Assessing Success and Performance within the Public Sector
| Date | 01 September 1998 |
| DOI | https://doi.org/10.1108/13619322199700024 |
| Pages | 8-15 |
| Published date | 01 September 1998 |
| Author | Helen Smith,Bev Frowen |
| Subject Matter | Health & social care |
8The Mental Health Review 2:3 © Pavilion Publishing (Brighton) 1997
Helen Smith, Senior Consultant
CMHSD
Bev Frowen, Regional Director
CMHSD IN WALES
T
he quest for improvements in public sector
performance has been a long one.1The
debate continues, but there is little doubt
that recent initiatives take their origins from the
Thatcherite Financial Management Initiative of
1982 in which the Treasury issued the edict:
‘All managers at all levels of Government departments
should have a clear view of their objectives; and assess,
and wherever possible measure, outputs or performance
in relation to these objectives’.
This response, at its most simplistic, was an attempt
to rein in the growth of the public sector and in
particular, to account for ever-growing expenditure.
More recent central Government initiatives include
the Resource Management Initiative in the early
1990s, Value for Money audits and — with respect
to standards — the NHS Patients’ Charter, Citizens’
Charter and Government league tables.
Organisations develop systems of assessing
performance and quality at varying speeds and
through different pathways, each signalling some-
thing about their inherent culture, philosophy and
business of the organisation.2During the eighties
and nineties, the public sector, particularly the
NHS, saw a phenomenal growth in performance
indicators — or PIs as they became known — pre-
dominately focused on measuring activity and cost,
with very little attention to assessing efficiency and
effectiveness. PIs were designed to be a substitute
for profitability and used as an alternative to the
‘bottom line’ in the private sector; performance mea-
sures in the public sector focused on productivity and
efficiency.1
However, the necessary precondition for a
high quality public service is to know — and have
consensus on — what such a service is, before it is
possible to know whether it is being provided or
how to measure it. This process will crucially have
to incorporate the experiences and views of people
from minority ethnic groups.3Many initiatives fail
because they attempt to control quality without
either a clear sense of what the service is there to
achieve for people, an understanding of the value-
driven nature of quality assurance in the health
and social care field, or proper linking between the
academic literature and actual service development.4
Linked to these points, most organisations have
constructed indicators based on inputs and outputs
but seldom outcomes. In particular, there has been
widespread appeal in using the three ‘Es’: Economy
Efficiency and Effectiveness, concepts promoted by
the National Audit Office and the Audit Commission.
These however, focus heavily on cost whilst ignoring
the issue of quality, vital in health and social care
services. Measuring effectiveness in mental health
services can be fraught with ambiguity and subject
to the value-based beliefs and perceptions of those
involved. The criteria by which effectiveness is
judged will change in response to political and
local circumstances.
T
o effectively measure the many factors that
influence good practice, a multiplicity of ways of
promoting quality must be built into all aspects of
the service system: the purchasing strategy, the
CPA/care management system, the community
care plan and so on. Quality assurance is complex
because when people with mental health problems
live and work in the real world, they live and
work in a complex ‘system’ of community and
Assessing Success and Performance
within the Public Sector
FRAMEWORK FEATURE
To continue reading
Request your trial