Public service targets miss the point

For chancellor Gordon Brown, public service agreements are the
tools that guarantee the Treasury’s money is well spent. But
as the latest PSAs were announced, charities questioned whether
they can really help the overall quality of service delivery,
writes Lindsay Clark.

The set of agreements the Treasury launched earlier this week
included targets to “improve the quality of life and
independence of vulnerable older people by supporting them to live
in their own homes where possible.” The number supported at
home should increase by 1% annually in 2007 and 2008. Those
receiving intensive support at home should increase to 34% of the
total being supported at home or in residence, the targets
say.

Although Jim Donovan, spokesperson for older person’s charity
WRVS (formerly Women’s Royal Voluntary Service), said older people
should be supported at home, but this is just one of a number of
factors contributing to quality of life. “The only definition
of improved quality of life is that they are able to live at home.
Older people can have a dire existence at home if they are
immobile, remote from family or have no human contact. Quality of
life is a totally laudable objective but if you speak to older
people about what makes for quality of life it includes contact,
meeting people, doing things that add to their
experience.”

Donovan said there was a danger that councils would not focus on
the quality of home support for older people, instead concentrating
on the number able to live at home to meet the target. “If
we’re talking about high quality supporting with community
transport schemes, shopping schemes and neighbour schemes, then
that’s great, but the only thing that is measured is this 1%
more living at home.”

Mervyn Kohler, head of public affairs with Help the Aged, agreed.
“Those targets do not refer to the real objectives of
rehabilitation, enabling people to live successful lives. This is
only about supporting people in the home. That could be a weakness
of the PSA programme as a whole. It should be a good tool to
improve services, but the problem is if something is not in the
target then it can be neglected.”

Local PSAs, which were introduced in the spending review of 2000
and many of which involve social services, require local
authorities to negotiate with central government on a number of
different targets.

In 2002, the chancellor announced that spending on public services
would increase by £61 billion in the period to 2005-6. But the
money is handed out on condition that local PSA targets are met.
Councils that achieve all 12 targets can earn up to an extra 2.5
per cent of their net budget.

Since their introduction, the government has reduced the number of
PSAs amid criticism that they were creating unnecessary bureaucracy
and distorting service delivery.

Paul Ennals, chief executive of the National Children’s
Bureau, welcomed the new style of targets. “I think it is
right to slim down, we were drowning in targets before. This is an
improvement in the range – retained some central targets, but
with more focus on local educational attainment.”

The new targets said local authorities should lower the gap in
educational achievement between looked after children and their
peers. They also say that by 2008, 80% of children under 16 who
have been looked after for two and a half years or more, will have
been living in the same placement for at least two years, or are
placed for adoption.

If government only measures one factor in improving the lives of
looked after children, then the stability of their environment is
probably the right one, Ennals said.

But while the intentions behind the targets may be laudable, lack
of funding in the wider service makes an overall improvement in
service more difficult to achieve, according to Marjorie Wallace,
Chief Executive of the mental health charity SANE.

The PSAs now say that all those with mental health problems should
have access to crisis services.

“While no-one would argue that we need to improve life
outcomes for people with mental illness, like so many of the
reforms in mental health it is about intention rather than
achievable change, as the aspiration comes with no dedicated
funding,” Wallace said. “While we have overcrowded
acute units and overloaded community teams, improving access to
crisis services will mean little more than a few hours extra in
A&E before being turned back to struggle alone in the
community.”

Clearly while some see PSAs as a useful tool to ensure extra
funding affects change in local services, they have some way to go
before they reflect the balance of support care services users
require.