Choice is at the top of the current public policy debate. Nobody could imagine a Blair speech on public service reform without a serious plug for choice. Even the Conservatives and the Lib Dems have picked up on the agenda, with proposals for pupil passports and the like being put forward.
However, contrary to what many think, choice is not all about schools and the agonies of parents in London. Nor is it, as some fear, a code word for privatisation and the break-up of the welfare state. A lot of it is just treating users of public services with respect, as though they really are unique individuals, and about placing them at the heart of public service delivery.
In this context, the New Local Government Network recently published its Making Choices report, the result of a year-long research project that focused on choice in local public services and drew its case-study material largely from examples of choice models used in local government. We regard choice as an important part of a public service reform agenda that tries to make services more responsive to users’ needs and ensures that services evolve in line with public choices rather than professional or producer preferences.
Some exciting examples now exist where the introduction of choice has massively raised service standards, improved user satisfaction and placed the user back at the heart of the service – what modernisation really is about, after all. Direct payments have brought a significant transformation to the lives of many disabled people. Choice-based lettings have given social housing tenants a say over their home allocation. Changes in marriage legislation have widened the choice of venue to include stately homes and the London Eye. Recipients of meals on wheels can choose from frozen and ready-cooked meals. Some patients who have waited six months for an operation are able to choose their hospital and so on.
All of these are examples where users have been empowered and given an option and not just been prescribed the way the local authority or government department thinks a service ought to be delivered. But is choice all good?
There are fears that choice could benefit the most articulate and informed – ie the middle classes. However, the middle classes have always had choices and could, if they choose, opt out of the public services altogether. An increase of choice to all users would mean that groups that previously had no options would now also benefit. We nevertheless disagree with the common view that choice is a good in itself and should be implemented in all service areas at all costs. We have to ensure, through careful planning and implementation, that negative effects on equity and service standards are avoided, that all users benefit from greater choice and that sufficient information is available to them.
The major fixation for many when debating choice is the issue about contestability and privatisation. But choice is not only about diverse providers (which may or may not include the private sector). Choice can also be delivered by one provider (public or private) offering a range of options that again place the user at the heart of the service, choosing the ways a service is delivered – including different channels to access a service.
Another weakness of the current argument is that it focuses largely on individual user choice. However, we feel that collective choice by groups of users is also worthy of consideration and might combat some of the fears regarding equity. There are some services, particularly those dealing with public space or requiring considerable strategic co-ordination, where individual choice is not suitable or possible and where a collective is better placed to decide how a service is run.
The NLGN study has found that offering choice to users is no simple matter. Major shifts are required in working practices and new infrastructures have to be established to monitor and administer the operation of service provision based on user choice. The enhancement of choice has the potential to have both a positive and a negative impact on equity, service standards and the working conditions of public service workers. Its impact relies heavily on the conditions under which choice is implemented. No ‘one-size-fits-all’ model of choice exists. Indeed, enhancing choice should be far more about flexibility and open-mindedness in response to the particularities of each service and the demands of its users.
Most importantly, choice can be a powerful tool for users to address problems they might experience with the delivery of their public services and users are best placed to identify these problems and to demand greater choice. One of the most successful choice schemes to date is direct payments for community care. This scheme entirely originated in the desire of the disabled users of local services and their representative organisations to give them greater freedom and independence over the way they were being cared for. In this case, choice has been a life-changing experience and brought many benefits otherwise unavailable to some of the most vulnerable groups of users.
l Making Choices: how can choice improve local public services is available
to readers of Progress, price £20 (plus £1.25 p&p) from [email protected] or 020 7357 0152. Reference: NLGN/ProgressiveChoice01