New Challenges for public services social dialogue: Integrating
service users and workforce involvement to support the
adaptation of social dialogue
Utrecht University School of Governance- June 6th 2014
The Italian Case
Lorenzo Bordogna and Stefano Neri
University of Milano
With financial support
from the European Union
VP/2013/0362
The interviews
14 interviews
1)
•
•
•
•
Education
2 employer representatives (level: 1 regional, 1 school)
3 union representatives (level: 1 national, 1 regional, 1 local)
1 user representative (involved at both regional and school levels)
1 representative of a municipality (a «mediator» between users
and employer)
2)
•
•
•
Health care
1 employer representative (national level)
3 union representatives (level: 2 national, 1 regional)
2 user representatives (involved at both regional and hospital
levels)
• 1 «expert» in the field (a national research institute
representative working in patient involvement projects)
L. Bordogna - S. Neri
2
Service user pressure
1) In both sectors increasing role of the single users
• Choice policy (especially in health care)
• Admistrative and judiciary claims (especially in health care)
Main drivers:
 increasing user awareness of entitlement
 declining doctor and teacher authority
2) Collective forms of participation, legally recognised, are
significant at organisational and local level, weak or very weak
at regional and national level
3) At national level, users association act as pressure groups,
not legally recognised, on specific issues
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3
Actors: who are the users?
1) Education
• Individually: parents and students
• Collectively: parent association
associations
and
committees,
student
2) Health care
• Individually: patients and patient families
• Collectively: patient associations, voluntary organisations providing
health care services (often patient associations) and other
organisations promoting patient and citizen rights in health and
social care
Focus on collective forms of user participation
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4
Collective forms of user involvement
Education
National legal framework (1974; 1999)
1) «Collegial bodies» at single school level («School Councils»)
• Members:
parent
and
student
representatives,
staff
representatives, headmaster
User and staff representatives are directly elected
• Consultative and deliberative functions (e.g. extra-time activities,
supplementary courses)
• Some powers in working time distribution and in resource
management (e.g. supplementary courses)
2) «Territorial bodies» («Province Councils», «School District
Councils»), with user and staff representatives: abolished in 1999 and
not replaced by other representation boards (so far)
3) National user representation boards: never existed
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5
Collective forms of user involvement
Health care
National legal framework (1992), but also very relevant regional
regulation
1) Boards («Joint Consultative Committees», «Participation Units»),
including staff and user representatives, at Local Health Authority or
Hospital Trust level (single-employer level):
• Users representative selected among patient associations and
voluntary sector organisations, appointed by managers of the
public healthcare organisations
• Main functions
 Cooperation in the definition of the quality and service access
standards;
 Control and monitoring of quality and service access standards
However: high level of regional and local differences
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6
Collective forms of user involvement
Health care
2) In some Regions, there is a regional board, («Regional Joint
Consultative Committees», «Regional Participation Units») including
staff and users representatives
• Members appointed by the regional Minister of Health
• Main functions:
 Coordination of the activities and initiatives of the single
organisation committees
 Consultation in Regional policies concerning quality and service
access
However: the Regional level boards are less important and
widespread than the single organisation boards
3) No national boards or other statutory forms of participation
At national level political pressure by patient associations on single
pathology issues
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7
Social dialogue and service user involvement
1) Relevant differences between users role in the two public service
sectors, but quite similar relationship between service user
involvement and social dialogue
2) The forms of user involvement are 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)
• they do not affect which actors are represented within systems of
social dialogue
However: they may have indirect influence on issues of social
dialogue in both sectors. E.g.:
• Demand for supplementary courses may lead to change in the
working time organisation for teachers and other staff in schools
• Waiting times or service standard monitoring may bring about
changes in work organisation, or in the staff number employed in a
service
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8
Social dialogue and service user involvement
2) Public managers (headmasters, hospital chief executives) may be
«intermediaries» between user representatives and unions, in case
user demands may have consequences on pay and working conditions
3) User associations and unions are occasional allies in case of local or
national campaigns (e.g. campaigns against cuts in school funding or
in the NHS fund)
4) Emerging role of the pensioner unions as user associations in health
care
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9
Some critical issues about user representatives
1) Training
2) Selection and representativeness
3) Conflicts among different types of user associations
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