New Challenges for public services social dialogue: Integrating
service users and workforce involvement to support the
adaptation of social dialogue
King’s College London - February 6th 2014
The Italian Case
Lorenzo Bordogna and Stefano Neri
University of Milano
With financial support
from the European Union
VP/2013/0362
Background
• The involvement of service users and (especially) local
communities was an important issue in the 1970s
• Purpose: promoting more participation and democracy
within the organisations providing public services
 Education (1974): introduction of «collegial bodies» at
national, local and school level, including users’
representatives (parents and students; consultative and
deliberative bodies)
 Health care (1978): municipalities in charge of promoting
local community participation, mainly through the
appointment of municipal representatives within the
healthcare organisations management bodies
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Background
• 1980-1990s: failure of the 1970s policies
Abolition (health) or substantial decline (education) of previous
institutional mechanims to promote participation and involvement
of local communities and service users
•
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1990s: New Managerialism (NPM-inspired)
Users considered as customers
Importance of consumer choice (healthcare)
Little attention for user involvement in the governance of public
service organisations
• From late 1990s: very slow development of new forms of direct
and indirect user involvement
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User Involvement in Education
• 1999: reform of «collegial bodies» at national, regional, province
and single-school level
• But failure: very limited participation and functions (mostly
consultative), except for kindergartens (schools for 3-6 year-old
children)
• «Social management» in the kindergartens:
 Mainly in municipal and in third-sector kindergartens (35-40% of 36 year-old children, 60% are state kindergartens)
 Built on 1970s institutional legacy
 Within each kindergarten, management councils including staff and
parents elected representatives
 Relevant and increasing functions in resource management
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User Involvement in Health Care
• Italian NHS highly decentralised (Regions have wide decisional
power in the healhcare sector)
• Committees and commissions, including users representatives, at
regional and, mainly, at Local Health Authority and Hospital Trust
level (single-employer level)
They are
 Mainly advisory bodies (but also with some decision power),
involved in service planning
 Users representative selected among patient association members,
appointed by managers of the public healthcare organisations
 Committees organised on specific medical disciplines (oncology,
diabetes, chronical pathologies)
• High level of regional and local differences
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Which answers to specific questions in E3?
• So far, these forms of direct user involvement seem to be separate
from social dialogue institutions
• In both sectors they do not directly deal with typical issues of
social dialogue (e.g. pay and working conditions)
• These forms do not affect which actors are represented within
systems of social dialogue (question «a»)
However:
• Committees and councils involving users have an increasing
influence on service planning
• Patients’ associations and parents have also an increasing role in
service providing and in resource management (linked to the
austerity measures in the financial crisis)
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Which answers to specific questions in E3?
• This trend could indirectly affect social dialogue and its
institutions:
 Possible implications for traditional representative voice (question
«b») as well as for the scope of social dialogue (question «c»)
 Emerging conflicts between the concerns of service users and the
interests of social partners (question «c»)
E.g.: the working time, the pressure for service personalisation by
the users
• The consequences for the social partners and workplace practice
of these ongoing changes could be significant in the long term,
especially in the education sector, where users involvement looks
stronger (question «d»)
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