE BACKGROUND AND CONTEXT 1.1 In June 2006, the Scottish Executive published Transforming Public Services: The next phase of reform. It made the case for significant changes in public services on the basis of five propositions:

• Public services are valued and are improving – reform is not based on an assumption of failure.

• People expect more and better public services. • Demographic change – affects pattern of service need/demand and implications for

the workforce. • People want services organised around needs and aspirations. • Technology offers an increased range of delivery options.

1.2 The report then set out five fundamental principles around which reform should be organised:

• User focus and personalisation • Driving up quality and enhancing innovation • Greater efficiency and productivity • Joining up and minimising separation • Strengthening accountability

Research Methods 1.3 To test these principles in more detail, the Scottish Executive has undertaken a number of activities, including a series of dialogue events with public service leaders in nine areas across Scotland, and a written consultation based on the questions set out in Transforming Public Services. The Scottish Council Foundation designed and facilitated a smaller series of public involvement groups in five locations across Scotland during September 2006. This report presents the main findings of those groups. 1.4 Neighbourhoods were selected from among those areas where the service leaders dialogue process was already underway. The exception was a remote area of North West Highland, chosen to reflect the distinct experiences of public service use in that setting. Communities within each authority were identified to reflect a broad typology developed in previous studies undertaken by the researchers (Scottish Council Foundation 2002; 2000). These are termed the ‘four nations’ of Scotland: ‘excluded’, ‘insecure’, ‘settled’ and ‘affluent’:

• ‘Excluded’ Scotland: An area facing problems of enduring economic and social disadvantage (Maryhill in north west Glasgow);

• ‘Insecure rural’ Scotland: An area considered to be vulnerable to economic and social decline: (town of Galashiels, Borders);

• ‘Insecure remote’ Scotland: An area considered to be vulnerable to economic and social decline (small town of Lochinver, Highland);

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• ‘Settled’ Scotland: An area with a mixed indigenous/commuter population, relatively low unemployment but not necessarily affluent (Town Centre of Stirling);

• ‘Affluent Scotland’: An area with a stable and prosperous population, as indicated by high rates of employment and home ownership (Stockbridge within the New Town of Edinburgh);

1.5 The decision was made to recruit a cross-section of 16 adult residents from each area, to take part in a one-day group discussion. We decided to hold in-depth discussions (deliberative workshops) rather than shorter focus groups, enabling us to combine both open-ended dialogue where participants could identify their own local priorities, and responses to case study materials prepared in advance. The aim was to reduce the likely respondent bias from using established community/voluntary sector networks. Recruitment quotas were established using small-area Scottish Index of Multiple Deprivation (SIMD) data and local profile data from the 2001 Census. 1.6 An independent recruitment agency (Criteria) was appointed to select a balanced group of participants on the basis of sex, age group, household type and socio-economic quotas reflecting as closely as possible the profile information. Incentives were offered for participation and follow-up phone calls were made shortly before each event to check those recruited were still intending to participate. Table 1.1 shows the age, sex, socio-economic and ethnic composition of those attending the five groups. 1.7 In total, 69 people took part. The recruitment agency was asked to recruit minority ethnic participants where possible. This proved to be difficult for the first three groups recruited, due largely to the profile of the local population. The agency was asked to take extra steps in Edinburgh (which were unsuccessful) and in Stirling. One Asian Scot participated in Stirling, and two Polish migrants were recruited (but one of them failed to take part). The drop-out rate varied from 1 in Borders and Highland to 4 in Edinburgh. Some of the groups experienced ‘differential’ drop-out: in Edinburgh, for example, 2 participants aged under 30 did not join the group. In Stirling, the three people recruited who did not attend were aged 25-30. In Glasgow, both ‘no-shows’ were in their early 30s and of social group DE. 1.8 There is a clear distinction to be drawn between area-based socio-economic and demographic measures and individual-level characteristics. Social geographers have studied the concept of ‘ecological fallacy’, in order to understand ‘neighbourhood effects’ where individual attitudes and behaviours appear consistent with, or diverge from, expected effects based on knowledge of area composition. The number of participants involved in this research limit how far we can test whether experiences and attitudes ‘map’ onto what might be expected from an area-based typology. The group composition, in four cases out of five, was a close reflection of the quotas identified. However, the biased nature of drop-out in the Glasgow case meant the small group composition there was a less accurate reflection of the local profile than in the other four areas.

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Table 1.1: Composition of the groups Edinburgh Glasgow Highland Borders Stirling Total Age group 18-24 1 4 1 3 1 10 25-44 6 4 8 3 5 26 45-64 4 3 4 5 6 22 65+ 1 3 2 4 1 11 Sex Male 5 6 7 8 8 34 Female 7 8 8 7 5 35 Socio-Economic Group AB 8 2 3 3 2 18 C1 2 5 5 4 5 21 C2 1 2 2 2 2 9 DE 1 5 5 6 4 21 Ethnicity White Scottish/ British

12 14 15 15 11 67

Asian Scottish

0 0 0 0 1 1

White Polish 0 0 0 0 1 1 Total 12 14 15 15 13 69 Format of Events 1.8 Two short questionnaires were designed to capture baseline data covering service experiences and attitudes (pre-survey) and responses at the end of the day’s discussion (post-survey). Survey findings are based on small numbers in each case, and cannot be aggregated across the five locations in any meaningful sense. Each group was a small cross-section of the adult population in each location. However, they offer indicative findings for further consideration, and suggest apparent similarities and differences between people living in these diverse neighbourhoods. 1.9 The groups spent the best part of a day deliberating on various aspects of public services in their area. The discussion guide was informed, in part, by previous exercises exploring quality of life priorities using similar methods. As well as the surveys, the day combined open-ended plenary sessions, small group work to consider priority themes in more detail, and the use of vignettes (case study materials) to generate discussion on both individual and area-level public service scenarios. Materials for the groups were developed following a brief literature review1. A summary of findings from this literature review is included in Annex 1. Priority and significant themes 1.10 Two trends emerged in most of the discussions and can be thought of as a backdrop for interpreting responses:

1 This was a selective review of key published sources, with the purpose of informing design of participant surveys and informing other discussion materials, rather than a formal systematic literature review.

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• Social changes, including both parents working, less time for volunteering, loss of community and lifestyle changes, have increased pressures on public service.

• A sense that individuality and personal/social mobility have eroded people’s investment in their community.

1.11 Groups were asked to identify a number of significant public service issues and trends in their area. They were encouraged to think of examples where service issues had got better, worse or stayed the same in recent years. Through discussion in the full group, participants then agreed a set of three priorities to consider in more detail. These were a mix of familiar public policy challenges (e.g. community safety and the role of policing), emerging trends (e.g. changing demography and possible consequences for public services) and over-arching objectives (e.g. accountability; efficient use of public finances). 1.12 Priority themes across the groups are shown in Table 1.2. This shows, for example, that Transport and Travel was identified as a significant issue in all five locations, and that two groups selected this as a priority. This is denoted by [5 – 2] shown after the issue descriptor. Further significant issues (i.e. those identified in the opening plenary session, but not chosen for more detailed discussion) are highlighted in Table A1 (Annex 2). Table 1.2: Priority themes identified in each location Priority themes are shown by two ticks. Other significant issues are shown by * Priority issues Edinburgh Glasgow Highland Borders Stirling

Transport and Travel, especially bus services [5-2]

* *

*

Public/Community Safety, Policing and Crime [4-2]

*

*

Funding for Public Services/PFI; Standards and Value for Money; local taxes and spending; financial allocations [3-3]

Accountability, Participation, Public and community involvement [3-3]

Equity between communities across the local authority, lack of consistency in service quality [2-1]

*

Communication & Information, sources of advice [2-1]

*

Planning & Coordination, reducing waste [1-1]

Employment (regular not seasonal or low-paid) [1-1]

Ageing population and healthy living [1-1]

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Report structure 1.13 Rather than organising the report around these priority themes, we have used the five fundamentals for transforming public services (as set out in the Scottish Executive’s report of June 2006) as our framework. 1.14 We have ‘clustered’ the output from group discussions to fit. We aimed to explore local understanding of the public service reform debate and self-identified priorities for reform, and then analysed them through the lens of these five fundamentals. The bullet points used to introduce each of the five principles are extracted from a presentation by the Scottish Executive in June 2006 to aid consistent interpretation. 1.15 In addition, we have drawn selectively upon summary reports from the nine dialogue events with public service leaders to provide an indication of how the concerns of service providers may overlap or differ from those of the general public. This publication is one of a number of reports related to the wider Transforming Public Services consultation process, they are all available on the Scottish Executive website (www.scotland.gov.uk).

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CHAPTER TWO USER-FOCUS AND PERSONALISATION Scottish Executive goals • simpler access to public services • a genuine voice for the public in how services are planned, delivered and

scrutinised • greater choice in what services can be obtained, when and how they are used • unified, easy to access complaints system Context User focus, personalisation and choice have emerged as key objectives in a range of public policy areas. The debate on what kind of choice is best suited to service user needs, and to tax-financed public services as distinct from market goods and services, is set to gather momentum. While few are willing to stand against these objectives, evidence in Scotland/UK on how best to extend appropriate forms of choice – within existing public service institutions or through greater ‘contestability’ on the side of provision – remains limited. Moreover, the debate in Scotland has been focused mainly on personalised public services rather than on contestability and choice between providers from different sectors (which has greater prominence in the UK Government’s recent publications on public service reform, Strategy Unit, 2006). Although the evolution of a “British model of reform” has been identified as an area for exploration (National School for Government, 2006), devolution is more likely to mean that various working models, rather than a single approach, will emerge in practice. One size fits one? Personalisation and choice in public services 2.1 There was less explicit reference to these principles in the groups than might have been expected, before case study material was used to prompt discussion. We consider in later sections the value participants placed on having someone responsible for dealing with a concern, and doing it promptly; being listened to and receiving feedback; and being given a suitable account of the reasons behind decisions. By personalised services, participants tended to refer to localised face-to-face contact with people they could identify – such as a local police station rather than a call centre (Borders group). The same group associated ‘personal’ with services promoting independence and dignity, especially care services to help elderly people stay at home for as long as possible. 2.2 The Edinburgh group discussed the idea of ‘topping-up’ as a means of some personalisation over and above universal standards. There was some recognition that trade-offs are required within limited public resources. While some individuals may wish to pay for enhanced services if they can afford to, others in the same group believed the public interest was best served by pursuing higher universal standards rather than more personalisation:

‘I would rather see [services] standardised and the quality of what’s provided made better, than see more personalisation.’ [Edinburgh, 45-54 year old woman]

‘Within standardisation, you can still have some personalisation. An example is, if they’re refurbishing houses these days, the tenants get a choice as to what paint they

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want to use. It’s the same standard that’s being applied, but they get some choice.’ [Edinburgh, 55-64 year old man]

2.3 Under the heading of user focus and personalisation, participants in the Edinburgh public service leaders dialogue session called for a greater commitment to direct payments for people with disabilities and care needs.

Responses to personalised care vignettes 2.4 Case study vignettes were presented to each of the groups, introducing individuals who had service needs with different levels of complexity: more intensive personal care for an elderly woman to live in sheltered accommodation with possible dementia; earlier diagnosis of illness and better communication by professionals needed for a young woman with special needs; and support for a young man to establish a small business. Two of these vignettes refer to service users who are among those less likely to benefit from public services - people with disabilities and other special needs, and older, frail people (Social Exclusion Unit, 2005) - and are discussed in this section (see boxes). 2.5 In responding to the vignettes through small group discussions, participants in all locations highlighted the potential for many agencies to be available, or needed, to support one person at any time (full responses to these vignettes are presented in Tables B1 and B2 in Annex 3). Vignette on diagnosis of illness for person with special needs (Maureen) Maureen is in her early 20s and lives with her parents. She went to schools for pupils with special needs. She had been experiencing severe headaches and loss of balance, so her doctor referred her to the Outpatients’ department at the local hospital. She asked her Mum to go with her to the appointment. On arriving at the hospital, the receptionist spoke only to Maureen’s Mum to ask for Maureen’s personal details. When they saw the consultant, he also spoke to her mother rather than to Maureen. After three attempts to diagnose the problem, her condition was identified correctly as a brain tumour and she underwent a course of chemotherapy. It was successful and she made a full recovery. 2.6 In the case of Maureen, participants expressed a strong commitment to treating everyone as individuals, regardless of special needs and ability to articulate concerns. Communication with individuals, and advocates as appropriate, was expected. This should apply to all front-line staff, from receptionists to consultants. Greater awareness of staff, and training to enhance professional skills and communication abilities were proposed. One group emphasised the importance of speedy and local diagnosis/treatment, echoing a more general principle for NHS treatment to live up to. 2.7 Participants cautioned against making prior assumptions about lack of personal capacity. Instead, proper assessment should be carried out with family involvement, and ideally a case worker should be assigned to help join up services and offer advocacy if required. Specialist counselling through the treatment and recovery stages was considered important for service users who may be less able to make use of the full range of services

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independently. It was expected that specialist support should be funded and provided by NHS and local authority services. Vignette on possible dementia and sheltered housing (Maggie) Maggie is 80 years old and lives in sheltered accommodation. Recently, the resident warden service in her building was replaced by a visiting warden service (with twice-daily checks). After a few weeks, Maggie became increasingly confused and had almost stopped going out of her flat. Residents were concerned because she had also started to wander at night. They were worried, as well, that she was not eating properly and appeared to have lost weight. When they raised concerns with the visiting wardens, they were told that Maggie seemed fine, had never complained of feeling unwell or confused, and was always up and moving about when the wardens visited. 2.8 Responding to the case of Maggie, respondents placed a primary emphasis on family involvement, wherever possible, as well as a range of staff at her sheltered accommodation and primary care/social services. They focused on the need to take concerns seriously, rather than dismissing them on the grounds that ‘the expert knows better’ (in this case, visiting wardens). Participants also pointed to the value of ‘a compassionate and caring approach’ that comes from good company, friends and fellowship – that is, support that cannot easily be organised through public services. Responses were rooted in a strong commitment to helping people like Maggie to live independently for as long as possible, with more intensive personal support and adapted accommodation (e.g. installation of an alarm system). As with Maureen, individual involvement in meetings with advocates and family members was expected with no prior assumptions made about Maggie’s capacity to take part in decision-making. 2.9 Overall, responses showed the value placed by participants on personalised response, speed, and excellent communication skills from providers to users (and their families), as well as between providers. There was a common expectation that staff and budgets would be brought together to respond to individual needs and that individuals would be fully involved (with extra support provided if necessary) in decisions made. Public involvement: upstream and localised 2.10 One of the user focus objectives set out in Transforming Public Services (Scottish Executive, 2006) is: ‘a genuine voice for the public in how services are planned, delivered and scrutinised.’ While individuals and households experience the impact of these decisions ultimately, the process by which decisions are made should involve communities of interest (e.g. service users) as well as geographical communities. 2.11 Questions were placed on the surveys, testing the level of importance participants placed upon various ways of involving the public in service issues, and what difference they thought it would make if the public were more closely involved in decision-making. (Tables 2.1 and 2.2).

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Table 2.1 Importance attached to the public being informed and involved by public service providers. What level of importance would you give to the following as ways of public service providers informing / involving the public? (Post-event survey) No. of participants saying important or very important, by location

EDI GLA HGH BOR STI Total

Asking for people’s views and opinions before policies are decided

12 11 14 13 12 62

Providing information about policies and services

11 13 15 13 12 64

Involving people directly in the decision making process

12 14 14 13 12 65

Asking for people’s views and opinions when reviewing policy decisions

12 14 15 14 12 67

Reacting to issues raised by the public

12 13 14 14 12 65

Total

12 14 15 15 13 69

2.12 The first of the tables shows a consistently high degree of importance attached in each location to greater information sharing and public involvement, at various stages of the planning and decision-making process. The second table shows net ratings on how likely participants felt various improvements would be achieved as a result. Figures are shown by age group and although comparisons between the groups are difficult due to the large variation in numbers, they show the relative strength of agreement with each possible outcome within each age group.

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Table 2.2 Net likelihood of public information/involvement approaches making a difference. How likely do you think it is that any of the following would happen in your area if there were more information and involvement for the public? (post-event survey). Net likelihood scores by age group

16-24 25-44 45-64 65+

People will know more about how public services work

+ 3 + 27 + 17 + 6

Public service providers will make better decisions

+ 4 + 23 + 18 + 7

Services will focus on people’s needs

+ 4 + 26 + 18 + 4

Individuals and communities will have more power over public services

+ 2 + 22 + 11 + 4

People will feel more ownership of public services

+ 3 + 22 + 12 + 4

Public services will be better

+ 1 + 22 + 13 + 6

Total

10 26 22 11

2.13 Each group had much to say about the importance of what we might call ‘upstream’ accountability. First, there was a strong acceptance of the need for the public to play a more active role at the planning stage of decisions, rather than leaving it up to elected representatives to mediate public views (Glasgow group). The shortcomings of the current system were identified readily. Decision-making activity is seen as weighted towards telling the public what has been decided, or ‘rubber-stamping’ consultation on decisions that have been made but not yet publicised:

‘It’s [currently] just a pseudo-accountability. They will come and ask people what they think and then they just go and do what they were going to do anyway’. [Edinburgh, 25-34year old man]

2.14 The Stirling group agreed the public should be engaged before projects are planned, designed and money has been allocated, with follow up involvement to make sure all parties are satisfied. The implications of various options should be discussed before decisions are made. By increasing community consultation on how public funding is allocated, the Stirling group felt local spending decisions would become more accountable to residents. 2.15 In the Borders group, participants talked about better systems for ‘advance warning’ including public meetings at times people would be willing to attend and more prominent use of local newspapers. 2.16 While there was near unanimous support for greater public involvement in all stages of decision-making, there was much less discussion on methods of involvement that would work best. There was limited time available to discuss the critical question of how to achieve

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this aim. Further research on this topic would help to shed light on whether the public feels enthused about ‘other people’ getting involved rather than themselves, and on the range of methods that might be suitable. However, two specific suggestions were made. On the strength of the Waverley railway case (which the Borders group had felt poorly consulted upon), the case for holding a referendum on major developments was made. In Stirling, the option of payment for at least some public involvement activities was proposed as a means of ensuring a wider representation of views. The views of public service leaders 2.17 Public service leaders talked frequently about involving the public. In Ayrshire for example, consultation was thought to be essential to successful change management with stakeholders, service users and employees needing opportunities to input. In the Borders session, stakeholders talked of insisting every proposal begin with a description of how it is intended to benefit users of the service. They also wanted to engage more explicitly with the local community around agreed outcomes. Aberdeen stakeholders talked about greater use being made of local media and digital TV as means of local involvement. They also thought that local stakeholder conferences could help to encourage engagement and citizenship. 2.18 A number of calls were made for teaching citizenship in schools to help young people to be engaged and to understand their citizenship responsibilities. Stakeholders also thought users could be involved to a greater extent in setting priorities for services, and agencies should share feedback with the public more often. Edinburgh stakeholders thought engagement with communities could be joined up across the public sector and that resources should be directed to building capacity in communities. In these views, there appears to be a strong level of agreement between participants in the public and stakeholder groups. Summary of main points 2.19 By ‘personalised’ services, participants tended to refer to localised face-to-face contact with people they could identify – such as a local police station rather than a call centre – and to associate ‘personal’ with services promoting independence and dignity, especially care services to help elderly people stay at home for as long as possible. The idea of ‘topping-up’ as a means of limited personalisation over and above universal standards was also considered. Where a clear view was expressed, most participants supported improving the quality of universal services, accessible to all. Greater personalisation was considered by some to bring a risk of favouring those with better communication skills. 2.20 Responding to case study ‘vignettes’, participants expressed a strong commitment to helping people live independently for as long as possible, with more intensive personal support and adapted accommodation where appropriate. Individual involvement in meetings with advocates and family members was expected with no prior assumptions made about individual capacity to take part in decision-making. 2.21 Greater awareness and training for frontline staff were proposed in order to enhance professional skills and communication abilities. The need to take concerns seriously, rather than dismissing them on the grounds that ‘the expert knows better’, was also emphasised. 2.22 Participants placed a high value on personalised response, speed, and excellent communications skills among service providers towards users (and their families), as well as

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between providers. There was a common expectation that staff and budgets would be brought together to respond to individual needs and that individuals would be fully involved (with extra support provided if necessary) in decisions made. 2.23 A need for the public to play a more active role at the planning stage of decisions was identified, rather than leaving it only to elected representatives to mediate public views. Better systems for ‘advance warning’ were proposed, including public meetings at times people would be willing to attend and more prominent use of local newspapers.. 2.24 While there was near unanimous support for greater public involvement in all stages of decision-making, there was much less discussion on methods of involvement that would work best. The case for holding a referendum on major developments was made in one area (e.g. railway extension) and the option of paying citizens for at least some public involvement activities was suggested in another.

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CHAPTER THREE QUALITY AND INNOVATION Scottish Executive goals • universally high standards for all, available as locally as is possible • better services, delivered in better ways • strengthen leadership in public services • more effective, streamlined performance and scrutiny regime • foster an innovation culture, offering greater freedoms and operational autonomy,

incentives for successful implementation Context Assessments of satisfaction with public services tend to measure a mix of prior expectations (some of which are untested) and experiences (some of which may not be recent). They cannot be equated, simply, with assessments of service quality. This broader concept of quality is multi-dimensional. It encompasses the gap between expectations and experiences, and is informed by assessments of speed, courtesy, reliability, fit with life and work circumstances (e.g. extended opening hours), quality of communication (including face-to-face contact if preferred), and redress when concerns or complaints arise. In this section we consider some of the ‘building blocks’ of service quality, including satisfaction measures, and of innovation in terms of service extension and adaptation. Trends and satisfaction with service standards 3.1 The Scottish Executive (2006) makes the case for transforming public services in terms of building on an existing asset base rather than addressing deficits:

‘Public services are valued and are improving – reform is not based on an assumption of failure.’

3.2 Summary reports from the stakeholder dialogue sessions indicate that some service planners and providers believe, nonetheless, that the scale of reform needed is significant: ‘In order to ensure there is a sound platform for the delivery of cost-effective and high quality services, a complete process of business change is required’. [Borders dialogue session] 3.3 Across the five locations, common references were made to ‘good products and high standards of customer service’ as well as ‘speed of response following customer contacts’ as key elements of high quality service experiences. 3.4 The baseline survey asked respondents in the public groups to assess how standards in different public services and overall economic factors had changed in recent years. Table A2 (Annex 2) presents net ‘improved’ figures (number saying ‘got better’ minus those saying’ got worse’). Of the 35 scores (7 factors across five locations), 18 are rated on balance as having got better, 12 are rated as having got worse and a further 5 are rated as neutral. This

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measure only shows the balance between those giving one of these two responses, and does not include those saying ‘stayed the same’ or ‘don’t know.’ 3.5 Standard of living was judged to have improved, on balance, in all groups. Health services and public transport were viewed as having improved in all groups except in the Borders. The Highland group provided the strongest positive assessments of all, relating to standard of living and education, although the local economy was rated by a small margin as having got worse. On the other hand, road maintenance received the strongest negative rating of all, from the Edinburgh group, with all other groups also scoring this in net terms as having got worse. Police services were viewed in each location in neutral terms or by a small margin to have got worse. 3.6 Aggregating these net scores for each area (assuming for this purpose that each factor could be weighted equally), locations reflecting ‘insecure remote’ (Highland), ‘excluded’ (Glasgow) and ‘settled’ (Stirling) have the most consistent positive view of recent trends. ‘Affluent’ (Edinburgh) and ‘insecure rural’ (Borders) appear to have a more ambivalent view, rating only two of these factors on balance as having got better. 3.7 How people view recent trends may not be the same as how satisfied they feel currently with various services. The baseline and post-event surveys then asked respondents in the public groups to rate ten local public services on the basis of their satisfaction. Responses are shown in Table A3 (Annex 2) as net satisfaction scores (numbers satisfied or very satisfied minus those not very or not at all satisfied). The rank order is shown in Table A4. 3.8 In the pre-event survey, all but two of the fifty net satisfaction ratings (10 services across five locations) were rated as positive. Local GPs were rated in strongly positive terms in all groups, and ranked top in four of the locations. Local hospital services and Leisure provision also achieved high satisfaction scores in four locations, but with more modest ratings in Edinburgh. Maintenance services were rated particularly well in the two rural groups (though not water services in the Highland group). The only negative satisfaction scores in net terms were found for public transport in the Highland group and housing services in Stirling. By coincidence, Stirling Council’s proposed stock transfer of council housing to a housing association was being rejected clearly around the time of the meeting. 3.9 In the post-event survey, little change was observed for services scoring in strongly positive terms previously. Local GPs were ranked first or second in all groups. Leisure services, Hospitals and Emergency services scored positive ratings in every case. However, five ratings became negative (one service in each location). In the three cities, Maintenance services had negative satisfaction ratings, reflecting an element of dissatisfaction with roads and pavements in the capital city and in Stirling, while discussion of refuse collection and cleansing services led the Glasgow group towards a slightly less positive view by the end of the day. In Borders, Planning and environmental services were viewed least favourably, perhaps reflecting concerns expressed about the process leading to development of the Waverley railway line. The Highland group expressed by far the greatest dissatisfaction on public transport (declining from a net score of – 1 to – 11 between the surveys). 3.10 Participants living in diverse areas across Scotland expressed consistently positive satisfaction ratings with most services. Nonetheless, it is notable that residents of a low-income Glasgow neighbourhood appeared to be more satisfied than those living in more

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settled areas of Edinburgh and Stirling. A contrast between urban and rural areas is also evident. While Edinburgh participants rated public transport second highest, both Highland and Borders groups scored public transport lowest. And while all three urban groups rated Maintenance services lowest in the post-event survey, both rural groups expressed most satisfaction with these services. 3.11 Three statements about the local council were included in both surveys, based on questions used in the Scottish Household Survey (Corbett et al. 2005). Responses are shown in Table 3.1. Table 3.1: Net agreement scores with statements by location To what extent do you agree or disagree that your local council… Net agreement scores Edinburgh Glasgow Highland Borders Stirling Pre Post Pre Post Pre Post Pre Post Pre Post

…Provides high quality services

+ 4 0 + 7 + 4 + 6 0 + 5 +11 0 + 5

…Does the best with the money available

- 5 - 3 + 3 - 1 + 5 + 1 - 2 - 2 - 6 - 4

…Tackles key issues affecting quality of life in your neighbourhood

+ 1 0 + 3 - 2 + 2 0 - 1 + 7 - 6 0

3.12 For all groups, in the baseline survey, the proposition that their council provides high quality services attracted more agreement than the other statements did, with positive ratings in four of the five locations (and a neutral score in Stirling). Net ratings fell slightly in the post-event survey for Edinburgh, Glasgow and in Highland, but rose in Stirling and Borders (recording the highest agreement of all, +11). 3.13 On the value for money/efficiency prompt, that the council ‘does the best with the money available,’ ratings were lower than the quality of services responses in every case, though only marginally so in Highland, and were negative in Stirling, Edinburgh and Borders. The rating in Glasgow also became negative in the post-event survey. 3.14 Finally, for focus on local quality of life, initial ratings varied just above and below zero in Edinburgh, Glasgow and Highland on both surveys, while the assessment in both Stirling and Borders improved from initially negative ratings. Relatively high numbers felt unable to judge if their council tackles key quality of life issues locally in the post-event survey. 3.15 In sum, the Glasgow and Highland groups rated their council more favourably on these measures than the others in the baseline survey, with Stirling participants offering the least favourable view. In the post-event survey, the Borders group expressed higher levels of agreement (the only one to give two net positive scores out of three) while the Highland group’s scores were more neutral. No group offered a negative rating on ‘good quality services’, but four of the five groups did so on ‘best use of the budget’ and Glasgow did the same for ‘local focus on quality of life’. 3.16 Turning to the initial group discussions, NHS services were widely regarded as having improved and primary care services were considered as ‘first rate’ in the rural groups.

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However, concerns were raised about reduced coverage out-of-hours and a clear preference for face-to-face contact rather than using NHS 24 in both Glasgow and Borders. It was noted that waiting times to get a primary care appointment might mean ‘speaking to a nurse rather than a GP’. This was not necessarily seen as a poorer service response, but one that differs from common expectations. 3.17 Concerns were expressed as well about potential risks to local health service availability in Glasgow (possible re-organisation of hospital services leading to increased travel times) and to emergency services in Highland following a successful campaign to retain a local ambulance base. While participants in the Borders group were very satisfied with the quality of hospital and emergency services, they recognised that residents of outlying areas faced longer journey times and response times than they did living in a town. There was some recognition that the actual or proposed centralisation of key services like these would lead to winners and losers in terms of accessibility. 3.18 Improvements to the local environment were identified as a step forward. Participants in two groups (Borders and Stirling) found it easier to recycle household waste than in the past, although the Glasgow group pointed to a lack of recycling facilities. 3.19 Deteriorating standards identified in the three urban groups related to an overall sense of ‘the visible signs getting worse’ in Edinburgh (especially litter and road maintenance) and refuse/cleansing services ‘leaving something to be desired’ for households in the Glasgow group and for local businesses in Stirling. Lack of care and ‘pride in the job’ was thought to lead to rubbish strewn in back closes and a risk of vermin (Glasgow). Linked to discussion in Stirling about the proposed housing stock transfer, concern was expressed about falling standards:

‘It used to be that if work was done by a council worker, an inspector followed 3 days later to check it was okay.’ [Stirling, 45-64 year old man]

3.20 Insufficient funding for bus routes was raised in Borders, especially between the main towns and outlying areas in evenings and on weekends, and for connections to Edinburgh. The price of a return bus ticket from Galashiels to Edinburgh led participants to agree it was cheaper to drive. The Glasgow group attributed a perceived worsening in the quality of local bus services to privatisation, and a restriction of early evening services was identified even in urban areas of Stirling. 3.21 In terms of increased service provision, initial discussions in each group pointed consistently to the need for a greater policing presence especially at night, and (for towns and cities) in places where violence and anti-social behaviour associated with binge drinking was more likely to occur.

Consistently high standards between areas 3.22 A core aim of the Scottish Executive (2006) is to ensure public services deliver ‘universally high standards for all, as locally as is possible.’ Without prompting, a number of the groups identified the principle of equity of service standards between areas within their local authority as important. This is in line with other evidence pointing to the need for sub-authority level data to monitor whether equity is being achieved between localities (Scottish Consumer Council, 2004).

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3.23 In Stirling, this meant a desire for consistency of services between the central urban areas and outlying communities with their own very different needs (ranging from low-income ex-industrial villages to more affluent rural settlements). In the larger cities, participants placed a high value on equity considerations as well, but they took differing views on the nature of existing variations in standards. Edinburgh participants believed that living in a more affluent neighbourhood like theirs could mean less investment even in the basics (e.g. school fabric), while more money is focused on poorer areas. In contrast, the Glasgow group believed that better-off areas currently received better public services. 3.24 Equity between areas was less of an explicit theme in the rural groups, but participants in the more remote location (Highland) felt they did not receive an adequate level of basic services like water/sewerage and bus links, and the Borders group contrasted their inadequate bus timetable with standards available to Edinburgh residents: ‘Why should Galashiels not have a late-night bus service?’ [Galashiels, 25-44 year old man] 3.25 Each group agreed that minimum standards should be ensured for all, but that definitions would vary between neighbourhoods. One Edinburgh participant noted: ‘Who decides what the standards are? One person’s idea of a clean street is different from another’s.’ [Edinburgh, 35-44 year old woman] 3.26 The Edinburgh group pointed to a likely trade-off between high quality but uneven public services (like bus links) and less good but universal services available in all places. Participants agreed that a clear tension related to how high the minimum standards are set, above which variations may be acceptable if communities are willing to make different trade-offs. While a range of individual views were expressed across the groups, another Edinburgh participant summed up perhaps the most common view:

‘I think it should be high standards for everybody, not just if you’re educated and able to make your needs known.’ [Edinburgh, 45-54 year old woman]

3.27 Looking ahead, participants in the Glasgow group were keen to see consistency in quality standards across the city monitored and enforced. In Edinburgh, participants discussed whether a degree of competitive pressure might help to raise standards: ’If there was serious competition to the council then they would do something about it [levels of service].’ [Edinburgh, 25-34 year old woman]. They saw this not necessarily as introducing other providers of public services, but emphasised the value of clearer comparisons between different parts of the public sector and different geographical authorities. 3.28 Some of these issues were raised in the public service leader dialogue sessions: ‘Simple and comprehensible performance data could be published across services on a consistent national basis’. [Aberdeen dialogue session]

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3.29 The introduction of ‘public service rewards’ was also suggested in the Aberdeen dialogue session as a way of encouraging competition and as a means of driving up services standards, as long as this was done in a sophisticated way.

Innovation: new and adapted services 3.30 There was relatively little discussion in the groups on innovation in public services. Participants referred more commonly to maintaining existing services (i.e. minimising the risk of re-organisation leading to reduced access) or securing improvements to basic services they felt to be inadequate. However, each group did explore the theme of more adaptive and responsive services as user expectations and needs change. 3.31 Practical ways to extend existing services were identified. For example, the Stirling group saw pavement collection of household waste and heavy goods for recycling as a simple and modest improvement that ought to have been introduced much earlier (and is still not available to all). They posed the question: what will be the next step forward in terms of waste recycling and reduction? 3.32 Adapted health services were also discussed in Stirling. A widely held view concerned the need to extend coverage of primary care services to better meet the diverse needs of the workforce. More evening and weekend surgeries were supported, rather than only relying on NHS24. In addition, GP-initiated health check-ups were regarded as a positive step. 3.33 To serve the goal of improved community safety, Community wardens were welcomed by the Stirling group who supported further investment in their numbers. The need for more localised policing, with neighbourhood offices and a visible presence was also highlighted in the same group. 3.34 Future demographic change was a focus of discussion in the Borders group. The ageing of the population was considered to result in greater pressure on health and care services, and a need to invest more in ‘independent living’ and intermediate options like sheltered housing. Moreover, the group identified the need to change how we view the ageing of the workforce and the concept of retirement. They supported much greater choice over when and how to retire from work (including options to continue working part-time after retirement age) and stressed the need to draw upon the experience of the retired population, through ‘inter-age’ apprenticeships where their skills could be passed on to younger people, 3.35 The Highland group also discussed future demographic change. They noted the declining number of jobs over an extended period of years, particularly in the fishing industry. They held government responsible for allowing local fishermen to be driven out by foreign competition. The fear was also expressed that young people were moving from away from the Highlands to settle in larger cities, where it was perceived that jobs and affordable housing were more abundant. One participant noted:

‘They want us to keep this area populated, but we are losing jobs. This used to be a fishing and tourism community, but now it’s just getting down to tourism.’ [Highland, 44-64 year old man]

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3.36 In the Dundee public service leader dialogue session, participants referred to the demographic challenge of an ageing population in Scotland and of the burden of disease upon the health services as a trigger for speedy change. In the Borders stakeholder session, the best way to address demographic change through public service reform was perceived to be through multi-agency and co-located teams, with shared back office services, asset planning across agencies (including a single national database of properties); better information sharing and coordination of actions. 3.37 The Borders group identified, as well, emerging social and health needs they felt were poorly addressed by services currently. In common with other groups, a number of educational and community safety problems were traced back to parenting/family skills. They believed strongly that Parenting courses ought to be provided, or at least co-ordinated, by Social Work departments, and that families at risk of giving their children a poor start in life or who presented ongoing risks should be encouraged – perhaps obliged – to take up these services. One participant noted:

‘The situation is only going to get worse. These kids will become parents, their kids will act worse, and it will go on.’ [Borders, 45-64 year old woman]

3.38 In addition, the Borders group believed there is an increasing need to promote the concept of healthy life-styles, for example with accessible services to encourage healthy eating, and an increased emphasis on domestic science (Home Economics) in school. Customer care and communication 3.39 Consistent with recent research findings from the Scottish Consumer Council (2006), among others, participants emphasised the role of good customer care and the importance of clear communication. 3.39 The responsiveness of front-line staff in Glasgow Housing Association (GHA) was compared favourably with experiences before stock transfer. The Glasgow group also felt primary care staff did a good job of responding to their service needs. In Stirling, Local Enterprise Company staff were thought to be particularly helpful. They were described as ‘encouraging’, ‘accessible’, and provided follow-up customer care. Migrant workers in front-line service roles were discussed in the Borders group. Some participants called for better English language training for employees: ‘Foreign bus drivers don’t always give the information you need’. [Borders, 45-65 year old man] The views of public service leaders 3.40 The need for clear communication was also expressed by public service leaders in the Borders dialogue event, who talked about communication with the public being essential, perhaps via an integrated newsletter as this could help demonstrate that there is a single (shared) gateway for the public for services from the various agencies. Aberdeen stakeholders put forward the idea of a ‘tell us what you think’ day, where polling could be conducted on the subject of public services. The opportunity could be used to engage and to explain service priorities at a local level.

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3.41 Public service leaders in Inverness thought communication with the public about competing priorities and needs in delivering public services should be improved. They believed effective communication would enable the public to think about public services in a ‘whole system’ way, and be less likely to make unrealistic demands. The same group proposed the idea of a ‘single regional public engagement point for complaints, dispute resolution, consultation and communications.’ This could provide the critical mass to enable these functions to be carried out well. It was also suggested that methods of gathering public satisfaction information should be standardised. A further proposal came from leaders in Stirling, where it was felt that there could be greater harnessing across the board of user complaints and suggestions. One practical suggestion was to have a moderated on-line conferencing interface to focus upon user interest and to keep a dialogue going. Locating responsibility 3.42 Finally, central to achieving high quality public services, was the need for greater acceptance of shared responsibility between individuals/families, the community and public service providers. Sustained improvements were considered to depend not just on higher levels of investment or staffing, but improved communication, education to raise awareness (not only in schools but through community learning and development), closer public involvement in decision-making, and more responsive and directly accountable public service provision. (See also Chapter Six on Strengthening Accountability). Summary of main points 3.43 Participants living in diverse areas across Scotland expressed consistently positive satisfaction ratings with most services. Nonetheless, it is notable that residents of the most disadvantaged neighbourhood appeared to be more satisfied than those living in more settled and affluent areas. A contrast between urban and rural areas was also evident: while residents of one central city area rated public transport second highest in terms of satisfaction, participants from both rural groups scored public transport lowest. And while all three urban groups rated Maintenance services lowest, both rural groups expressed most satisfaction with these services. 3.44 No group offered a negative rating on ‘good quality services’ delivered by their council, but four of the five groups did so on the issue of making ‘best use of the budget’ and those in the most disadvantaged did the same for ‘local focus on quality of life’. 3.45 Improvements to the local environment were identified as a step forward in most areas, with participants noting it has become easier to recycle household waste than in the past. 3.46 However, deteriorating standards were identified in the three urban groups related to an overall sense of ‘the visible signs getting worse’, especially litter, refuse/cleansing services and road maintenance. Concerns were raised about reduced primary care coverage out-of-hours and a clear preference was expressed for face-to-face contact rather than using NHS24. Potential risks to local health service availability in future were identified in both urban and rural neighbourhoods. There was some recognition that the actual or proposed centralisation of key services like these would lead to winners and losers in terms of accessibility. Insufficient funding for bus routes and a restriction of early evening services was also raised as a main concern.

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3.47 In terms of increased service provision in future, greater policing presence especially at night, and (for towns and cities) in places where violence and anti-social behaviour associated with binge drinking was more likely to occur. Practical ways to extend existing services were identified, e.g. doorstep collection of household waste and heavy goods for recycling; extended opening hours in primary care services to better meet the diverse needs of the workforce; and greater use of Community Wardens. 3.48 In the larger cities, participants placed a high value on equity considerations as well, but they took differing views on the nature of existing variations in standards. Residents of the most disadvantaged neighbourhood wished to know more about service standards across the city, with many believing better-off areas enjoyed better public services. In the most affluent area, residents believed some of their public services were poorer due to greater targeting of resources in low-income neighbourhoods. In the most remote location, participants felt they did not receive an adequate level of basic services like water/sewerage and bus links, 3.49 Most participants recognised there is currently a trade-off between high quality but uneven public services and less good but universal services available in all places. They supported greater consistency in quality standards across their authority, with proper monitoring and enforcement of standards, as well as clearer comparisons between different parts of the public sector and different authorities. 3.50 Participants expected public services to become more adaptive and responsive services as user expectations and needs change. Participants emphasised the role of good customer care and the importance of clear communication. They noted that migrant workers in front-line service roles should be given language training to ensure their communication skills are good enough.

3.51 The possible consequences of demographic trends were considered. Participants identified a need to invest more to support ‘independent living’ and intermediate options like sheltered housing; and supported much greater choice over when and how to retire from work and better options for drawing upon the experience of the retired population. Some emerging social and health needs were felt to be poorly addressed by services currently. Support for parenting and promotion of healthy life-styles (diet and responsible drinking) was expressed.

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CHAPTER FOUR EFFICIENCY AND PRODUCTIVITY Scottish Executive goals • More resources for front-line delivery through the Efficient Government

programme • More streamlined and simplified performance reporting and scrutiny • Scottish Executive to become more proportionate in its monitoring • Fundamental review of inspection, regulation and audit arrangements Context The Scottish Executive ‘Efficient Government Initiative’ sets targets for efficiency savings across the devolved government, local authorities and health boards. In the tighter fiscal climate emerging, the need to achieve such savings for reinvestment in front-line service delivery has been recognised increasingly. Public service providers are being encouraged to collaborate in managing ‘back office functions’ as part of the drive towards ‘Shared Services’. In addition, more efficient approaches to reporting on service performance, and to the audit and inspection of service regimes, are viewed as necessary to enable service providers to achieve their objectives. Relatively less emphasis has been placed, to date, on improving workforce productivity in Scottish public services although steps to manage sick leave more actively have been taken widely. Improved productivity is likely to become a more prominent feature of the debate. Efficiency, priorities and assessing risk 4.1 Participants identified various examples of lack of efficiency in public services. These were not the same issues that tend to be reflected in policy and media debate: workforce productivity, staffing levels or indeed the overall size of the public sector. Instead, there was an emphasis on ‘wiser spending’ by setting priorities the public felt were more in line with their own. For example, in the Borders group, one participant called for: ‘Less waste on useless and unnecessary things like digging holes in the road, and more money for hospital services’ [Borders, 25-34 year old man] 4.2 In the Stirling group, participants drew attention to what they saw as ‘pointless tasks’ such as constantly doing the pavement in the town centre. 4.3 Public-Private Partnerships have been used to roll forward significant amounts of investment for capital-intensive projects, and to spread repayments over a number of years. The case for doing so is made on the grounds of ensuring schools, hospitals and transport infrastructure are modernised on a timescale in keeping with public expectations, and without significant increases in public borrowing. However, questions were raised in a number of the groups about the real need for at least some of the new hospitals (Stirling) and school developments (e.g. the Glasgow group questioned the benefits of closing four local schools and merging into one large new build school). 4.4 While replacing older buildings with fewer, modern buildings might bring important service benefits, participants felt that options to retain the status quo might be worth

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considering in some cases. Localised services with poorer infrastructure might, occasionally, be preferred to centralised services in modern settings. In the Borders group, most participants questioned the value of developing the Waverley railway line because of unknown cost, expected lack of use by existing residents compared with a bias towards new commuters and an uncertain liability on Council Tax payers for cost over-runs: ‘How can we be sure that the risk is being passed to private firms?’ [Borders, 45-54 year old man] Waste, value for money and focus 4.5 The argument that we need more efficient public services because of waste and inefficiency was made mainly by the Edinburgh group, with some references made in Stirling and Borders. Waste and duplication were considered to be a legitimate target because they prevent public services being delivered properly. In Edinburgh, participants discussed at length their concern that the lack of focus on value for money and clear priority-setting harms services in the long-term, as well as leading to higher Council Tax than actually required:

‘There’s wastage everywhere. You have to cut the fat away, and channel the money to where it’s really needed…Public services should only do the things that they can do well – or they should stop doing them. Get the people with the right skills to do the right things.’ [Edinburgh, 55-64 year old man]

‘I’d like reviews of: the need for the council to do care in the community; economic development; the need for police and fire boards, bearing in mind that councillors sit on the boards anyway; co-ordination of transport.’ [Edinburgh, 55-64 year old man]

4.6 In discussing how they would judge whether public services were improving, one participant in the Borders group expected to see Council Taxes frozen in real terms and services improved through efficiency savings. Others in the same group felt additional revenue could be raised from a development levy on new homes being built to attract commuters. As this would contribute to house price inflation above the means of average earners in the area, participants felt it was equitable to invest some of the proceeds from economic growth to benefit public services. 4.7 As noted earlier, there was little direct reference to traditional stereotypes about workforce productivity, such as ‘over-manning.’ However, some participants did refer to additional legislation and too much administration stopping front-line efficiency in policing. The Borders group spoke of local authority office hours being too short to meet the needs of working people, while in Stirling participants admitted to feeling unclear about what council staff do these days, ‘apart from developing strategies’. Diverse providers? 4.8 Public services are provided through public funding but not necessarily by the public sector. The case for commissioning voluntary sector providers of public services has been made, frequently, on the grounds of user focus and innovation, while some private providers are considered to offer improved efficiency or productivity.

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4.9 In Stirling, a range of different views was expressed, with general agreement that using others to deliver public services should happen only if it made services demonstrably better. Where voluntary organisations took on service delivery roles, participants were concerned that it might change their ethos towards profit. They stressed as well the need to ensure that services became more accountable not less so: even where services went out to tender, the local authority should retain a strong monitoring role, the ability to adapt or end contracts, and have powers to put in managers where contracts were not succeeding. 4.10 Related to a discussion on accountability in Edinburgh, the Borders group proposed that clearer comparisons were needed between private and public services. As an example, waiting times to have calls answered by the gas company might turn out to be worse than for the local council. 4.11 The post-event survey included a question on who might provide public services locally. Responses are shown in Table 4.1. Table 4.1: Net comfort scores with other providers by location How would you feel about public services being delivered by the voluntary or private sector?

Net scores: Comfortable/ Concerned

Edinburgh

Glasgow Highland Borders Stirling

Voluntary Sector

- 2 (1) + 10 (2) + 4 (1) +4 (4) + 5 (3)

Private Sector 0 (3) + 1 (6) + 8 (2) 0 (6) + 1 (4)

4.12 The table shows net scores derived as the difference between those feeling ‘comfortable’ and those feeling ‘concerned’. The combined number who answered ‘Neither’, ‘It depends’ or ‘Don’t know’ is shown in brackets. Of the 10 scores (voluntary and private sectors rated in five locations), 7 have net comfortable scores, 2 had neutral responses and 1 had a net concerned rating. 4.13 For the voluntary sector, the Glasgow group felt most comfortable about its potential role in delivering public services, while the Edinburgh group was the only one to express more concern than comfort. Comfort ratings with the private sector were lower than with the voluntary sector in three locations (Glasgow, Borders and Stirling), scoring close to zero in these groups as well as in the Edinburgh group. This ambivalent response contrasts with the Highland group, which expressed the most comfort with private providers of public services. This appears surprising, given participants’ clear dissatisfaction with at least one service delivered by regulated private operators (public transport). In addition, the scope for the private sector to run public services is likely to be least in remote rural communities. The views of public service leaders 4.14 Among the Edinburgh stakeholders, calls were made for greater capacity building with new providers or in new areas of service provision, and for improved learning between voluntary organisations. In Stirling, the advantages of looking for partners outwith the usual set of service-providers were discussed. A clear view of the role of the voluntary sector was

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called for. Simplified and outcome-focused grant agreements were suggested for the voluntary and not-for-profit sectors. 4.15 Dundee stakeholders talked about ‘recruiting talent’ from both the private and voluntary sectors, as well as working closely with and expanding current links with both sectors to build capacity in public services. It was thought necessary to look globally at currently available models, and to work towards ‘blending’ the best of each sector to arrive at the best solutions for public service delivery. Summary of main points 4.16 Waste and duplication were considered to be a legitimate target because they prevent public services being delivered effectively. 4.17 Participants put an emphasis on ‘wiser spending’ by setting priorities the public felt were more in line with their own. 4.18 While replacing older buildings with fewer, modern buildings might bring important service benefits, participants felt that options to retain the status quo (or intermediate options) might be worth considering. Some considered that localised services with ‘less than best’ infrastructure might, occasionally, be preferred to centralised services in modern settings. 4.19 The view was expressed consistently that voluntary and public service agencies should only be used to deliver public services if this made services demonstrably better. Where voluntary organisations took on service delivery roles, some participants were concerned that their ethos might change towards profit-making. They stressed as well the need to ensure that services became more accountable in future: even where services are tendered, participants felt the local authority should retain a strong monitoring role, the ability to adapt or end contracts, and have powers to put in managers where contracts were not succeeding.

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CHAPTER FIVE JOINING UP AND MINIMISING SEPARATION Scottish Executive goals • Achieving real outcomes against the priorities set by the people of Scotland • Reform pathfinders to demonstrate new ways to integrate service delivery • Ensure community knowledge of, and involvement in, the Community Planning

process. Context The concept of joining-up services is not new. In the 1990s, notions of ‘reinventing government’ and ‘holistic government’ proved influential in US and UK governments. In Scotland, Community Planning Partnerships provide a consistent local focus for joint strategy and delivery of more services, building on the various models of closer planning between separate agencies (notably the Joint Futures initiative between health and social work agencies and now Community Health Partnerships). Defining joining-up 5.1 A definition offered by one Edinburgh group participant was:

‘Joining-up is about efficiency, saving money, but it’s also about improving the quality of contact.’ [Edinburgh, 55-64 year old man]

5.2 Joining the gaps between policy intentions and outcomes was also identified as a goal. An example of this closer linkage was given in the Stirling group:

‘Employment is not the council’s responsibility but they are always training youngsters and ditching them when they’re qualified’. [Stirling, 45-64 year old man]

Responses to ‘joining-up’ vignette 5.3 A third vignette, or case study, was presented to group participants, detailing a young man aiming to establish a small business (see box). A summary of responses from each location is shown in Table B3, Annex 3. Vignette on small business start-up (Jamie) Jamie is 23 years old and wants to set up his own car repair business. He has the skills and a lot of useful contacts, so he thinks this could be a viable business. He lives at home with his parents in their council house, so isn’t worried about the cost of living while he gets his business up and running. But he has only £500 saved towards getting his business started. None of his family members has any experience of being self-employed. He is keen to make the right decisions, but isn’t sure what he needs to know, and where he can best find out what he should do to ensure his business will be successful. He wants to be able to reply upon a steady income. He is keen to make sure that he builds up the business, but also knows he needs to plan for the future.

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5.4 Across the locations, participants showed a relatively high level of awareness about information sources available. They referred to regulatory matters (e.g. tax), public sector support through enterprise bodies (with references made to Business Gateway) and voluntary sector support from Citizens Advice. In addition, a number of groups highlighted the importance of informal support from other experienced people. Numerous references were made to the importance of ‘independent’ sources of advice, available free of charge to the user. 5.5 Recognising the diversity of information and advice services, two groups emphasised the need for a ‘one stop shop’ approach or use of the Council Service Point to sign-post the user to the most relevant services. In addition to joined-up information, there was an expectation that different agencies should collaborate with each other. A diverse range of service providers was not considered necessarily to be a negative feature. However, a practical consequence of participants’ views is to consider greater use of the ‘single gateway’ model, where frontline staff could act as a broker between agencies on behalf of the user. Each group advised Jamie to use internet sources, suggesting that more of the joining-up can be done on-line. One group raised questions about the feasibility of Jamie’s plan because he had no assets to help secure a loan. 5.6 Participants also posed a number of questions to service providers, including how rules on regeneration funding could be changed to nurture an environment for small business start-ups. The Edinburgh group called for clarity on who should be the lead agency to promote local economic development. Better sign-posting 5.7 According to the group participants, good communication skills and information from trusted sources would help citizens to do some joining-up more easily. Sign-posting to appropriate sources of advice might offer, in some cases, a good alternative to the harder task of achieving service integration:

‘I don’t know if it’s actually about joining everything up. I know that if I go to a department, it wouldn’t necessarily have to be joined up as long as they were able to help me and gave me the right number – that would be helpful. But just to say that ‘this is nothing to do with me’ and leave you, isn’t right.’ [Edinburgh, 45-54 year old woman].

Communication and planning between sectors 5.8 Joining-up should apply not only to public sector bodies like the council, health board, local enterprise company and emergency services. Participants in two locations identified a clear need for better communication and joint planning across sectors, especially in the case of services like public transport which often span funding and strategic planning from the public sector and private providers operating on a franchise basis. Stirling participants felt closing the perceived communication gap between councils and bus companies should be a priority.

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5.9 The Highland group took this theme further. They reported that communication between public services, e.g. hospitals and schools, and public transport providers does not appear to take place. They proposed that all service provision covering remote rural areas should consider the implications of transport if services are to become more accessible. Examples were given of children being unable to take part in after-school activities, and adults having difficulty arranging hospital appointments, due to limited public transport provision at inconvenient times. In addition, labour market opportunities were restricted. 5.10 Joined up thinking around the provision of public services was identified as central to developing high quality services by Highland participants. For them, this meant thinking about roads, land prices and ‘red tape’ when aiming to encourage new businesses; linking social housing to land reform; raising staff awareness of travel time and transport links when services are not provided locally; and investing in school education on the basis of children’s needs. Concerns were raised that teacher: pupil ratios should not be set on the same basis as in larger settlements. The views of public service leaders 5.11 Turning to the public service leaders dialogue sessions, participants in Aberdeen suggested greater use of Joint Boards across services, for example covering police fire and health, overseeing implementation and operations. In Dundee, the use of shared services to ‘provide a local joint emergency contact centre for police, fire, rescue, council, health and voluntary sectors’ was offered as a way forward. They believed that, as a matter of urgency, legal barriers to joint working and the delivery of shared services should be removed. They called for joint health and social service drop-in clinics in the evenings and at weekends. Customers would be at the centre of the delivery mechanism, and wherever relevant, there would be continuity and a seamless tie-up between public and privately-delivered elements of services, such as in the social care of the elderly and disabled. 5.12 In Stirling it was suggested that responsibility for joining up is often passed up to the higher levels rather than remaining with the practitioners themselves. Where a member of the public accesses the wrong service, frontline staff should not simply advise the user that they are at the wrong place, but help them to locate the right service. 5.13 Public service leaders in Edinburgh referred to the case for greater co-terminosity, with the suggestion of sharing boundaries for the health board, police, fire, and local authorities. There were also familiar calls under a number of headings to focus on ‘whole system thinking’ rather than a silo approach. It was considered essential to clarify what should be delivered nationally and regionally, such as policing services, and what should be delivered locally, 5.14 In Lanarkshire, it was suggested that rationalising Health Board boundaries could improve co-ordination of services with partnerships. The Borders group also proposed moving towards multi-agency, co-located teams, combining health and care issues as one package to the end user. 5.15 Finally, in Inverness, one workshop participant called for the abolition of island councils and health boards, and to merge the two sectors across the three island authorities (Orkney, Shetland and Western Isles). An intermediate view was to merge health and local

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authorities within each island would be preferable, while others believed the way forward was through multi-skilled workers from a single agency providing health and social care services in the same location.

Summary of main points 5.16 One practical consequence of participants’ views on the issue of joining-up is to consider greater use of ‘single gateway’ models, where frontline staff act as a broker between various other agencies on behalf of the user. 5.17 Participants in two locations identified a clear need for better communication and joint planning across sectors, not just between public sector agencies. This was considered to be especially important in the case of services like public transport which often combine funding/strategic planning from the public sector with private providers operating on a franchise basis. Participants living in the most remote area stressed that all service provision planning needs to consider the implications of transport if services are to become more accessible.

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CHAPTER SIX STRENGTHENING ACCOUNTABILITY Scottish Executive goals • Strengthen democratic accountability • Ensuring that user experiences and views drive performance improvement • Simple, quick and effective redress when something goes wrong. • Providing focussed, appropriate, balanced and consistent information about

services, performance and people. • Strengthen accountability of senior officers. Context Public group participants explored strengthening accountability of public services in various ways, reflecting the multiple forms of accountability facing service leaders and providers. While there has been considerable discussion of how to improve turnout levels in elections, there appears to be more enthusiasm for improved forms of ‘everyday’ accountability. This spans closer involvement in the early stages of strategic decision-making through to better ways of leaders giving an account of their decisions; and to speedy, clear forms of redress when service users express concern or make complaints. In this way, strengthening accountability appears to be as much about ongoing processes of giving an account and holding to account as the public assessing performance in elections. Responsibility and responsiveness 6.1 Improved accountability as a key goal of public service reform was identified as a priority theme in three groups – Edinburgh, Highland and Stirling – and viewed as an objective running through all discussions in Borders. Accountability was explored in Highland and Stirling as a two-way process, involving better feedback from decision-makers and service providers and closer public involvement in scrutiny of decisions. 6.2 The overall sense of the Edinburgh group, which focused mainly upon the responsibility of leaders and decision-makers, was that accountability has declined. They thought this was marked by a general sense of no-one being willing to accept responsibility for what happens, especially mistakes and failures: ‘Everybody says ‘It’s not my fault’. It starts with Tony Blair and goes all the way down.’ [Edinburgh, 55-64 year old man] 6.3 This view was echoed in other groups, with various references to changing beliefs about the motivation, honesty and integrity of leaders. 6.4 Turning to the issue of expressing concerns and making complaints, evidence from the literature points to service user satisfaction arising from good information about services and standards; accessibility; listening to consumers; and professional staff attitudes (Scottish Consumer Council, 2006). Redress – or putting things right when they go wrong - is also an important part of the equation. In the baseline survey, we asked participants how confident they would be in receiving a satisfactory response (see also Scottish Consumer Council 2006; Scottish Council Foundation/Volunteer Development Scotland, 2006). Responses are shown

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in Table 6.1 as net confidence scores (i.e. the number saying ‘confident’ or ‘very confident’ minus those saying ‘not very’ or ‘not at all’ confident). Table 6.1. Net confidence scores in having a concern or complaint resolved well by location. If you had a concern or complaint with these public services in your area, how confident would you be in receiving a satisfactory response?

Net Confident scores

Edinburgh Glasgow Highland Borders Stirling

Local GP + 8 (2) + 11 (3) + 11 (0) + 11 (2) + 8 (1)

Local hospital + 4 (4) + 13 (1) + 3 (2) + 10 (3) + 6 (1)

Emergency + 4 (4) + 12 (2) + 9 (2) + 8 (3) + 2 (5)

Public transport

+ 3 (1) 0 (3) - 2 (5) + 1 (4) + 2 (5)

Leisure + 2 (6) +11 (3) + 6 (4) + 5 (4) + 8 (2)

Housing + 1 (9) + 4 (5) - 5 (4) + 3 (8) - 1 (6)

Maintenance 0 (2) + 6 (4) + 5 (5) + 3 (2) + 5 (4)

Social Work 0 (9) + 2 (8) + 4 (5) + 1 (8) + 1 (6)

Education 0 (7) + 6 (8) + 3 (4) + 4 (7) + 2 (5)

Planning and Environmental

-1 (6) + 2 (12) + 1 (8) 0 (7) - 3 (8)

6.5 Similar to the satisfaction ratings discussed earlier, five of a possible 50 net confidence ratings were negative while a further five scored zero. Respondents felt more confident that a concern or complaint would be handled well by local GPs, hospitals and/or Emergency services, though scores were relatively lower for hospital services in Edinburgh and Highland, and for emergency services in Edinburgh and Stirling. Leisure services were rated positively in this regard as well in most groups. In Glasgow and Borders, all confidence scores were positive or neutral. In contrast, the lowest degree of confidence was expressed in housing services by the Highland group, which also rated public transport in negative terms. In both Edinburgh and Stirling, least confidence was placed in planning/environmental services, while the Stirling group also gave housing a negative rating. 6.6 It is worth noting that the negative confidence ratings are relatively modest. Moreover, the number of respondents who either didn’t know or expressed neither confidence nor a lack of confidence (shown in the table in brackets) varied significantly. This reflects patterns of service use and knowledge. For example, more than half of participants in Edinburgh and in Borders were in this category for Housing, while Social Work, Planning/Environmental and (in two locations) Education also drew relatively high numbers of uncommitted responses.

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6.7 A TNS/System Three poll conducted in 2006 (SCF/VDS, 2006) asked a very similar question on satisfactory resolution of concerns or complaints, across a broader range of services2. It found GPs, school teachers, and Citizens Advice with the highest confidence ratings (at least 80% of respondents stating they would be confident or very confident). These were followed by Social Work, and by private service providers (telecoms company and supermarket) with intermediate scores. The generic ‘Department of your Council’ received the lowest satisfaction rating, and was the only service provider with a confidence rating less than 50%. 6.8 Comparing these with public views, public service leaders in Borders believed it was also important to clarify the complaints procedure, while Edinburgh suggested that ownership of the ‘user satisfaction’ focus should sit with one person running each of the service teams, including Local Authorities and NHS. Giving an account and holding to account

6.9 On a day-to-day basis, participants believed the most important element of accountability is someone to take responsibility for your inquiry, concern or complaint. As one of the Borders participants said, this means: ‘Not being passed from pillar to post’ [Borders, 65+ year old woman]. 6.10 Achieving this element of courtesy and responsiveness on a more consistent basis was thought to be an important way of resolving concerns locally, and avoiding prolonged and frustrating experiences for service users. 6.11 Participants in all of the public groups expressed strong support for localisation of services, including face-to-face contact with staff who have authority to make decisions and deploy resources. The neighbourhood committee structure of Glasgow Housing Association (GHA) was regarded as having improved accountability and located responsibility ‘closer to home.’ Agencies like GHA were seen as better placed than the Council’s centralised Housing Department had been in the past to listen and respond: ‘Things should be kept if possible at a local level, because it’s more likely that [decision-makers] will understand what the situation is.’ [Glasgow, 25-44 year old woman] 6.12 In terms of decisions that affect a number of households, streets or communities as a whole, participants stressed the importance of better communication in advance of what is planned by the local authority or other public service agencies. (This ‘upstream’ activity is explored in more detail in Chapter Two). Further ‘downstream’, participants only felt able to hold decision-makers to account if they were given a better account of why decisions have been made, especially where the reasons appear difficult to understand, or changes are unpopular. There was recognition in most groups that decisions may go against what the majority wants, or that some areas may benefit more than others. The common view was that people in positions of authority should be more willing to communicate their reasons openly and take responsibility for their decisions. One participant in the Edinburgh group drew this distinction:

2 This was part of a monthly omnibus poll covering 1,000+ adults across Scotland.

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‘Accountability is not about making a decision. It’s about standing by your decision and if have screwed it up, you’ve got to put your hand up and say ‘I did that’. [Edinburgh, 55-64 year old man]

6.13 Moreover, where there is a willingness to consult the public on various options, participants believed there is also a responsibility on service providers to offer feedback setting out where decision-makers agree and disagree with public views, and why. 6.14 ‘Long-run accountability’ might be a useful term to focus on the timescales for spending allocated budgets, and making sure that they are realistic. The Borders group discussed the time horizon over which accountability can be achieved. Drawing on the example of the Waverley railway line from Edinburgh to the Borders, participants felt they knew only in outline what was being planned, and were particularly interested to know more about the financial assumptions built into the plan Because the costs of the development will be significant, and the use of private finance means the cost will be paid back over a very long period, the group asked how they could hold local decision-makers to account. They felt unclear about the actual future costs, whether there was an alternative to private finance, and how much say the council really had, as their locally elected body, in deciding which firm offered best value for money. If the real costs are not apparent for some years, they asked, how can future councillors and service managers be held to account for decisions made largely by their predecessors? 6.15 On a related theme of holding elected representatives to account, Stirling participants were unclear to whom they should bring their complaints when a new electoral system is used from 2007. In multi-member wards covering larger areas than single wards do currently, will constituents be able to work out the most appropriate councillor to take up their issue? There was limited scope for discussion on this issue, which could have explored constituents’ experiences to date of approaching regional list MSPs and ‘all Scotland’ MEPs (both systems introduced in 1999). It should be noted, however, that local councillors might serve as a more common first point of contact for members of the public. The consequences for local accountability of electing councillors by STV should be explored.

Two-way accountability 6.16 Accountability was viewed, in many cases, as a ‘two-way street’. Citizens were seen as having responsibilities to each other. For example, a perceived erosion of the sense of community was identified in Edinburgh. A lower level of personal ‘investment’ in communities was thought to be one factor causing some standards to deteriorate, like littering. It was recognized that even record levels of investment in street cleansing would not solve the problem of litter being dropped in the first place. For that to happen, citizens must feel a stake in having cleaner streets. This ‘stakeholder citizen’ model appears to be distinct from a ‘shareholder citizen’ idea also discussed in the Edinburgh group. They explored whether a change of mindset and practice in the relationship between the local authority and the public would help:

‘Citizens should be seen as ‘shareholders’ rather than customers, as we can’t really move our custom.’ [Edinburgh, 35-44 year old woman]

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‘…if you felt like the council was run more like a business and that you were treated as a shareholder …that’s effectively what we are because we’re paying our council tax.” [Edinburgh, 35-44 year old woman] “We should get an annual report – something that’s meaningful to us.” [Edinburgh, 35-44 year old man]

6.17 Linked to the notion of two-way accountability is the concept of co-production as explored in areas as diverse as personal care for adults with disabilities and community safety. Participants in the Stirling group accepted the public’s responsibility to re-build respect for the police if progress towards community safety is to be sustained:

‘The bobby on the beat is a deterrent in itself, because they could develop a relationship with the local population’. [Stirling, 25-44 year old man]

6.18 However, they expressed some concern about police attitudes towards the public, and a wish to see the police take steps to improve public confidence in their role. The point was illustrated further by a discussion in the Borders group. One participant [Borders woman aged 65+] shared a recent experience of alerting the police when she discovered her neighbour had been attacked violently at home. Her intervention may have prevented him bleeding to death. Her action would be judged by most people as that of a concerned citizen, with a stake in the wellbeing of others. Yet, she was described apparently only half in joke by one police officer as a ‘trouble maker’. 6.19 Public service leaders in Edinburgh also made the case for greater shared responsibility, and believed that to improve the relationship between public service providers and citizens in the health arena, for example, a loyalty card incentive scheme could be introduced to reward those adopting a healthy lifestyle. Independent not vested interests 6.20 Strong standards of accountability were considered to emerge when information is regarded as accurate and trustworthy, and when decision-makers act in the broad public interest. It was believed in two of the groups (Edinburgh and Stirling) that, by virtue of being elected, councillors would tend to support decisions that benefit their own party, ward and those who are more likely to vote. For example, facilities for young people were considered as likely to lose out against older peoples’ concerns about noise and disturbance. 6.21 The theme of independent information and action was a common feature in the group discussions, leading some participants to support less involvement of political parties in local government:

‘Neutral councils, it’s party politics, it should be for the benefit of the public not the party.’ [Stirling, 65+ year old man] ‘If you want true accountability from councillors you shouldn’t have them linked to any party – they should all be independent. They potentially have to stick to the party line rather than do what’s good for their local electorate.’ [Edinburgh, 55-64 year old man]

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6.22 It is worth noting that Stirling and Edinburgh represent two councils which have had a strong tradition of competitive local politics and changes of administration. In the rural areas, where Independent councillors continue to have an important role, this was less of an issue. However, these participants identified other ways of drawing upon independent sources of information (stronger community councils proposed by the Highland group) and expertise (such as a stronger role for professional advisers playing a role similar to Audit Scotland locally and the idea of ‘professional’ councillors proposed in Borders). The views of public service leaders 6.23 Participants in the Inverness public service leader dialogue session discussed the general public’s limited understanding of the role of councillors. Participants in the Edinburgh workshop suggested giving to locally elected members a scrutiny or challenge function around the delivery of services by other public agencies on behalf of service users. A suggestion was made in Inverness that local government could provide public scrutiny of NDPBs and other public bodies in their area, and that this could be another way of enhancing the scrutiny role of councillors. There was also a call, from stakeholders in the Borders, for more local Council representatives on Health Boards. Authentic performance measures 6.24 How well decision-makers give an account of their performance, and how effectively the public can hold them to account, depends on relevant information being made easily accessible. An emerging sense was clear in two of the groups that what gets measured and reported on may not be the most useful indicators, and that how we go about monitoring performance may also need to change. In Stirling, participants were critical of so-called ‘box-ticking’ in the NHS and were not confident that these led to services offering what people need and expect. The Edinburgh group asked whether independent inspection of service costs and effectiveness was working well. Some scepticism was expressed over whether public bodies could do this and suggested private expertise be drawn upon. In Highland there was a general issue regarding the lack of information sharing by the Council with residents. One participant said this makes the Council:

‘Intimidating to speak to because they have all of the information and we don’t.’ [Highland, 25-44 year old woman]

6.25 In the concluding session, groups considered the issue of ‘vital signs’ or authentic measures that would persuade them significant improvements to public services were being achieved. While it was considered important to have access to information that carried public trust, participants made clear they would prefer to ‘see with their own eyes’ the evidence of progress. One Edinburgh participant explained:

‘If I’m living in an area of high crime, how I’m going to realise that crime rates have gone down is that I felt safe at all times to go out, without my property being stolen, or my person harmed, or the old lady next door is able to go out at all times of night without any interference’. [Edinburgh, 45-54 year old woman]

The views of public service leaders

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6.26 Public service leaders in Lanarkshire suggested that there should be one system of performance monitoring, and that audit and inspection be simplified and oriented to focus on the customer. This was echoed in the suggestion that less time be spent on audit and more on delivery, provided that outcomes are clear. In Borders there was a desire to move away from the current system of performance measurement, based on the single agency model, to measuring partnership performance. As part of this, it would be necessary to ensure the connections between local and national performance frameworks. In addition, the Aberdeen group called for simple and comprehensible performance data published across services on a consistent national basis. 6.27 Edinburgh public service leaders suggested that partnership agreement goals might be set to cover both the Executive and local government emerging from the 2007 manifestos. They also wanted to see shared performance targets set for senior Scottish Executive staff and their local authority or NHS counterparts. Inverness stakeholders expressed a view that the ‘contract’ between central and local government should be made more explicit, with a stronger focus on outcomes. 6.28 The Edinburgh group also suggested that:

‘There should be just one inspection organisation or performance management framework across the public sector. This would focus on quality of life outcomes, providing the focus of a streamlined and fit-for-purpose scrutiny process.’

More autonomous, more accountable? 6.29 Does autonomy lend itself to greater responsibility for decisions made and, in turn, improved accountability? Two of the groups discussed greater financial autonomy for local councils as a potential route to stronger accountability. 6.30 One group (Stirling) discussed the effect of the majority of funding for local authority services coming directly from the Scottish Executive. They felt this meant councils were not really in control of their own affairs. They concluded that councils ‘deserved to have more autonomy’ to test whether it would lead to a more genuine debate about priorities and greater responsibility for their actions. They believed it was time: ‘… to deal with the tensions between local authorities and the Scottish Executive’ [Stirling, 25-44 year old man]. 6.31 Over-spending by Scottish Borders Council led to a crisis in the Education budget in recent years. While this damaged public confidence, participants in the Borders group felt nonetheless that councils should have more powers of decision-making, more financial autonomy and greater discretion, in order to improve accountability. In particular, they felt the council ought to have more say than they felt it has on whether private finance initiatives go ahead and with which partners. 6.32 In contrast to experiences in the Glasgow group, the proposed housing stock transfer in Stirling (which was being voted on at the time) was viewed more sceptically3. It was thought to have been ‘forced’ by the Scottish Executive rather than developed as an

3 The Stirling proposal was rejected by a margin of two to one in October 2006.

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expression of local demand. They felt this raised questions about who would have authority over standard setting. 6.33 Stirling stakeholders also discussed the notion of greater financial empowerment at a local level, leaving services with greater control over how to spend their money. They believed there would need to be clear communication on standard practices at the same time, however, to avoid questions about why services were being delivered differently across Scotland. 6.34 A further idea enabling joint working put forward by the Edinburgh group included delegation of financial controls to Community Planning Partnerships (CPPs), and establishing a pathfinder CPP to join up services delivering key quality of life outcomes. Ayrshire stakeholders wanted to see the creation of more effective joint working within the partnerships, in order to deal with conflicts and differential accountability between partners.

Accountability for actions not just intentions 6.35 The Stirling group discussed, in depth, what they expected public service authorities to be accountable for. They reached the view that ccontinual development of strategies, followed by consultation, has replaced actually achieving changes. While both strategy and consultation were thought to be important, participants were interested in seeing fewer competing strategies and more genuinely responsive consultations. 6.36 Participants were, thus, clear that they wanted to hold elected representatives to account for what they have achieved (or failed to), not what strategy documents set out to do. The Edinburgh group commented that appointed officials should not be held directly accountable for failures arising from trying to deliver policies decided by elected leaders. Accountable leaders 6.37 Some discussion took place on the right and wrong kinds of accountability. The option of electing some appointed posts, such as the Chief Constable of a police authority, was raised in Stirling as one means to improve accountability. However, participants in Edinburgh spoke of the need to balance accountability with leadership:

‘If you have too much accountability then I don’t really think anything changes. You’ll never get any radical ideas, because people are too scared.’ [Edinburgh, 35-44 year old man] ‘Tackle the vested interests that fear change in public services – although it’s only human nature to fear change. Also tackle public aversion to change in some services that they feel strongly about – perhaps don’t consult on the aims, but on the methods, so that you can make progress.’ [Edinburgh, 35-44 year old man]

6.38 Turning to public service leaders, some Borders participants pressed for a leadership development programme across the public services, voluntary and private partnerships. A joint public sector committee was suggested by Aberdeen public service leaders, including senior members such as Council leaders and Health Board Chairs. In Ayrshire participants thought it was necessary to create a local vision for reform that is promoted actively by those at the top and which demonstrates how benefits will apply locally. In addition, it was

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considered essential to establish local performance indicators that drive leaders towards an agenda of reform. Successful change leaders were defined as those who promote a culture of integrated working amongst senior and middle managers. Summary of main points 6.39 Participants in all of the public groups expressed strong support for localisation of services, including face-to-face contact with staff who have authority to make decisions and deploy resources. Further ‘downstream’, participants only felt able to hold decision-makers to account if they were given a better account of why decisions have been made, especially where the reasons appear difficult to understand, or changes are unpopular. There was recognition in most groups that decisions might go against what the majority wants, or that some areas may benefit more than others. The common view was that people in positions of authority should be more willing to communicate their reasons openly and take responsibility for their decisions. 6.40 ‘Long-run accountability’ concerns the timescales for spending allocated budgets, and making sure that they are realistic. In the case of large Public Private Partnerships where actual costs do not become apparent for some years, participants were unclear how councillors and service leaders could be held to account for decisions made largely by their predecessors. 6.41 ‘Two-way accountability’ describes a process of more active communication, engagement, responsiveness and feedback between service providers and users. Possible ways to change the ‘terms of engagement’ included ‘stakeholder citizen’ and ‘shareholder citizen’ concepts. Linked to this is the concept of co-production between service providers and users, as developed in areas as diverse as personal care for adults with disabilities and community safety. 6.42 A high value was placed on independent sources of information about service performance. This was influenced by a perceived lack of information sharing by some councils. Participants in the two rural areas proposed a stronger role for community councils, greater expertise through professional advisers playing a role similar to Audit Scotland locally and the idea of ‘professional’ councillors. Participants in most groups took a sceptical view towards a continuing role for party politics in local government. 6.43 It was felt that what gets measured and reported on may not be the most useful indicators of service priority and standards. How we go about monitoring performance may also need to change. Each group considered the issue of ‘vital signs’ that would persuade them significant improvements to public services were being achieved in their area. While it was considered important to have access to information that carried public trust, participants made clear they would prefer to ‘see with their own eyes’ the evidence of progress. 6.44 Greater financial autonomy for local councils was proposed as a potential route to stronger accountability. It was felt that councils deserved to have more autonomy in order to test whether this would lead to a more genuine debate about priorities and greater local responsibility for their decisions. Participants wanted to hold their elected representatives to account for what they actually achieve, not good intentions expressed in strategy documents.

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CHAPTER SEVEN CONCLUSION: TEN PROPOSITIONS ON PUBLIC SERVICE REFORM In this concluding section, we offer our interpretation of the fieldwork evidence in the form of ten propositions for public service reform. Improve the quality of feedback 7.1 Our first proposition concerns the relationship between service providers and users. Public service decision-makers and providers should improve their capacity to seek and respond to service user feedback. The principle of giving a good enough account of decisions made emerges from the fieldwork evidence consistently. Our experience in other areas leads us to believe that public service managers and elected leaders need to do more to understand this need to provide ‘full feedback’, offering an account of where they agree and disagree with public priorities, and why. Be clear on priorities and expectations 7.2 Part of the leadership role in public services is to lead a debate on priority setting in the public interest. There is a clear distinction to be drawn here with most market goods and services. Our expectations as consumers have risen steadily, with the growth of internet trade/retail, 24-hour shopping and telephone transactions. At the same time, these expectations spill over into public services. Yet, these are tax-financed, subject to finite public spending and cannot deliver the same degree of personalisation we can achieve by paying for services. The citizen interest is not the same as the consumer’s, although core elements of good customer service should apply increasingly to public services. 7.3 Tradeoffs are an implicit part of public service decision-making: how to target on the basis of client group and/or area when needs vary; what services to make available on a universal basis; what minimum standards should be guaranteed regardless of where the service user lives and so on. Making this more explicit might help towards the goal of raising appropriate public expectations – i.e. for the public to become more demanding of providers on what they fairly can be expected to deliver. Devolve more powers as they are earned to strengthen accountability 7.4 Participants in the five groups had much in common with each other in terms of the principles they expect to apply to improving public services. The diversity of locations means the specific local priorities for reform vary. This suggests to us the need for an enhanced degree of local decision-making, and perhaps budgetary power, at the sub-authority level. A potential link was made between greater fiscal autonomy for local government and stronger accountability to the public. A clear challenge for central government is to find ways of devolving greater autonomy, at least to areas which have earned it, while ensuring authorities performing less well meet minimum standards across the board. 7.5 At the same time, participants placed a high value on equity of service standards between areas within their authority, as well as between authorities. This calls for more localised datasets to assist with the role of scrutiny. Achieving the right balance between localisation and equity is a familiar challenge. We believe this calls for further testing of

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discretionary action at the local level, especially to achieve demonstrable improvements in the ‘vital signs’ by which residents are likely to judge the true extent of progress. Variations of this kind should complement the successful achievement of agreed minimum standards. Adapt services and skills to serve a more diverse population 7.6 An ageing Scottish population is likely to mean greater need to support independent living, for advocacy and other forms of support for vulnerable service users, as well as improved training and awareness among service planners and frontline staff on the growing diversity of the population they serve (e.g. by impairment, language, cultural needs). This should apply as well to a more diverse workforce, to ensure that migrants working directly with the public (e.g. bus drivers) have good enough English to communicate well with service users. A core part of citizenship is being able to access the full range of public services needed. Greater equalities/diversity awareness skills will be needed to place public service reform in the context of full citizenship. 7.7 In addition, public services must become more adaptive to changes in lifestyle and working patterns. While group participants did not make explicit references to ‘innovation’, they identified practical ways to extend and adapt existing services to better meet their needs – including longer opening hours in primary care centres, doorstep collection of household waste and goods for recycling to be available to all, and extending the Community Wardens initiative further. They emphasised the service gaps they believed should be addressed – more visible local policing being the most common example – as well as proposing new types of services to respond to issues of growing concern, notably support for parenting as well as healthy living (better diet and, by implication, responsible drinking). Reforms need to connect more clearly with public concerns about reducing waste and improving efficiency 7.8 Public views on reducing waste and improving efficiency appear to be expressed less clearly than on other Scottish Executive fundamentals of reform. Nonetheless, evidence in this study shows members of the public are keen to discuss how to improve efficiency because they believe this will lead to better services, not only to moderate Council Tax levels. Survey findings indicate many participants think their council delivers high quality services while at the same time doubting it achieves the best it can with the money available. Developing a better understanding of citizen and local taxpayer interests in improved efficiency will be essential if the Efficient Government Initiative is to deliver sustained improvements to frontline services. How services are funded and delivered may be more important than who delivers them 7.9 There is clear policy divergence across Britain in how to reform public services. In Scotland, few explicit references are made to ‘contestability.’ Instead, it appears that the fundamentals are to be pursued mainly through reform of existing institutions rather than a significant expansion of alternative providers. 7.10 Discussion on who should deliver public services was limited in the public groups. Different views were expressed, with the balance of opinion being unconcerned or undecided about other providers. Participants were relatively more comfortable with the idea of the voluntary sector playing a greater role in public service provision than the private sector.

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Residents of the least advantaged neighbourhood were most comfortable of all, while participants form the most affluent area were least comfortable with this option. Residents from the most remote rural location were most comfortable with the private sector playing a greater role, although the underlying issues of high costs and lower demand facing any provider in such areas was not explored fully. Some support was expressed, as well, or private sector skills being used to support financial audit and monitoring of standards. 7.11 We believe there are no intrinsic reasons why public, voluntary and private sector providers cannot achieve significant progress on each of the five fundamentals set out by the Scottish Executive, even if they face different incentives and pressures. Whatever balance of provision is considered best, the public will expect to see improved scrutiny of standards by local authorities and poor performance addressed quickly. Pursue two-way and ‘long-run’ accountability 7.12 Evidence from the study persuades us there is a demand for new ideas on how to improve local accountability and responsibility for decision-making. Participants expressed almost unanimous support for closer public involvement at all stages of the decision-making process, and believed this would lead to tangible improvements in public services. 7.13 This suggests a model of ‘two-way accountability’, where decision-makers and providers are willing to engage with the public in new ways, and where citizens are willing to engage with some of the hard choices emerging in their area. As well as working with established community and voluntary networks, there may be a case for paying people to participate and developing their expertise over time. In addition, greater use of deliberative polling may be appropriate. However, the suggested use of local referendums is unlikely to resolve issues with a clear regional dimension (e.g. railway development or congestion charging), where residents of neighbouring authorities may express different interests (e.g. the Greater Stockholm congestion charge referendum, September 2006). 7.14 Some participants raised the idea of being treated as ‘shareholders’, with a stake in the success of their area. Their idea of receiving a clearer account of the decisions made and planned by their public service leaders, in the form of an annual report/AGM, has merit in principle. More important than this kind of output, however, is the associated change of mindset needed on the part of providers towards the public. We conclude that basic improvements in customer service standards in all public services would go some way to addressing this point. 7.15 Looking ahead, the idea of ‘long-run’ accountability should have greater prominence. There is little sense from providers of a consistent ‘futures’ perspective. This was raised by participants in relation to the financing of Public Private Partnerships. While these may offer the only way to fund large capital projects for public services, some participants expressed concern about a lack of transparency over how decisions are made and how the eventual costs are accounted for. By definition, those who make decisions may not be in positions of authority when repayments are finally completed. Moreover, participants questioned the assumption that the public will prefer, in all cases, new schools and hospitals. There may be support for intermediate reform options (e.g. good enough provision provided locally) rather than more centralised solutions.

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Local and virtual accessibility 7.16 Participants expressed strong support for all service users to have a choice over how to communicate with service providers. Some felt they would be very comfortable with using on-line sources of information and guidance, but recognised others would not. Concerns were raised over the drift towards call centre communications for issues they felt are best dealt with locally and on a face-to-face basis. This covers private providers (e.g. banking and utilities) as well as public services (e.g. the desire for local police stations with full staffing). Public service reform should consider how to extend choices for service users with different communications skills and preferences. Expertise and independence 7.17 A higher value should be placed on the goals of independence and improved expertise. Greater public confidence is needed around information on service standards, trends and comparisons between neighbourhoods and authorities. Some support was expressed for the idea of more ‘professional’ councillors and leadership expertise. In two areas, this led to participants questioning the continued role of party politics in local government. Whatever political complexion emerges in 2007, we believe it is essential that public service leaders consider how to promote the public interest in their area, and demonstrate that standards of monitoring/scrutiny are improving. Move further towards joining-up and ‘single gateway’ approaches 7.18 The goal of joining-up public services to provide easier access and better outcomes is not new. Yet, with some notable exceptions, progress in Scotland appears to have been limited. We believe there is strong support both among the public and stakeholders to move further in this direction. As well as joint strategic work through Community Planning Partnerships, joining-up could extend to joint budgeting around shared aims, joint consultations on local objectives, shared or multi-agency staff and shared back-room functions. Moreover, this principle should apply to closer cross-sectoral working, e.g. to ensure local transport provision by franchised operators is factored into public service reform. 7.19 Finally, public participants did not expect all services to be available under one roof, and indeed placed a value on a mix of statutory and independent providers being available. However, they did express support for the first point of contact being able to signpost users towards the most appropriate sources of information and advice. Such ‘single gateway’ models have been used to drive reform of the former Benefits Agency and Employment Centre. We believe they have considerable merit as a way to make the joining-up agenda work for service users.

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REFERENCES Audit Scotland (2005). Improving customer satisfaction through better customer contact, Edinburgh: Audit Scotland. British Medical Association (BMA), Board of Science, Healthcare in a Rural Setting, January 2005 Bromley, C., & Given, L. (2005). Public Perceptions of Scotland after Devolution: Findings from the 2004 Scottish Social Attitudes Survey, Edinburgh: Scottish Executive.www.scotland.gov.uk/Resource/Doc/57346/0016846.pdf Bromley, C., Curtice, J., & Given, L. (2005). Public Attitudes to Devolution: the First Four Years, London: The National Centre for Social Research. Corbett, J., et al (2005). Annual Report: Results from 2005 Scottish Household Survey, Edinburgh: Scottish Executive. COSLA website www.cosla.org.uk (Offers councils ways of making changes in services, but no information about public attitudes to services). Crafts N. (2004). High Quality Public Services for Scotland, Allander Series Papers, Glasgow: Fraser of Allander Institute for Research of the Scottish Economy Farmer, J., Hinds, K., Richards, H., Godden, D. (2004). Access, Satisfaction and Expectations: a Comparison of Attitudes to Health Care in Rural and Urban Scotland, University of Aberdeen and the Scottish Centre for Social Research. National Consumer Council (2004). User Power: the participation of users in public services, London: NCC. National School of Government (2006) Conference Programme for ‘21st Century Public Services: Putting People First’, 23 May, see www.strategy.gov.uk Rose, N., & Glendinning, R. (2004). Public Attitudes to the National Health Service in Scotland – 2004 Survey, Edinburgh: Scottish Executive. www.scotland.gov.uk/library5/government/panhss-00.asp Scottish Consumer Council (May 2006). Building on Success: Consumer satisfaction with public services, Glasgow: SSC Scottish Consumer Council (2005a). Health On-line: Public attitudes to data sharing in the NHS, Glasgow: SCC. Scottish Consumer Council (2005b). Is anybody listening: the user perspective on interpretation and translation services for minority ethnic communities, Glasgow: SCC.

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Scottish Consumer Council (2005c). Making the difference: research and parents’ views of Scottish Executive proposals to improve parental involvement and representation in schools, Glasgow: SCC. Scottish Consumer Council (2004). How do you rate your Council? A study of the use and relevance of local government performance information, Glasgow: SCC. Scottish Consumer Council (2000). A New Route: Views of local bus services in Scotland, Glasgow: SCC. Scottish Council Foundation & Volunteer Development Scotland (2006) In search of a High-Trust Society, SCF/VDS (2006) www.scottishcouncilfoundation.org Scottish Council Foundation (2002) Possible Scotland, Edinburgh: SCF, PHIS & HEBS. Scottish Council Foundation (2002) Beyond Disappointment: Building Better Communities, Edinburgh: SCF, Cairn HA & Chartered Institute of Housing in Scotland. Scottish Executive (June 2006) Transforming Public Services: The next phase of reform, Scottish Executive www.scotland.gov.uk/Publications/2006/06/15110925 Social Exclusion Unit Interim Report (October, 2005). Improving Services, Improving Lives: Evidence and Key Themes, London: Office of the Deputy Prime Minister

Strategy Unit (2006) The UK Government’s Approach to Public Service Reform, London: Prime Minister’s Strategy Unit www.strategy.gov.uk/downloads/work_areas/public_service_reform/sj_report.pdf

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ANNEX 1 SUMMARY OF FINDINGS FROM LITERATURE REVIEW Background 1. Transforming Public Services (Scottish Executive, 2006) sets out the basic public service reform

issues that the Scottish Executive plans to address. The proposals are relevant to local government, police and fire services, the NHS, the enterprise networks, further and higher education institutions, the justice system, the Executive, NDPBs and executive agencies. The reform agenda identifies the five elements as:

• User focused and personalised public services, based on empowered service users and a

responsibility to listen to the concerns of users and have a complaints system in place • Increase quality and encourage innovation • Improve efficiency and productivity, including scrutiny • Join up services and minimize separation; including looking at services from user’s

perspective; community planning; and, an e-government strategy • Strengthen accountability, and enhance customer satisfaction

2. Research into public, consumer and citizen perspectives and priorities around public service

provision provides a strong base from which to gauge levels of interest, barriers to service users and many of the priorities in relation to focus of delivery, quality, efficiency, coherence and accountability of public services.

Unlocking User Satisfaction 3. Information and communication, interactions with frontline staff, building personal capacity,

joining up, the role of the voluntary/community sector, levers and incentives have all been identified as important to public awareness, use and satisfaction (Office of the Deputy Prime Minister 2005). Research into consumer satisfaction with public services (SCC, 2006) identified six keys to unlocking satisfaction as:

• information about services; • information about standards; • access; • putting things right; • professionalism and staff attitudes; and, • listening to consumers.

4. An important element of satisfaction would appear to be familiarity with how services are

delivered, with users more likely to report satisfaction than non-users, with non-users’ perceptions thought to be affected more by the media.

5. Clear communication and information so that people understand how they can best interact with

the service is a priority. This applies across a variety of contexts, for instance:

• developing parental involvement, where research has found some confusion about the role of School Boards linked to a lack of information about them (SCC, 2004);

• satisfaction with local public transport, where a perceived lack of consumer input around the complaints procedures and some confusion about who to take complaints was found to undermine levels of satisfaction with the service (SCC, 2000).

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6. Fast access and good communication have also been highlighted as important to satisfaction levels with NHS services, with waiting appearing to be less of a driver of overall satisfaction when other aspects of care are taken into account (Page, 2006).

7. The Scottish Social Attitudes survey seeks views on whether the standards of the health service,

quality of education, general standard of living, public transport and the strength of the economy has increased or fallen over the previous year (Bromley and Given, 2005). It showed little notable change in the evaluation of the health service, education and general standard of living between 2001, 2003, and 2004. These questions were also included in the initial survey undertaken in the current research, with participants generally giving more positive responses (Table 1)

Table 1: Perceptions of Changing Service Standards (Compares results of the Scottish Social Attitudes survey (shown in columns labelled ‘SSA’) with the responses provided by participants in the SCF focus groups (‘SCF’))

Improved Stayed the same

Fallen Don’t know

SSA SCF SSA SCF SSA SCF SSA SCF

General standard of living 31% 54% 40% 32% 24% 7% 5% 6%

Quality of education 26% 38% 37% 34% 21% 16% 16% 12%

Standard of health service 18% 36% 31% 30% 46% 18% 5% 16%

Public transport 25% 36% 41% 39% 21% 19% 13% 6%

Strength of local economy 27% 31% 29% 24% 27% 28% 17% 16% 8. Although the small number of people participating in the research means it is not possible to draw

any conclusions on the differences, it does highlight to the difficulty of interpreting the reasons why people make the judgements that they do. The real challenge would appear to be to identify how expectations and experience affect individuals’ and communities’ understanding of public services.

Changing Service-Provider Behaviours 9. Improving customer satisfaction has been recognised as important by many councils (Audit

Scotland, 2005). Council spending on customer service and contact is currently at least £40 million a year. Since 2000, in addition to a council’s own resources, the Modernising Government Fund has provided some £100 million of support to councils and other public bodies to aid modernisation programmes. Although noting that the results of the investigation should be treated with caution, the Audit Scotland report found that of the 17 local authorities that had surveyed users of all services since 2000, maximum satisfaction levels ranged between 59% and 92%. The 1999-2002 Scottish Household Survey also showed that satisfaction levels with a range of important council services ranged between 30% and 80% (REF?). Audit Scotland (ibid) emphasised the importance of Councils putting a specific strategy in place if they are to manage improvements in customer satisfaction levels.

10. The need for strategies for ensuring effective implementation of service provision, with

monitoring and evaluation built-in, has been highlighted across a number of services. For instance, research into provision of translation and interpretation services in the public sector for minority ethnic communities (SCC, 2005) highlighted the difficulties people perceived with the service despite the development of a number of guidelines and policy statements. It also

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highlighted the importance of strategic intervention around the quality of services. Crafts (2004) identified a combination of:

• weak incentives to producers; • poor data collection and monitoring by those responsible for ensuring good results; and, • an absence of competition or contestability in provision;

as reasons for the elusiveness of public service productivity improvements in the past. Getting the best outcomes from public expenditure was thought to require the allocation of funds on the basis of benefit-cost comparisons, and the creation of incentives that encourage the efficient use of inputs, while putting the interests of users first was paramount.

11. Research by the National Consumer Council, exploring how to increase user participation in

public services (NCC 2004), highlighted the importance of those who engage users actually listening to what they had to say. This echoes findings from other research, where a perceived lack of either response or action as a result of involvement processes were felt to undermine public confidence in user engagement. The importance of establishing feedback loops can be seen as central to user focused and personalised public services (Elrick et al, 2003, Elrick et al, 2004).

Local Information 12. Local context, as well as service priorities, needs to be taken into consideration when assessing

overall performance, so that these can properly reflect local conditions (Page, 2006). Views on the type of performance people felt they received from their local council (SCC, 2004) identified the need for more meaningful information on their performance. For example, it was thought that too often the type of information produced was difficult to understand and didn’t match what people wanted to know. The need for information to be provided at a sub-authority level to ensure equal levels of services between localities was also highlighted. Weaknesses around performance indicators were identified as not reflecting the needs and priorities of local people. One consequence of this is that local people might not be equipped with the information they need to challenge the local authorities. How information was brought to people was also identified as an issue, with local newspaper adverts not seen as effective in promoting public awareness.

Expectations and Perceptions 13. Expectations of access to services also appear to have an impact on how people use the services

available. For instance, a study of attitudes to health care services in rural Scotland (Farmer et al, 2004) found that nearly a third of people in rural areas (30%) said that they would phone a GP if they thought that someone in their family was having a heart attack in the middle of the night, as opposed to 15% across Scotland as a whole. Rural participants were also most likely to think that their nearest Accident & Emergency department was too far away, which might explain the increased likelihood of contacting their GP. The majority of participants (79%) across Scotland believed that standards of health care in rural areas should be as good as those in urban areas, even if they cost more to provide. Research into healthcare in rural settings (BMA, 2005) suggests that core services essential to maintain a sense of community are a shop, primary school, GP and community hall, while a local Post Office could also be considered essential. The consequences of a decline in these amenities meant a need to travel further to access services. Poorer people and the elderly were thought to be those most likely to suffer as a result of this change.

14. The importance of joining up services in both planning and provision is intimately linked to

ensuring access to services, in rural areas in particular. Transforming Public Services recognises the importance of:

• priorities for action being shared across public services, with an outcomes focused approach;

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• developing the capacity for leadership of public services; and, • organising services across public bodies without creating more bureaucracy.

15. Managing expectations, whether high or low, was highlighted as a key component of how service

delivery is perceived, with the generally low satisfaction rates of those in social classes A/B thought to indicate higher expectations (SCC, 2006). Public perceptions of what is most important for quality of life and their priorities for improvements are not necessarily the same. Page (2006) suggests that there is a real challenge in establishing how much weight should be given to perceptions, financial and managerial measures and how much to outcomes. The amount spent on services rarely seems to have much to do with how well or badly they are rated by users.

16. Perception appears to have an impact not only on how public services are viewed but also on who

is seen as responsible for perceived improvements or declines in service levels. Expectations of the Parliament in 1999 highlighted that 49% thought that having a Parliament would produce a better health service and 56% thought it would increase the standard of education, but by 2003 these views had fallen to 37% and 23% respectively (Bromley et al, 2005). When asked to look back to 1999, just 20% said that the standard of the health service had improved while 46% thought it had fallen. Meanwhile, 25% said that education standards had increased with 29% believing that they had fallen. It is interesting to note, however, that those who thought that the NHS or education standards had increased were more likely to give the credit for this to the Scottish Parliament than to the UK Government, while those who thought that standards had fallen were more likely to blame the UK Government.

17. Public attitudes to data sharing in the NHS (SCC, 2005) highlight the importance of informing

and involving members of the public in increasing public confidence and ensuring that they are informed about their rights. Participants were found to recognise the advantages of wider information-sharing through technology, but they thought it was important to retain choice over what happens and to be informed about developments. Ensuring security of information and confidentiality were the main concerns.

18. There is increasing evidence of the benefits of listening to and involving people as an integral part

of service provision and design (ESRC, 2006). This has been identified as particularly important with consumers and service users that are less likely to participate. The National Consumer Council (2004) focused on users of housing services and community care. They highlighted the importance of confidence in relation to participation. Unlike general civic participation, where evidence indicates that income and status have an impact on people’s involvement, public service user participation engages with some of the less well-off in society. It was felt that users are often motivated to participate because they are concerned about particular issues, for instance quality of services. Participation was seen as not just good for developing service provision but also good for participants, providing opportunities for them to develop their skills, experience and fulfilment. Collectivist incentives were thought to be highly significant. The research suggests that participation helps to develop a sense of allegiance to shared goals, a sense of community and shared values.

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ANNEX 2 TABLES Table A1: Further significant issues identified by public groups in each location Further significant issues identified by each group shown by * Other significant issues Edinburgh Glasgow Highland Borders Stirling

Quality of local environment, parks/green spaces [3-0]

* * * Health & Care services, organisation of hospital services, waiting for appointments [3-0]

* * *

Roads and parking, pavements and pedestrians [2-0]

* * Litter and cleansing/refuse collection [2-0]

* * Education, childcare services [2-0]

* *

Adaptable public services, matched with lifestyle changes [1-0]

*

Adequate and affordable housing [1-0]

* Fuel and heating costs [1-0] * Employment & training services and benefits agency (Jobcentre Plus) [1-0]

*

Water services [1-0]

* Social Services [1-0]

* Too much strategy, not enough action/impact [1-0]

*

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Table A2: Net ‘improved’ scores for services by location How do you think standards in the following have changed in recent years? Net ‘improved’ scores

Edinburgh Glasgow Highland Borders Stirling

General standard of living

+ 6 + 6 + 11 + 5 + 4

Quality of education

- 1 + 3 + 8 - 1 + 5

Health service provision

0 + 4 + 1 + 6 + 1

Public transport

+ 4 + 2 + 3 0 + 2

Strength of local economy

0 + 2 - 1 - 4 + 5

Road maintenance

- 9 - 2 - 4 - 4 - 1

Local policing

- 3 0 0 - 1 - 3

Aggregate net

- 3 + 15 + 18 + 1 + 13

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Table A3: Net satisfaction scores for services by location To what extent are you satisfied with these local public services? Net Satisfaction scores

Edinburgh Glasgow Highland Borders Stirling

Pre Post Pre Post Pre Post Pre Post Pre Post

Housing Service

+ 4 + 1 + 9 + 8 0 + 2 + 5 + 3 - 3 0

Leisure + 4 + 7 +13 + 9 +12 + 8 +10 + 9 + 7 +12

Maintenance + 4 - 3 + 3 - 1 +14 +15 + 9 +12 + 3 - 4

Social Work 0 0 + 4 + 7 + 7 + 5 + 3 + 4 0 + 3

Education + 4 + 5 + 8 + 9 + 9 + 6 + 5 + 4 + 5 + 5

Planning and environmental

+ 3 + 1 + 6 + 3 + 5 + 8 + 1 - 2 0 + 1

Local GP +12 + 9 +13 + 13 +11 +12 +13 +11 +12 +10

Local hospital + 2 + 5 +11 + 11 + 7 + 3 +10 +11 +10 + 8

Emergency + 6 + 5 +12 +12 +13 +10 + 5 + 6 + 6 + 5

Local public transport

+ 8 + 6 + 4 0 - 1 - 11 0 0 + 5 + 1

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Table A4: Ranking of net satisfaction scores by location To what extent are you satisfied with these local public services? Net Satisfaction scores (rank 1 to 10)

Edinburgh Glasgow Highland Borders Stirling

Pre Post Pre Post Pre Post Pre Post Pre Post Housing Service

4 = 7 = 5 6 9 9 5 = 8 10 9

Leisure 4 = 2 1 = 4 = 3 4 = 2 = 5 3 1

Maintenance 4 = 10 10 10 1 1 4 1 7 10

Social Work 10 9 8 = 7 6 = 7 8 6 = 8 = 6

Education 4 = 4 = 6 4 = 5 6 5 = 6 = 5 = 4 =

Planning and environmental

8 7 = 7 8 8 4 = 9 10 8 = 7 =

Local GP 1 1 1 = 1 4 2 1 2 = 1 2

Local hospital 9 4 = 4 3 6 = 8 2 = 2 = 2 3

Emergency 3 4 = 3 2 2 3 5 = 4 4 4 =

Local public transport

2 3 8 = 9 10 10 10 9 5 = 7 =

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ANNEX 3 VIGNETTE RESPONSES Table B1: Responses to vignette on illness with special needs (Maureen) Responses to this vignette were not reported by the Edinburgh group due to time constraints.

Glasgow: To have been spoken to personally. Highland: Maureen should have been treated as an individual, with the same requirements as anyone else. The assumption was made that because of special needs she would not be able to understand. Borders: Entitled to expect the best possible level of service. She should be treated as an individual. Staff should speak to Maureen and her mother, not just her mother. Entitled to earlier diagnosis and treatment than she got.

Quality of service needed

Stirling: Treated as an individual and not through her mother. As a young woman in her early twenties, may be well aware of what the problem was, but this would depend on her special needs. . Glasgow: Doctor should have spoken to Maureen instead of her mother Personal details should have been taken from Maureen by the receptionist. Highland: Service should be from Social Services and NHS with Government support. Borders: N/A

How should services be provided?

Stirling: Locally and speedily due to the nature of the medical problem Glasgow: She should have been asked if she required additional help due to her specific needs. Highland: When she is well and able to return home, she is back into the system. This needs a direct approach with no assumptions made. Speaking to Maureen directly through a qualified person who understands her needs and wants would be helpful - an assigned case worker who would assess her needs. Would be able to live her own life. Borders: Social Worker, Care Worker/Family Support Worker.

Additional help or support needed?

Stirling: Yes, due to being a special needs person, counselling about the relevant illness, support during and after the illness and assistance from the local council Glasgow: By NHS and provided by the hospital. Highland: Government funding – additional help and support. Borders: Funding from government money, NHS, private insurance?

How funded?

Stirling: Funded and provided by the NHS. Glasgow: Patient care. Highland: To achieve an individual life within the community, with her own home and job Borders: The schools Maureen went to; professional skills and communication abilities of staff including doctors and more Family Care Workers.

Investment priorities

Stirling: More awareness for GPs to recognise possible symptoms and more scanners to be made available – shorter waiting lists

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Table B2: Responses to vignette on possible dementia and sheltered housing (Maggie)

Edinburgh: Residents should go to her family first. Also GP, district nurse, social services. Glasgow: Glasgow Housing Association; Social Work services; doctor; family members (if any). Highland: Whoever is the warden’s supervisors, report their concerns with the GP or District Nurse, the person’s family – the local GP, her family, the staff – chief care person. Borders: Assuming Maggie has no other family members, the resident warden first. The warden should then contact Maggie’s GP.

Who to raise concerns with?

Stirling: The warden, warden’s supervisor, relatives, her physician, doctor to visit home (within sheltered accommodation) Edinburgh: Compassion – taking the concerns seriously and passing them on. Needs a joined-up, co-ordinated response. Support from a Carer needed. Glasgow: Housing Officer and doctor to visit; hospital treatment; home help; proper assessment; good company. Highland: Should expect GP to arrange an assessment involving Maggie and her family with her agreement – unpredictable. Maggie needs Meals on Wheels, Home Care Services, Panic Alarm, Door Alarms to warn warden if Maggie is going for a walk in the middle of the night – frequent visits by staff and doctor, nurse, family stimulation, fellowship with others, hot meal daily. Borders: An immediate response from the GP - to do an assessment and decide if she needs to see a Social Worker. Possibly medication (to help stabilise) and an alarm system at home.

Response needed, including services

Stirling: Someone to check her mentally and physically, and routinely check through time. Home help, more personal watch (resident warden not a visiting one) meals delivered, relatives/ neighbours more actively involved. Edinburgh: Depends on what the professionals have to say – but support with meals, for instance. Glasgow: Social Work services; meals on Wheels; equip house to meet her needs, e.g. personal alarm. Highland: A selection of activities which involves other residents, homecare visits a.m. and p.m. Make sure that Maggie is having at least one hot meal a day, establish a good neighbour and install a door alarm – caring for people, assistance in dressing, washing, bathing and eating and in taking medication at the appropriate times and helping to bed at night. Borders: A carer, Meals on Wheels and an alarm system.

Support needed to stay in flat

Stirling: Ask her what she needs. Edinburgh: Local authority. Central government funding on free personal care. Glasgow: Local authority and NHS should provide; central government and perhaps European sources of funding. Highland: Local authority should be providing this – social work - and sheltered housing provider. Local authority, or self funding, or family could help towards this – council tax. Borders: NHS and a ‘benefits check’ to see if Maggie is receiving all she is entitled to claim.

Who should provide support and how funded?

Stirling: Social/care worker, council, relatives/ friends, neighbours, nurse. The council and health services should fund. Edinburgh: Depends on her mental state. Glasgow: Ask her what she would like; involve the family where possible. Highland: Should be consulted at all times as these changes are for her, take part in any meetings and discussion about her – advocate and family Borders: “Talk to her and not about her.” (i.e. don’t make assumptions about her lack of capacity).

How can she be involved?

Stirling: Discussions with physician, care workers, relatives

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Table B3: Responses to vignette on small business start-up (Jamie)

Edinburgh: Help with a start-up plan, information on grants and funding support available, help with market research, finding business premises, insurance requirements. Glasgow: How to run a small business; tax and national insurance; licensing. Highland: Business plan highlighting, charging and business growth/competition Financial tax and pension side Premises to let or buy Source suppliers and delivery companies Help with managing different aspects of business and rules and regulations of governing bodies Borders: Business information services; information on how to develop marketing and business plans; information on budgeting; premises; set-up costs; grants available; professional advice on liability insurances.

Type of information needed

Stirling: Support of someone with a ‘business mind’. Generic skills; Business plan; available premises Edinburgh: Needs a ‘one stop shop’ or at least a single point of contact. Other, existing businesses. Glasgow: Small business enterprise; bank for a loan; range of potential sponsors; Inland Revenue; another garage for advice. Highland: The bank for financial help or maybe local business (grants, local initiative agencies) Library to help with a list of said agencies Independent agencies (free ones) Borders: Scottish Enterprise Borders (Business Gateway); Princes Scottish Youth Business Trust; the Bank.

Who should he go to?

Stirling: STEPs – course on resources, money, advice, business plan, premises. Bank – always make secured loans implies assets needed. Help from family? Established area of business, so start smaller – can he succeed without more assets and experience? Edinburgh: Council, Scottish Enterprise/ Business Gateway, but also banks, Chamber of Commerce, Citizens’ Advice. “That is the basic thing for the Scottish Executive to answer: who do they want to be running economic development?” [Edinburgh,55- 64 year old man] Glasgow: Inland Revenue; Citizens Advice. Highland: Enterprise schemes and initiatives concerning the pitfalls of new business. Local grants for young person’s initiatives, Council Service Point with information and contact numbers, maybe contacting the college or university that exams were taken in Borders: Health & Safety, Environmental Services at local Council.

Public services that might help him

Stirling: Forth Valley Enterprise – Business Gateway (50:50 match) – IT equipment. Edinburgh: Via the Internet, Chamber of Commerce, Credit Unions. Glasgow: Through the Internet; Small Business Gateway; Shell Livewire Programme. Highland: By freephone telephone numbers; Adverts in directories; Local service points; Internet; General media; By a collaboration of different independent agencies listing all aspects of grants, monies and pitfalls. Borders: Local service providers and through the Internet.

How best can these be provided (in an accessible and supportive way?)

Stirling: STEP programme – regular consultation, not direct funding. Issue: regeneration money only available if Jamie employs staff from the local community – not widely available.

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ANNEX 4 FIELDWORK DOCUMENTS C1. Recruitment Screener Respondents Name: ________________________ Time of session: ___________________________ Date of session: ___________________________ Session No.: _______________________________ Good morning/ afternoon/ evening, we are carrying out a research survey on behalf of the Scottish Council Foundation and are arranging a Citizens’ panel to discuss health and well-being. We would like your views and opinions and would pay a cash fee. This is not a sales exercise. Would this be something that would interest you?

DEMOGRAPHICS Q1a Code Gender: Male 1 Female 2

In each session: X8 to be females X8 to be males at Q1a

Q1b Age: ___________________________

Session 1 (Galashiels):

X2 to be aged 16-25 years at Q1b X4 to be aged 25-44 years at Q1b X4 to be aged 45-64 years at Q1b X6 to be aged 65+ years at Q1b

Session 2 (Lochinver):

X2 to be aged 16-25 years at Q1b X5 to be aged 25-44 years at Q1b X6 to be aged 45-64 years at Q1b X3 to be aged 65+ years at Q1b

Session 3 (Glasgow): X4 to be aged 16-29 years at Q1b X5 to be aged 30-44 years at Q1b X4 to be aged 45-64 years at Q1b X3 to be aged 65+ years at Q1b

Session 4 (Edinburgh):

X2 to be aged 16-25 years at Q1b X8 to be aged 25-44 years at Q1b X4 to be aged 45-64 years at Q1b X2 to be aged 65+ years at Q1b

Session 5 (Stirling):

X6 to be aged 16-25 years at Q1b X6 to be aged 25-44 years at Q1b X2 to be aged 45-64 years at Q1b X2 to be aged 65+ years at Q1b

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Q1c Are you at present (code all that apply): Married 1 Single 2 Divorced 3 Widowed 4 Separated 5 Cohabiting 6 Living with parents 7 Sharing with friends 8 Living alone 9 Q1d Do you have children or are you expecting your first child? Yes, I have children 1 Complete grid below Yes, expecting first child 2 N/A No 3 Continue to Q1e Respondent’s children:

Gender Age

Living at Home

Away from home

In each session:

At least x3 to have children living at home at Q1d Recruiter note: Where possible respondent social grade to be based on respondent’s occupation (see instructions at Q1f – Q1h below for details) Q1e Respondent working status:

Working full time 1 Ask Q1f (30+ Hours per week) Working part time 2 Ask Q1f

(6-29 Hours per week)

Working less than 6 hours 3 Ask Q1g Caring full time for family 4 Ask Q1g (not working elsewhere) Education (GCSE or pre-GCSE) 5 Ask Q1g Education (A-level or equivalent) 6 Ask Q1g Education (Degree or equivalent) 7 Qualify as C1 SEG – Go to Q2 Education (Post-graduate) 8 Qualify as C1 SEG – Go to Q2

Unemployed 5 Ask Q1h Off work with long term illness 6 Ask Q1h Retired 7 Ask Q1h

If respondent is working full/ part time (codes 1 or 2) - ask Q1f

If respondent codes 3 – 6 ask Q1g (i.e. ask occupation of head of household to

ascertain SEG)

If respondent codes 5 – 7 ask Q1h (i.e. ask them what their previous occupation was to ascertain SEG)

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Ask to respondents currently working only: Q1f Occupation of respondent:

________________________________________________________

________________________________________________________ Qualifications: ____________________________________________

Number in Charge of: _____________SOCIAL GRADE: ____________

See Q1h instructions for Social grade quotas

Ask to those working less than 6 hours a week, caring full time for family or in GCSE/A-Level/education equivalent only: Q1g Occupation of Chief Income Earner (Probe fully):

________________________________________________________

________________________________________________________ Qualifications: ____________________________________________

Number in Charge of: _____________SOCIAL GRADE: ____________

See Q1h instructions for Social grade quotas

Ask to respondents who are unemployed, non-working due to long term illness or retired only: Q1h Occupation of respondent:

________________________________________________________

________________________________________________________ Qualifications: ____________________________________________

Number in Charge of: _____________SOCIAL GRADE: ____________

Session 1 (Galashiels): X3 to be AB’s at Q1h

X7 to be C1C2’s at Q1h X6 to be DE’s at Q1h

Session 2 (Lochinver): X2 to be AB’s at Q1h

X9 to be C1C2’s at Q1h X5 to be DE’s at Q1h

Session 3 (Glasgow): X2 to be AB’s at Q1h

X3 to be C1C2’s at Q1h X5 to be DE’s at Q1h

PLUS X2 to be unemployed (SEG to be

ascertained from previous job) at Q1h

X4 to be students (C1’s) at Q1h

Session 4 (Edinburgh): X11 to be AB’s at Q1h X3 to be C1C2’s at Q1h X2 to be DE’s at Q1h

Session 5 (Stirling): X3 to be AB’s at Q1h

X7 to be C1C2’s at Q1h X6 to be DE’s at Q1h

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Q2a Can I just check where you are permanently a resident:

Galashiels town centre 1 Continue Session 1 Outside of Galashiels town centre X Close

Lochinver/Assynt 3 Continue Session 2 Outside of Lochinver/ Assynt X Close

Maryhill (Glasgow) 5 Continue Session 3 Outside of Maryhill X Close

Stockbridge (Edinburgh) 7 Continue Session 4 Outside of Stockbridge X Close

Stirling town centre 9 Continue Session 5 Outside of Stirling town centre X Close

Session 1 (Galashiels):

All to live in Galashiels town centre at Q2a

Session 2 (Lochinver): All to live in Lochinver/ Assynt at Q2a

Session 3 (Glasgow):

All to live in Maryhill at Q2a

Session 4 (Edinburgh): All to live in Stockbridge at Q2a

Session 5 (Stirling):

All to live in Stirling town centre at Q2a Q2b And can you tell me which of the following best describes your current living arrangements?

Ask sessions 1, 2, 4 & 5 only: Owner/family member of the owner of the property you live in 1 Living in Social housing 2 Tenant in private rented accommodation 3 Other (write in): ________________________ 4

Ask session 3 (Glasgow) only: Owner/family member of the owner of the property you live in 5 Living in Glasgow Housing Association housing 6 Living in other social housing other than Glasgow Housing Association 7

housing Tenant in private rented accommodation 8 Other (write in): ________________________ 9

Session 1 (Galashiels): X9 to be the owner or family member of the owner at Q2b

X4 to be living in social housing at Q2b X3 to be living in private rented accommodation at Q2b

Session 2 (Lochinver):

X7 to be the owner or family member of the owner at Q2b X7 to be living in social housing at Q2b

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X2 to be living in private rented accommodation at Q2b

Session 3 (Glasgow): X5 to be the owner or family member of the owner at Q2b

X6 to be living in Glasgow Housing Association property at Q2b X4 to be living in social housing not provided by the Glasgow Housing

Association Property at Q2b

X1 to be living in private rented accommodation at Q2b

Session 4 (Edinburgh): X11 to be the owner or family member of the owner at Q2b

X1 to be living in social housing at Q2b X4 to be living in private rented accommodation at Q2b

Session 5 (Stirling):

X7 to be the owner or family member of the owner at Q2b X4 to be living in social housing at Q2b

X5 to be living in private rented accommodation at Q2b

OCCUPATION/INDUSTRY EXCLUSIONS Q3 Thinking about the following occupations, can you tell me if:

a) you currently work in or have worked in the past? b) any member of your family or close friends currently work in?

Read out: a) b) A senior position in government or local council X X An elected position in government or local council X X __________________________________________ None of the above 0 0

If yes to any responses above the line, close interview

All to code None of the above at Q3a and Q3b Q3c Do you intend to work in any of those occupations in the next 6 months? Yes X Close No 2 Continue

PREVIOUS ATTENDANCE Q4 Have you ever participated in any research on behalf of the Scottish Council Foundation in the past? Yes 1 No 2

No quota – it is however important we know for information purposes however if they have participated in a session for the Scottish Council

Foundation in the past at Q4

INVITE TO PARTICIPATE IF RESPONDENT MEETS ALL QUOTAS

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Method of sending invitation: PLEASE RECORD IN FULL (MAY MULTICODE) Post 1 Email 2 Fax (write in number: ________________________) 3 Other _____________________________________________________

RESPONDENTS DETAILS INTERVIEWERS DECLARATION Title: ______________________________________ First name: _________________________________ Surname: __________________________________ Address: ___________________________________

___________________________________________ Postcode:___________________________________

Telephone Number (Home): ____________________

Telephone Number (Work): _____________________

Telephone Number (Mobile): ____________________ Email Address:_______________________________

This interview was conducted in accordance with the Market Research Code of Conduct. The respondent is not a relative or friend of mine.

Face to Face 1 Telephone 2 Street 3 Door to Door 4

Interviewer’s signature: _________________________ Date: _____________________2006

71

Interviewer Instructions

Pre-check Please inform all respondents that they may be contacted by Criteria for validation purposes.

Respondent data may be retained by Criteria for up to 12 months for validation purposes.

Group numbers Please recruit 16 respondents to attend the session

Durations All sessions will last for 6 hours

Lunch will be provided

Incentives £60.00 per respondent

Information to be recorded on profiles

Name, Age, SEG, housing status, family status

Respondent Information Please inform all respondents that they may be viewed, filmed and recorded for the purpose of

the research

Contact Numbers Please inform all respondents attending that their contact number may be passed on to the

venue for the purpose of contacting them on the day in the event they are delayed

Session Sex Age SEG/Lifestage Household Type Neighbourhood Date/

Location

1 X8 F X8 M

X2: 16-25 X4: 25-44 X4: 45-64 X6: 65+

X3: AB’s X7: C1C2’s X6: DE’s

X9: the owner/ family Member of the owner of

their home X4: living in social housing X3 living in private rented

accommodation

Live in Galashiels town centre

Kings Hotel

Thursday 14th September

2 X8 F X8 M

X2: 16-25 X5: 25-44 X6: 45-64 X3: 65+

X2: AB’s X9: C1C2’s X5: DE’s

X7: the owner/ family Member of the owner of

their home X7: living in social housing X2 living in private rented

accommodation

Lochinver/ Assynt

Lochinver Community Hall

Tuesday 19th September

3 X8 F X8 M

X4: 16-29 X5: 30-44 X4: 45-64 X3: 65+

X2: AB’s X3: C1C2’s X5: DE’s

X2 unemployed

(SEG to be ascertained from

previous job)

X4 students (C1’s)

X5 owner/family member of the owner

X6 living in Glasgow Housing Association

property X4 living in social housing

not provided by the Glasgow Housing

Association X1 living in private rented

accommodation

Live in Maryhill (Glasgow)

Kelvin Conference

Centre

Wednesday 20th September

4 X8 F X8 M

X2: 16-25 X8: 25-44 X4: 45-64 X2: 65+

X11: AB’s X3: C1C2’s X2: DE’s

X11: owner/family member of the owner of

their home X1: living in social housing

X4: living in private Rented accommodation

All live in Stockbridge (Edinburgh)

Eglinton Offices

Friday 22nd September

E X8 F X8 M

X6: 16-25 X6: 25-44 X2: 45-64 X2: 65+

X3: AB’s X7: C1C2’s X6: DE’s

X7: owner/family member Of the owner of their

home X4: living in social housing

X5: living in private Rented accommodation

Live in Stirling town centre

Terraces Hotel

Tuesday 26th September

72

C2: Pre- and Post-Event Questionnaires

INTRODUCTORY QUESTIONNAIRE

• Your responses will be treated in confidence. • Please tick the boxes clearly to indicate your answer for each question. • Please answer as many questions as you can - but leave blank any you

cannot answer. Q1. How important were each of the following considerations when you decided to take part in the group? Please tick one answer in each row. Very

important Fairly important

Neither Not very important

Not at all important

Don’t Know

I am interested in the idea of involving the public more

It is a good way of getting my views heard

I am being paid for my time

I am interested in taking part in new research

I am curious to know what happens at events like this

Other (please provide details)

Q2. How do you feel about taking part in the group? Please tick as many answers as you like. Interested [ ] Nervous [ ] Looking forward to it [ ] An easy way to earn some money [ ] Not sure what we were going to do [ ] Excited [ ] It will probably be boring [ ] An important thing to be involved in [ ] Hopeful that it will make a difference [ ] None of these [ ] Other (please provide details)

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Q3. To what extent do you agree/ disagree with these descriptions of your community? (please tick one answer in each row)

Strongly agree

Agree Neither agree nor disagree

Disagree Strongly disagree

Don't know

A good place to live

A good place to bring up children

A good place to grow old in

A clean environment

A safe and secure place

High standards in public services

Jobs for all who want to work

Confident for the future

Q4. Do you think that your local council:

Strongly agree

Agree Neither agree nor disagree

Disagree Strongly disagree

Don't know

Provides high quality services

Does the best with the money available

Tackles key issues affecting quality of life in your neighbourhood

Q5. How do you think standards in the following have changed in recent years? (Please tick one answer in each row)

Improved Stayed the same

Fallen Don’t know

General standard of living Quality of the education service Health service provision Public transport Strength of the local economy Road maintenance Local policing

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Q6a. How would you describe your/ your family’s use of these public services in your area? (Please tick one answer in each row)

Regular users

Irregular users

Rare users

Non- users

Don’t know

Housing Service

Leisure Services (e.g. library, swimming, community halls)

Maintenance Services (e.g. street cleaning, lighting, rubbish)

Social Work services

Education services

Planning and environmental services

Local GP services

Local health services

Emergency services (fire, police, ambulance)

Local public transport

Q6b. How satisfied are you with these public services in your area? (Please tick one answer in each row)

Very satisfied

Satisfied Neither Not very satisfied

Not at all satisfied

Don’t know

Housing Service

Leisure Service (e.g. library, swimming, community halls)

Maintenance Services (e.g. street cleaning, lighting, rubbish)

Social Work services

Education Services

Planning and Environmental services

Local GP services

Local hospital service

Emergency services (fire, police, ambulance)

Local public transport

75

Q6c. If you had a concern or complaint with these public services in your area how confident would you be in receiving a satisfactory response? (Please tick one answer in each row)

Very confident

Confident Neither Not very confident

Not at all confident

Don’t know

Housing Service

Leisure Service (e.g. library, swimming, community halls)

Maintenance Services (e.g. street cleaning, lighting, rubbish)

Social Work services

Education Services

Planning and Environmental services

Local GP services

Local hospital service

Emergency services (fire, police, ambulance)

Local public transport

Q7a. Have you heard about Community Planning?

Yes No Don’t know Q7b. How much would you say you know about community planning?

Q7c. Have you ever been involved in the community planning process?

Yes No Don’t know Q7d. Do you know anyone who has been involved in the community planning process?

Yes No Don’t know

A great deal A fair amount Not much Not at all Don’t know

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Q8. What level of importance would you give to the following as ways of public service providers informing / involving the public? (Please tick one answer in each row) Very

importantImportant Neither Not very

important Not at all important

Don’t know

Providing information about policies and services

Asking for people’s views and opinions before policies are decided

Asking for people’s views and opinions when reviewing policy decisions

Involving people directly in the decision making process

Reacting to issues raised by the public

Are you: Male [ ] Female [ ] Age: 18-24 24-44 45-64 65+

Thank you for completing this questionnaire.

77

POST DISCUSSION QUESTIONNAIRE

• Your responses will be treated in confidence. • Please tick the boxes clearly to indicate your answer for each question. • Please answer as many questions as you can - but leave blank any you

cannot answer. Q1. Did you find the discussion? (Please tick as many answers as you like) Interesting [ ] Too complicated [ ] Enjoyable [ ] An easy way to earn some money [ ] Informative [ ] Boring [ ] Thought Provoking [ ] Pointless [ ] An important thing to be involved in [ ] None of these [ ] Other (please provide details)

Q2a. Do you feel that you had a chance to be involved in the discussion in the main group?

Yes No Don’t know Q2b. Do you feel that you had a chance to be involved in the discussion in the small group?

Yes No Don’t know Q3. What kind of influence have the things you’ve heard today had on how you think about public service provision?

A great deal A fair amount Not much None at all

Don’t know

78

Q4. Do you think that your local council: (please tick one answer in each row)

Strongly agree

Agree Neither agree nordisagree

Disagree Strongly disagree

Don't know

Provides high quality services

Does the best with the money available

Tackles key issues affecting quality of life in your neighbourhood

Q5. How satisfied are you with these public services in your area? (Please tick one answer in each row)

Very satisfied

Satisfied Neither Not very satisfied

Not at all satisfied

Don’t know

Housing Service

Leisure Service (e.g. library, swimming, community halls)

Maintenance Services (e.g. street cleaning, lighting, rubbish)

Social Work services

Education Services

Planning and Environmental services

Local GP services

Local hospital service

Emergency services (fire, police, ambulance)

Local public transport

Q6. How would you feel about some public services being delivered by:

Very comfortable

Comfortable Neither concerned/ nor comfortable

Concerned Very concerned

Depends Don’t Know

Voluntary sector

Private

79

Q7a. Do you feel you know more about community planning?

Yes No Don’t know Q7b. How much of a difference do you think community planning might make?

Q7c. Would you like to become more involved in your Community Planning process?

Yes No Don’t know Q8. What level of importance would you give to the following as ways of providers informing / involving the public? (Please tick one answer in each row)

Very important

Important Neither Not very important

Not at all important

Don’t know

Providing information about policies and services

Asking for people’s views and opinions before policies are decided

Asking for people’s views and opinions when reviewing policy decisions

Involving people directly in the decision making processes

Reacting to issues raised by the public

A great deal

A fair amount Not much Not at all Don’t know

80

Q9. How likely do you think it is that any of the following would happen in your area if there was more public involvement? (Please Tick one answer in each row)

Very likely

Likely Neither Unlikely Very unlikely

Don't know

Public services will make better decisions

Services will be provided in different ways

Services will focus on people’s needs

Individuals and communities will have more power over public services

People will feel more ownership of public services

Public services will be better

People will know more about how public services work

Are you: Male [ ] Female [ ] Age 18-24 24-44 45-64 65+ Any other comments:

Thank you for your participation in the research

81

C3: Focus Group Discussion Guide

Focus Group Programme

10:00 Arrival 10:15 Introductions to the research and each other 10:30 Session one:

Working in plenary to explore participants’ sense of the changes in public service provision in their areas in recent years.

Questions: What has got better? What has got worse? What has stayed the same? What do they think is distinctive about public services and how do they differ from market based provision? Work through what has been discussed and identify with participants their top priorities for deeper discussion.

11:10 Break 11:20 Session one continues:

Small group discussion on why these priority trends might have changed.

Questions: How do they know (personal experience, friend or family experiences, through the media, in the ether)? How they think public services might be more effective? Who should be responsible for taking things forward? How people can influence what happens?

11:50 Feedback and plenary discussion 12:10 Highlights from pre-event questionnaire and discuss 12:30 Lunch 13:15 Session two:

Introduction to the vignettes and small group discussion. Envisage that there are four vignettes and each small group focuses on two of these covering:

Questions Why the person/ community are in this position? What might be done to address it? What public services need to be involved in delivery? Who should be involved in developing solutions? What are the key factors that might make a difference, e.g. information/ communication, local availability / transport? What kind of timescale is acceptable/ necessary?

13:55 Feedback and plenary discussion 14:15 Break

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14:25 Session three: In plenary discuss a vision for public services, followed by small group work focused on their priorities.

Questions: What are the key qualities that participants feel matter most? How do they link together? Do any conflict with other priorities? What priorities for reform would they set? How might these be taken forward locally? How should responsibility for these be shared? How will we know/ assess what is effective?

15:10 Feedback and plenary discussion 15:50 Complete post event questionnaire and pay participants 16:00 CLOSE

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C4: Full Vignettes Vignette on diagnosis of illness for person with special needs (Maureen) Maureen is in her early 20s and lives with her parents. She went to schools for pupils with special needs. She had been experiencing severe headaches and loss of balance, so her doctor referred her to the Outpatients’ department at the local hospital. She asked her Mum to go with her to the appointment. On arriving at the hospital, the receptionist spoke only to Maureen’s Mum to ask for Maureen’s personal details. When they saw the consultant, he also spoke to her mother rather than to Maureen. After three attempts to diagnose the problem, her condition was identified correctly as a brain tumour and she underwent a course of chemotherapy. It was successful and she made a full recovery. Vignette on possible dementia and sheltered housing (Maggie) Maggie is 80 years old and lives in sheltered accommodation. Recently, the resident warden service in her building was replaced by a visiting warden service (with twice-daily checks). After a few weeks, Maggie became increasingly confused and had almost stopped going out of her flat. Residents were concerned because she had also started to wander at night. They were worried, as well, that she was not eating properly and appeared to have lost weight. When they raised concerns with the visiting wardens, they were told that Maggie seemed fine, had never complained of feeling unwell or confused, and was always up and moving about when the wardens visited. Vignette on small business start-up (Jamie) Jamie is 23 years old and wants to set up his own car repair business. He has the skills and a lot of useful contacts, so he thinks this could be a viable business. He lives at home with his parents in their council house, so isn’t worried about the cost of living while he gets his business up and running. But he has only £500 saved towards getting his business started. None of his family members has any experience of being self-employed. He is keen to make the right decisions, but isn’t sure what he needs to know, and where he can best find out what he should do to ensure his business will be successful. He wants to be able to reply upon a steady income. He is keen to make sure that he builds up the business, but also knows he needs to plan for the future.

ISBN 978 0 7559 1506 4 (web only publication)