Reform Scotland

Reshaping Scotland’s public services – David Welsh

Scotland’s local public services, especially in a post-COVID (era face significant challenges – the sectors may even be unsustainable in the current form – exacerbated here by more entrenched demographic, economic and policy challenges. Culturally and financially, there is greater dependence on the public sector in Scotland than in the rest of the UK. As well as employing almost a quarter of its people (compared to under a fifth for the UK), frontline public services are impacted by historically lower economic growth and corresponding levels of unemployment, poverty and poor health. Unsurprisingly, the public sector as a proportion of GDP in Scotland remains high, at over 55%. Our clients in local authorities experience near permanent pressure to reduce budgets.

The tendency has been to conclude that wholesale restructuring of local government might be the answer. Certainly, there’s merit in exploring whether 32 local councils, 31 health & social care partnerships, 14 NHS boards, several national agencies, the planned National Care Service and many other public sector bodies operating regionally and locally are needed for just 5 million people.

But wholesale reorganisation will be a distraction from the main priorities of delivering positive outcomes. In fact, back office functions comprise less than 15% of total costs in our public bodies, so major savings will not deliver cost reductions required to release resources for investment.

Improving outcomes should involve more exploration of what is actually needed (demand) rather than how these are delivered (supply).

WHAT ARE OUR LOCAL PUBLIC SERVICES FOR?
The starting point is that they should help us ‘live well locally’: playing the key role in enabling communities and citizens to drive improvements in wellbeing, promoting inclusive growth and facilitating moves towards a low carbon economy.

While this may require some structural changes, it’s mainly a cultural shift – our public bodies need to cooperate better and intervene earlier; and our communities and citizens need to take more responsibility for service design and delivery where they live and work. By implication this should encourage a lot more local creativity and innovation.

To do that, here are four guiding principles to consider: 

  1. Simplify
  2. Manage demand better, intervene earlier
  3. Collaborate more
  4. Think ‘Place’
  5. Simplify…and ensure that communities know who is actually responsible locally

1. Simplify…and ensure that communities know who is actually responsible locally
Jack McConnell’s opening call notes that it is nearly 30 years since the last big change to our local governance arrangements. But the picture is more complicated than that: Scottish Enterprise was created around the same time, then the parliament at Holyrood in 1999 and Community Planning Partnerships (CPPs); Health & Social Care Partnerships were legislated for in 2012 followed by the creation of Police Scotland and the Scottish Fire & Rescue Service.

It’s a busy terrain, and current arrangements are not in our view really citizen or community focused.

Here’s an example. MainStreet recently worked with one of the NHS Scotland boards, supporting a review into Children’s Services. Mapping in this instance a child with ADHD, we documented likely or possible interactions with multiple statutory agencies: teachers, nurses and mental health professionals in schools directly as well as educational psychology in the local council; five teams within Children & Adolescent Mental Health Services (CAMHS) and other social care professionals (including GPs) in the local Health & Social Care Partnership; several teams and specialists around Community Paediatrics in NHS settings. That’s before commissioned services in the community or voluntary sector, and before consideration of Scottish Government programmes with associated ringfenced funding streams.

It’s confusing, inefficient and unnecessary:  responsibilities and accountabilities are unclear and understandably decision-making is difficult.  It takes time and effort not only for staff to navigate through the system but for already vulnerable children and their families. 

2. Manage demand better and intervene earlier
As Johann Lamont writes: a lot of this is basic stuff. “we have to understand the problems, understand their causes, and work to find solutions”. 

Scotland suffers from some stubborn social and economic problems, many of which drive negative outcomes e.g. drug and alcohol abuse and obesity. Anecdotally, we have heard Scottish Government officials say that 50% of public spending here is negative i.e. short-term spending designed to address social problems.

The majority of our local public sector bodies still lag behind the private sector in fully understanding ‘what’ is required by citizens and communities rather than ‘how’ these might be delivered. A more rigorous understanding of demand in our communities will allow our public bodies to focus better on prevention but also inform efforts to reverse dependency through behaviour change.

But current funding mechanisms and governance arrangements across our public services make these difficult to deal with effectively. However attractive it may be, at a time of significant economic restraint, our public bodies are not incentivised to set aside additional resources towards long-term preventative services. This is despite explicit recommendations for a ‘radical shift towards preventative public spending” advocated by the Christie Commission in 2012.

Public sector bodies locally  – via more robust CPP arrangements – should coordinate and undertake regular demand insight analysis with their citizens and communities to inform shared priorities and effective inter-agency interventions. The Scottish Government, with support of COSLA and others, should support and fund the rapid development of capacity and capability in demand insight across local public services.

3.Collaborate much more…success built on local partners working together
The most effective and efficient local public services are those that are planned, financed, coordinated and delivered locally by all relevant stakeholders. Given requirements to cut costs and improve outcomes, more coordinated collaboration between all of our public bodies – local authorities, health & social care, education and skills, local enterprise, voluntary and community sector groups – can help reduce duplication and harness broader skills and experiences for entrenched societal problems.

Despite the progress made in recent years through the introduction of CPPs, there is much more that can be done. CPPs are still fairly loose arrangements for visioning and planning rather than delivery, facilitated by local authorities and with limited formal financial strength. This does not lend itself to integrated delivery of locally designed solutions. Giving CPPs or equivalents some sizeable budget for delivery of outcomes would facilitate closer working between agencies.

Even in financially difficult times, why can’t the Scottish Government and its partners create something like a Local Public Services Innovation Fund through which CPPs or equivalents could apply for soft loans for long-term preventative programmes that will deliver savings in the medium term?

4. Think ‘places’…rather than services
If we are serious about devolving power more, then we also have to think more about local ‘places’: that is, local geographies that support communities, and provide the context to meet needs through effective, prioritised investment.  

We’ve been involved in several place-based reviews over the past couple of years. These are aligned with the Place Principle, taking the form of short schemes designed to help all partners working locally (public sector bodies from relevant CPPs, local enterprise, community organisations and residents) to take stock of current and planned activity, to collectively consider priorities, and align existing and future plans and resources for maximum benefit for that Place. That is, they allow partners to develop a holistic view of need and ambition locally – and to ensure that changes being made or proposed by the Council or the NHS or HSCP or the College – or whoever – are relevant and that they benefit the people who live and work and invest in places.

These have been meaningful exercises, resulting in locally generated place plans with shared commitment to asset and service developments in these areas. Some of these have been supported by specific government funds.

But more could be done. On these projects, we detected real frustration that funding and reporting structures mitigate against a genuine focus on Place. In one instance we noted that a place-based approach to the development of a new secondary ‘school as community campus’ in a specific rural community could incorporate more health and social care support – with strong local support. And yet, current NHS Scotland processes still maintain biases towards bigger hospital sites.  

As Alison Evison writes, those with an interest in our local public services have been saying the same thing for years. And the Accounts Commission makes similar points in its Local government in Scotland: Overview 2023 report. Among its five themes are ‘flexible finances and resources’, ‘greater collaboration’, and ‘focusing on community needs and inequalities’.

We now need to get moving on it.

David Welsh is a Director at MainStreet, an independent consultancy that works predominately with local public services in Scotland. It focuses on place-based working, health & social care transformation and personalisation.

 

 

 

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