It's a question of choice...
11 March 2013
Choice is increasingly seen as the key to unlocking both greater efficiency and higher levels of citizen satisfaction in public services. But, says Alan Leaman, we must be careful to define exactly what we mean by the word choice
The age of austerity will, we now know, last until at least 2018. Public sector budgets will continue to be reduced throughout this time; no part of public services can expect to be immune. But, despite constrained resources, there is every sign that the public expect to experience continuing improvements in the choice and availability of services.
Efforts to square this circle – the need to meet rising expectations at a time of declining resources – often focus on plans to promote greater choice for citizens.
Tony Blair argued that "choice is too important to be the monopoly of the wealthy", though, arguably, he was able to sweeten his policies for health and education with plenty of cash.
David Cameron has been even more explicit about the centrality of choice to his reform agenda, writing that "I want to bring to everyone the choice and standards that the best provide". The Open Public Services White Paper of 2011 and its follow-up report in 2012 set out his case.
It is clear that our political classes increasingly see the spread of choice as the key to unlocking both greater efficiency and higher levels of citizen satisfaction in public services. The public tell us in polls that they agree.
A new report from the Management Consultancies Association, Choice in Public Services: Making Choice Real, looks at the history of this argument and the prospects for future reform. It is based on discussions with some of the country's leading experts and practitioners in our member firms. We have submitted it to the Cabinet Office's review into barriers to choice which David Boyle will publish early this year.
Two messages stand out from the report. First, we recommend that the government develops and promotes a clearer approach to choice. At the moment, the word itself is being used by different people to mean different things. It is even being used by the same people, in the same document, to describe a wide variety of different approaches, some of which may not really represent a choice at all.
This lack of clarity has confused the debate about public sector reform, hindered policy-making and damaged public understanding.
Our paper suggests concepts such as horizontal and vertical choices. Put simply, a horizontal choice enables the citizen to select their own provider, such as a different GP. A vertical choice asks the citizen to select from different options put forward by a single provider.
These choices are different in their nature and require different responses. The picture is complicated still further by many other initiatives, such as commissioning, and the expression of preferences, that are sometimes, arguably wrongly, also characterised as choice, though they can be clearly related.
These distinctions matter because they frame policy-making and the public's reactions. But they are frequently muddled, risking inappropriate interventions and false expectations.
Second, we propose a series of choice concordats, in which the citizen's rights and obligations are explained far more clearly than at present. At the moment, available choices are too often hidden from view, and the comparative data that we need to make sense of them is not available. On the public's side, there is too little understanding of our own obligations and responsibilities, such as to share accurate information about ourselves.
These concordats are an alternative to more regulation which, paradoxically, is often used to mandate choice. In aggregate, they could also be joined into a public service choices information service, which would help identify best practice, allowing citizens not only to switch providers effectively, but also to help them demand better from their current service.
The experience of many of the consultancies who contributed to our report is that choice can go hand-in-hand with improved efficiency and savings. When offered choices which resonate, the public often saves money for taxpayers. And, as the case studies in the report illustrate, improved public engagement with services which leads to more personalised services can improve not just the quality of services but also their productivity.
Nor does choice have to be exercised for everyone in order for it to be effective. In some contexts, the example set by a minority will influence provision for all.
For 30 years or more, public sector reform has been constrained by over-simplified and polarised ideas, whether about the innate superiority of the private sector or the untouchable principles of public service. The reality is that choice can be at the heart of a more nuanced discourse and that the debate has moved far beyond any simple duality.
This report should be an influential contribution to a vital area of policy and management debate.
Alan Leaman is chief executive of the Management Consultancies Association
This article first appeared in Public Servant magazine