Calls for care services to be decentralised

PUBLIC HEALTH and care services should devolve greater power to local providers to improve quality, according to the National Economic and Social Council.

The council says it has had concerns about quality, standards and accountability in human services for some time, and yesterday published the first in a series of reports on public services.

“Allied to NESC’s concerns is the existence of public anxiety about the failure of regulation and standards in both financial and human services, along with a demand for higher standards and better service provision.”

The overall aim of the reports is to look at how regulation and standards can best contribute to improving quality of human services, including in disability care, elderly care, end-of-life care, schools and policing.

The authors say there is “much more” to regulating effectively than rules and compliance. There is an increasing focus on the needs of the service user as distinct from the needs of the provider, with more consultation.

“The evidence reviewed in the report suggests a fruitful approach to quality improvement is to set a small number of guiding principles ‘at the centre’ and devolve their application to the local context.” The approach requires a support and oversight role for the centre, giving local providers the opportunity to be flexible and to improve quality.

“In the current economic climate this is proving challenging, where there can be a conflict between delegating authority and the desire to control resources more directly from the centre,” the authors note.

The report calls for learning from local experimentation, greater connection between bodies concerned with standards and the ongoing improvement of quality by increments.