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Public Services are not working – so why don’t we care? – The Times

Geoff Mawdsley
The Times, 14 April 2008

While the future of the constitution continues to dominate politics this side of the Border, we must be careful that the debate does not overshadow other vital issues that Scotland needs to confront – and confront urgently.

The questions of whether there should be a referendum on independence or whether further powers should be devolved to the Scottish Parliament are, of course, hugely important. But we should also remember that the constitutional question has been a major bone of contention since the 1970s.

The danger is that the current debate will obscure other matters which are equally important, not just to the political class, but to everyone in Scotland.

Reform Scotland’s first report ‘Powers for Growth’ dealt with one of these issues – how we could increase our growth rate to the levels of the most successful economies in the world. It recognised that, while important in its own right, this was also relevant to the ongoing constitutional debate because we need to be clear about what we wish to do with any additional powers. Our conclusion was that further powers would be helpful if used to create an environment conducive to growth with a reduced tax burden and lower public spending as a share of GDP.

Hand in hand with that goes another huge challenge facing Scotland – how to improve our public services, in particular health, education and policing. This is the subject of Reform Scotland’s second report ‘Power for the Public’, which is published today. It starts by assessing objectively how our main public services are performing. Like the economy, not everything is doom and gloom. There have been positive developments, particularly in health and education. For example, waiting lists have fallen, mortality rates for major diseases have improved and attainment in our schools has increased. Yet, we have to consider these improvements alongside the enormous sums of money invested in these services over the last decade – increases of 55%, 87% and 44% on health, education and justice respectively.

Bearing this in mind, and when compared to other European countries such as the Netherlands, Denmark and Switzerland, the performance of our major public services starts to look less impressive. In our health service, patients still have to endure lengthy waits for treatment while waiting lists are negligible in many European countries. In addition, a study by the National Cancer Institute in Milan found five-year survival rates for female cancer sufferers in Scotland to be the poorest of 22 countries.

In education the story is similar. Despite improvements, we are not keeping pace with other countries as shown by various international studies of educational attainment. In relation to crime it is worse, with violent crime rising to the point where it is now higher per head in Glasgow than it is in New York City.

Given the fact that our spending as a percentage of GDP in these areas is on a par with other European countries, the only reasonable conclusion is that we could and should be doing better. The mystery is that although these services have a direct bearing on everyone’s quality of life, debate about them is far less advanced than it is on the economy.

It is high time that we had an open and informed dialogue in Scotland about how to improve our public services, particularly since the Scottish Parliament already has the powers to bring about change in these areas. Our report aims to stimulate this debate by examining the different systems used in other countries to provide health, education and policing and to see what lessons we can learn.

There is no such thing as a perfect system. However, our research did identify some common features of successful systems which should form the principles underpinning public service reform in Scotland.

First, our public services need to be more directly accountable to the people and local communities they serve. In healthcare and education, this means finding ways of empowering patients and parents so that these services develop to suit their needs and wishes. In policing, it requires new methods of ensuring direct, democratic accountability to local communities.

Secondly, operational decisions need to be taken as close as possible to the people they affect, so that those responsible for directly managing and providing the service can respond to the needs and wishes of individuals, families and local communities. This helps management to implement quickly changes that can make the service more effective both in terms of quality and cost.

Thirdly, the provision of public services needs to be diversified with different approaches in different areas as well as a wider range of providers. This greater diversity would extend choice for the users of these services and this process would in turn drive innovation and higher standards as new, better ways of providing services are discovered and implemented.

These principles have enabled other countries to deliver higher standards in their public services, while guaranteeing universal access. We need to look at how we can apply these principles to each of our main public services and this will be the focus of Reform Scotland’s work over the coming months.

If we aspire to match the standards of other countries we have no time to lose because these countries are not standing still.

The debate must start now – it is too important to be crowded out by the argument over our constitutional future.