Scotland wants its public bodies to save money by working more closely together and in partnership with the private sector. But can savings really be made this way? US research suggests they can
The Scottish National Party’s Programme for Government sets out 12 key commitments. Midway through these commitments (number 6 in fact) is a specific promise to ‘reform our public services’. A focus on reform is, of course, nothing new. In fact, reform is something of a constant in the rhetoric of successive governments since devolution.
We can go back to 1999 when Donald Dewar, in his first programme for government as first minister, expressed an expectation that innovation would come from public bodies working closer together and in partnership with private bodies. Four first ministers later and closer examination of Alex Salmond’s commitment to reform in 2012 finds a call for ‘greater collaboration and partnership working’.
A further similarity in the commitments from both first ministers is on the quality of public services. Dewar stated that his priority was for high quality public services, while Salmond recognises public service quality as the bedrock of society and future prosperity in Scotland.
Over the years, the drive by ministers to encourage collaboration as well as partnership working has continued, although any encouragement has stopped short of structural reform. More recently the emphasis on collaboration can be traced to the Christie Commission report in 2011.
The commission urged greater collaboration and linked it to a need for service integration as a means to help Scotland navigate the path between increased demand and reduced public resources. Christie specifically claimed evidence that public bodies (and the services delivered) can become more efficient and effective by working collaboratively to achieve outcomes.
So, the desire for collaboration, partnership and quality public services is nothing new. But times and economic conditions have now changed. Can the dual ambition of quality and collaboration be achieved in these harder economic times? Can service quality be maintained while the need for efficiency savings continues? More importantly, is there practical evidence that Scotland’s public bodies can learn from?
There is a US not-for-profit organisation that would in fact claim ‘yes’ as the answer to all three of these questions. The Massachusetts-based Institute for Healthcare Improvement has produced case-study evidence that practical collaboration enables a reduction of expenditure while improving quality. The approach, which has eradication of waste at its heart, focuses upon costs and on quality at the same time, and results in what it claims is a ‘patient-positive relationship’.
The institute says that 1% of operating costs will be removed within 12 months of the collaboration, while a further 1% will be removed in each succeeding year while service quality is improved. Moreover, a collective savings figure of $30m to the state can be demonstrated. Expenditure reductions are quoted in terms of savings per hospital admission.
This is the type of practical evidence that can appear attractive to Scotland’s public service managers who will recognise the essential (and usual) ingredients for yet another efficiency drive – waste, a focus on operating costs and then eventual savings.
But in this Massachusetts example, the seemingly impossible equation (collaboration + service quality = reduced costs), does seem to add up. There is, it seems, at least one good opportunity for our public service leaders to look outwith Scotland’s borders for the practical evidence to collaborate while saving money.
Don Peebles is policy and technical manager at CIPFA in Scotland. Maureen Bisognano, chief executive officer of the Institute for Healthcare Improvement, will be speaking at the CIPFA in Scotland annual conference on 15-16 March
