This report from the Audit Commission reveals that a recent poll of local government services found that the public want more responsive public sector services and they want to see more choice of provider and of services as a way of getting them. They also want high universal standards, not a postcode lottery. But there is a debate about whether greater choice is the right approach to improving public services. The two sides have taken entrenched positions with little movement into the no man’s land between them. The poll also clearly demonstrated that there was no enthusiasm for paying more for choice through higher taxes. More is being invested in public services, so the issue is how can greater choice be introduced in a way which gives good value for money and, arguably, better value for money than other ways of seeking improvement.The challenges are to ensure that greater choice is matched with greater fairness; to remove practical barriers, such as those preventing greater use of direct payments for people receiving social care, and to manage the limitations of choice in producing more responsive services.
Tameside Metropolitan Borough Council has become the first local authority in England to sign an ambitious agreement that could be worth more than six million pounds for local services if it achieves certain performance targets.The deal is the first to be reached under the second generation of the Local Public Service Agreement scheme launched by the government at the end of last year. The idea is to give councils more leeway to set targets based on their priorities for improvement locally, rather than having national goals set by central government. Authorities that meet the performance targets earn a reward grant equivalent to two and a half per cent of the authority’s budget for one year.
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The National Health Service is being warned today to be cautious in introducing new ‘case management’ initiatives in helping older people with long-term health conditions stay out of hospital. The advice comes in a report from the King’s Fund, which says evidence on the effectiveness of such measures is weak.The report studies the evidence behind government moves to get all Primary Care Trusts in England to establish case management programmes by 2008. Case management, it explains, involves providing tailored-care to those people seen to be at most at risk of hospital admission. It is an important weapon in efforts to cut emergency hospital bed days by five per cent from next year. Ministers favour a nurse-led case management approach and one such scheme is already being piloted in nine primary care trusts. Three thousand community matrons will be recruited to extend this work across the country.
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