1. 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 VP/2013/0362 With financial support from the European Union

2. L. Bordogna - S. Neri2 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

3. L. Bordogna - S. Neri3 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 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

4. L. Bordogna - S. Neri4 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 3- 6 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

5. L. Bordogna - S. Neri5 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

6. L. Bordogna - S. Neri6 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)

7. L. Bordogna - S. Neri7 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»)