Public Sector Reforms Initiatives - Case Study Example

 Public Sector Reforms Initiatives – Modernising Agenda Introduction Governments have been concerned with reforms in public services in general and public sector in particular for nearly three decades now. These reforms cover the wide areas of delegation of authority, accountability for actions taken / the results thereof, and flexibility of approach. Within this broad spectrum, the initiatives include modernising agenda, customer service excellence, quality of life etc. The objective of the reforms is to enhance the quality and efficiency of functioning of the service departments directly working under the governments such as defence, railways, roads and the underground transport systems, and of the corporations owned substantially by the governments - the public sector corporations. With increased spending outlays on public services, the importance of successfully implementing the reform initiatives has become more obvious. It is desirable and possible to achieve substantial results both in terms of the quality of services rendered and in improving the operational efficiencies by a continuous process of reforming. This paper deals with the modernising agenda of the public sector reforms initiatives with particular emphasis on reforms in healthcare services in UK. Published literature on the experience of the government of UK, Australia and other European countries, and that of professional bodies formed the basis for this paper. Relevant information has been accessed using the Internet and the sources have been duly identified in the body of the text and in the References Section. Public sector reforms 2 Public sector & public services Public sector can be generally identified as government departments or government owned corporations. By one definition, “public sector is that portion of society controlled by national, state or provincial, and local governments…and overlaps with private sector in providing certain goods and services…the extent of overlap varies from country to country…” (Whatis?com, 2008). According to another, “…in most countries the public sector includes such services as the police, military, public roads, public transit, primary education and healthcare for the poor…” (Investorwords, 2008). Cowper identifies the public services of the UK as, “…the central government, both civil servants and others in non-departmental public bodies and public corporations, as well as local government, including social services and teachers, the National Health Service, the police and armed forces…” (Cowper, 2008, pp. 4&5). Need for reforms Public sector is considered as providing services irrespective of the profit motive in the larger interests of all sections of the society. In democratically run countries, it is constrained by the policies and dictates of the political party in power at any time. Political parties exercise power in the name of the public who are the real owners of the public sector. Since the public sector is dealing with taxpayers’ money and is subject to intense scrutiny and questioning of all its decisions on the one hand, and deal with political masters on the other, its managers tend to play safe and take the path of least resistance, even though from a good management point of view such a course of action may be incorrect. The result is inordinate delays, inefficiency in the use of resources and Public sector reforms 3 poor quality of service. This has been the general perception of the public as well. Continuously improving living standards and competitive politics ensure that the public sector with all its warts is kept in the limelight, demanding reforms for improvement in the quality of services and functional efficiency. National Health Service (NHS), UK was no exception. History of NHS reforms in brief According to Cowper, the first phase of public services reforms in UK commenced in the early 1980s and ran up to 1997, and the second phase in the later period. While the first phase reforms were about improved competitiveness of the public sector through delegation of responsibility and on performance accountability, the second phase centered on partnership and collaboration among public sector units with a view to deliver superior services to the consumers. As a part of this second phase, reforms of the market-based structure for the NHS have been initiated (Cowper, 2008). Set up in 1948, the core objective of NHS is to provide good and practically free healthcare to all residents of UK. NHS works under the Department of Health and has a structure comprising Strategic Health Authorities, NHS Trusts, Primary Care Trusts, hospitals and GP Practices. The concept and coverage of its activities can be seen in the graphic illustration provided by NHS and shown below. Public sector reforms 4 NHS Structure (Source: NHS.UK) NHS has been a service subject to increasing demands and rising costs since inception. To tackle these issues, various reforms were being put in place from time to time in the functioning of NHS. Goodwin traces the changes, particularly from 1990s through the present times (Goodwin, 2002). ‘Managed competition’ was one such concept to control costs and was introduced during the 90s (Mays et al. cited in Goodwin, 2002). The idea of this concept was to create a publicly managed healthcare market, give freedom of management and to create competition between the local health authorities in healthcare services. The idea found favour with other nations as well since they were also suffering from problems similar to NHS in UK. Goodwin states that this reform was unsuccessful in UK and even in other countries, since the expected savings failed to materialise and the administrative costs of creating and managing the market increased. “The collective ethos of the NHS was seriously undermined and, as a result, a health service developed that was increasingly inequitable in terms of access to care whilst Public sector reforms 5 health inequalities between high and low social classes widened” (Benzeval et al., cited in Goodwin, 2002). Modernising agenda – The idea The advent of Labour Government in 1997 witnessed the end of ‘managed competition’ and birth of ‘modernising agenda’ reform for NHS. Modernising agenda was incorporated in the NHS Plan of 2000. This plan was the outcome of the administrative reforms introduced by the government through Public Service Agreements (PSAs). According to a Cabinet Office note, functioning of all the public services in UK is subject to their respective PSAs. They define the relationship between the government and its departments. Introduced in 1998, the PSA concept covered three vital areas viz., modernisation, accountability and reforms (Cabinet Office, UK, 1999). PSAs are entered into between the departments and the ministries controlling them. Each PSA identifies aims and objectives, performance target and efficiency / value targets for the concerned departments. It is designed to integrate the overall objectives of the government and the department, in the context of improved services to the public and co-operation at the international level for sustainable economic growth. Towards this end, SMART (specific, measurable, achievable, relevant and timed) targets are agreed upon and monitored. Finally since the services are to be rendered within the available resource, specific targets identifying value-for-money are set along with mechanism for measuring the output against targets. NHS Plan of 2000 Public sector reforms 6 This 10 year plan identified five key areas for implementation viz., investments through greater public funding, ensuring quality standards, improving access to care services, promoting inter-professional working and integrating service provision, and providing a more public health or ‘whole-systems’ approach (Goodwin, 2002). A key feature of this plan is while quality standards are imposed from above, sufficient freedom of action is left to the healthcare providers to innovate and improve services to achieve the set goals. The greater the success, the greater will be the autonomy of actions (Dept. of Health, cited in Goodwin, 2002). Under the investment strategy, quantified areas of improvement in the number of beds, hospitals, equipment of different kind critical to medical care etc. have been spelt out. Correspondingly, the increased human resources in doctors, nurses and other supporting staff have been provided for. These enhanced investments are to be funded by increased taxes. For ensuring improved quality standards that are uniform throughout the system, healthcare is centralised and more intensely managed. In administrative terms, the plan consisted of setting up National Service Frameworks, a National Institute for Clinical Effectiveness, and a Commission for Health Improvement to monitor the delivery of care under a new national performance framework. National Service Frameworks specify the standard of care for specific areas of health needs such as cancer, diabetes, heart diseases etc. and provide indicators for measuring performance. These indicators are in line with the goals set up in NHS Plan Public sector reforms 7 2000 to achieve specific results in a time bound manner (Dept. of Health, cited in Goodwin, 2002). National Institute for Clinical Effectiveness was conceived to promote standarised and cost effective drug prescription throughout NHS (NHS Executive, cited in Goodwin 2002). This institution is part of the efforts to improve quality standards. For the same reason of improving quality standards, the Commission for Health Improvement was also set up. Its function is to assess quality of service of each and every NHS organisation, investigate failures and suggest good practices to NHS (Dept. of Health, cited in Goodwin, 2002). Experience of NHS 2000 According to Goodwin, there are positive and negative aspects to the modernising agenda and its off-shoot, the NHS 2000 plan. On the positive side, it is an ambitious plan, much admired and often referred to in good terms by others such as in the USA, while comparing the status of healthcare delivery in their own countries. It has successfully integrated healthcare and a range of social care providers to create a single network (Dept. of Health, cited in Goodwin, 2002). Criticisms centre around the limited success in providing uniform standards of service across all regions of the country, emphasis being more on providing healthcare than on reducing poverty as a means to improved health standards of citizens. The most serious drawback of the plan is the failure of service integration and professional team working, says Walsh et al. (Walsh et al. cited in Goodwin, 2002). Public sector reforms 8 The drawbacks experienced in the past 7 to 8 years in implementing the modernising agenda having been identified, it is possible to take the agenda forward to overcome the same. Conclusion The traditional notion of a public sector being inefficient and non-accountable has no place in the modern times. Certain services have to be necessarily provided by the public sector in view of either they being not attractive for businesses or for reasons of achieving social equity irrespective of the ability of the consumers to afford. Healthcare is one of the most vital areas of public services and is expensive and is therefore under public sector domain in many countries, either fully as in UK or partially as in the USA. Rising demands and rising costs of healthcare make it imperative that governments act to reform this service to provide good quality service at affordable costs. The experience of NHS in UK since its inception and through successive reforms, culminating in the modernising agenda of the current times, gives hope in many areas and identifies further areas for future reforms. Public sector reforms 9 References Benzeval M, Judge K, Whitehead M., Editors (1995). Tackling inequalities in health: an agenda for action. London, King's Fund. Cowper J.E. (2008). World Bank Report 2008, Retrieved: December 5, 2008, from: http://www1.worldbank.org/publicsector/civilservice/rsUK.pdf Department of Health. Modernising health and social services. National priorities guidance 2000/2001–2002/2003. London: Department of Health; 2000. Goodwin, N. (2002). Creating an integrated public sector? Labour's plans for the modernisation of the English healthcare system, International Journal of Integrated Care. Retrieved: December 5, 2008, from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1480391 Cabinet office (1999). Guide to the centre of government - Part III: The modernisation agenda. Retrieved: December 5, 2008, from: http://www.archive.cabinetoffice.gov.uk/roleofcentre/modagenda.htm Investorword, Public sector, Retrieved: Retrieved: December 3, 2008, from: http://www.investorwords.com/3947/public_sector.html NHS Modernisation agenda. Retrieved: December 4, 2008, from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008323 NHS UK, NHS Structure (2008). Retrieved: December 5, 2008, from: http://www.nhs.uk Walsh, N, et al. (2002). PMS pilots: final report of a national evaluation. Health Services Management Centre, University of Birmingham. Whatis?com &Tech Target, (2008). Public sector, Retrieved: December 3, 2008, from: http://whatis.techtarget.com/definition/0,,sid9_gci1154572,00.html Read More