Quality Systems in the Public Sector A Study of Quality Initiatives in the NHS Scotland

The disintegration of some service provisions covered by the public sector is the cause of concern. In some cases where services, earlier provided by public sector organizations, were privatized led to the dramatic change in the quality and cost of service. This makes a study of concepts of quality management in the context of the public sector necessary to understand the reasons behind the ‘market failure’ of public sector service providers.The problems that assail these services are inherent in any government enterprise such as lack of coordination, slow decision making, inflexibility, lack of incentive to perform and so on. Consider the following observation of Joseph Stiglitz (1998).Making government processes more open, transparent, and democratic and more participation and effort at consensus-building are likely to result in not only in a process that is fairer but one with outcomes that are more likely to be in accord with the general interests.The administration introduced a strict financial regime that introduced cash limits, cash planning, competitive tendering and privatization. Underpinning these and subsequent initiatives was a market forces philosophy that emphasized the need for value for money and the specification of service standards (Glynn amp. Perkins, 1997). The Citizen’s1 and Patient’s2 Charters underscored this philosophy with their consumer-oriented focus which used bureaucratic solutions to address some inefficiencies. for example, the lateness of trains, poor appointment systems, and inefficient communication (ibid). However, in practice, there have only been partial improvements that could have been achieved even without the much-trumpeted quality campaigns. The market also creates new problems and a number of crises and scandals seem to be addressed at the political level by pleas to utilize resources more effectively. These pleas mean that more and more the focus is turning back to central planning in the provision of care and further away from so-called market mechanisms.