Monday, 21 February 2011

Questions for a public services revolution: is Cameron's plan rather "one size fits all"?

David Cameron sets out in the Daily Telegraph his plans for public service reform. The argument is extremely close to that set out by new number 10 policy chief Paul Kirby, in co-authoring a KPMG paper on Payment by Results, which Next Left discussed on Friday night.

This might be a very big moment - the biggest change in the public services since Beveridge we are again told. As usual, the rhetoric seems rather overblown. Cameron says he is ending the "state monopoly in public services".

Eleven privately-run prisons in the UK suggests alternative providers have got quite close to the core functions of the irreducible state for some time. While there are instinctive responses from those who instinctively belief the state is always the worst-possible provider, and those deeply sceptical of the value to be added from private provision, the policy choices as to whether and where this approach could improve public services depend on answering a more complex set of questions.

Which services?

Cameron's argument is that state provision has to be justified. But he has already made up his mind - a "new presumption" - that there are very few cases where state provision should be justified, such as the judiciary and security services.

We will soon publish a White Paper setting out our approach to public service reform. It will put in place principles that will signal the decisive end of the old-fashioned, top-down, take-what-you're-given model of public services.

Perhaps the Prime Minister himself risks falling prey to 'one size fits all' thinking which suggests there is a single Whitehall lever which can transform public services. That would certainly appear to be a legitimate critique of no 10 policy chief Paul Kirby's argument for a "without exception" approach to the urgent introduction of payment-by-results everywhere.

Payment by results should be implemented across the public sector without exception – where it exists already, it should be made more forceful and sophisticated, where it does not exist, it should be introduced with very limited transitional periods.

Kirby's blanket veto on exceptions looks very difficult to sustain, and the exceptions will extend beyond the Prime Minister's list of two. What the government needs to provide are clear criteria of where Payment-by-Results would be appropriate, and where it wouldn't, and the evidence base as to why it would succeed in the areas (almost everywhere, in their view) in the areas proposed.

Which results?

Payment by results depends on fundamentally on knowing what results you want, and these being highly measurable, not "gameable" by practioners, and genuinely contestable by alternative providers.

Most of the academic and practical evidence suggests these are complex issues. Any measure being relied on for measurement is likely to become an unreliable indicator of broader service quality.

There is little difficulty in, for example, in measuring success in the timely provision of passports to those who are entitled to one. Outcomes for heart operations are rather more straightforward than mental health; health prevention is perhaps more complex still. Bus services are rather more straightforwardly contestable than trains, (given sufficient demand); some of the core functions of central banking perhaps rather less so. I imagine that accountants could probable deal with any technical barriers to making fulfilling the functions of the Monarchy contestable between providers - after all, there is a history of global exchange and several potential foreign providers with experience in the field - but may struggle to do so while maintaining public legitimacy. This may provide a more significant "barrier to entry" than some realise.

The Canadian approach of measuring user satisfaction with services goes some way to dealing with measuring the wrong indicators - if you can fake that, you have solved any political problems at least - though the measurement of this is still somewhat gameable.

Which providers?

Supporters of the Cameron agenda will say it is about a "big society" plurality of providers, as the Prime Minister argues today.

everywhere else should be open to diversity; open to everyone who gets and values the importance of our public service ethos.

It is not clear how that test will be defined. Are there any organisations who would fail to meet it?

Sceptics believe big corporates will have the muscle and capacity to capture most of the action.

Cameron says

And to give our principle of choice real bite, we will also create a new presumption that services should be delivered at the lowest possible level

Yet that would need to be reflected in policy. in the Work Programme, the decision to contract on a regional basis means that smaller providers are squeezed out, even if they may have particular local expertise or ability to reach specific groups (like the disabled), unless they can persuade the holders of contracts. So this is not widely seen as a good example of promoting diverse provision, despite being one of the largest programmes involving the approach which Cameron advocates.

More accountability or less?

Is the focus too much on providers; too little on service users and citizens? The new Cameron approach risks having rather less to say to the citizen than John Major's citizen's charter which, though widely mocked for being incremental rather than visionary, proved quietly influential on public service reform over the last two decades.

The focus on making alternative provision will excite those who would like to compete to be paid, by taxpayers, for providing public services. The theory is that this will be good news for service users, as long as contestability drives an enormous positive shift in service performance. One reason for public scepticism that this is enough is that we all experience very different levels of service in the market - John Lewis tending to be rather good, while banks are widely thought to not very interested in their customers.

In public services, contracted-out tasks like the marking of exam papers turned out to be surprisingly difficult, even to meet timetables, aside from question marks about whether the job was being done professionally. It is not particularly helpful form of redress, if at risk of not getting A-level results in time to go to university, to hear that the marking company might well lose the contract in some future year.

What is needed is clarity about the level of service performance expected or guaranteed, real rights of appeal and redress against significant failure to perform these. Contracting out services to national government as a customer without providing such rights could well weaken accountability to users and citizens, rather than strengthening it. This promising alternative approach was set out by Tony Wright, then a Labour MP who was the widely respected chair of the Public Administration Select Committee, a few years ago in a Fabian pamphlet 'A New Social Contract: From Targets to Rights in Public Services', summarised in this Independent commentary

These issues of user rights and representation are, to some extent, separable from the issue of the provision of services, though they provide an important and contentful challenge to both marketisers and defenders of the status quo.

This proposal for service guarantees will not commend itself to two groups of people. It will be disliked by those on the right, for whom the ideological task is to roll back public provision of key services. They will not be attracted to an approach that has the potential to strengthen attachment to public services through a more explicit kind of contract. Equally, the proposal will not appeal to those on the left who are content simply to defend the state against the market, or to argue for more taxes and higher spending, but who dislike attempts to insist that the services provided by the state should be assessed in terms of their performance for users.

Kirby's paper argues there is a sharp distinction between personal services, and those where the customer is local or national government. It is implausible that there are not always overlapping demands here.

Three distinct customer roles should be created for each of the different types of service – personal, local and national – with these customers radically empowered to decide what they want and from whom

It would rather undermine the whole purpose if the end-user has a very weak voice where the "customer" is defined national or local government, who are then "radically empowered" to, for example, withdraw from a currently mandated level of service.


On the big society, the government has toned down the rhetoric, sensibly now arguing that change must be incremental and gradual, but it is ratcheting it up on public service reform, with Cameron struggling to match the temptation to not just match but considerably raise the (now traditional) Blairesque rhetoric of ever bolder radicalism and reform in public services.

That is a calculated risk. Promising a transformation in services and how they are experienced creates an expectation of delivering one, probably by the end of the Parliament.

But it also claims a sense of direction for a government which is a curious mixture of largely mandateless Maoism, determined to change the facts on the ground if it only gets one Parliament, and a nervous willingness to u-turn in the face of popular challenges.

The issues are rather more complex than Cameron's pitch suggests. It is a political choice too to define the agenda as a once in a century radical break, rather than an attempt to deepen previous reform agendas. Today's rhetoric does suggest that ambition. That will excite the right and embolden opponents of these changes. As Cameron says that he is proposing a radical break, this also potentially opens up political space for Labour to remain "pro-reform" (though this positioning term, considered important by commentators as a badge of centrism or moderation, is often largely meaningless) while being able to critique the reform package proposed, as long as they make the case for alternatives which would strengthen public services, and the voice and power of citizens who use them.


richard.blogger said...

Last year, at a local public meeting, the most eloquent and passionate speech I have heard in support of our local NHS hospital came from a local Tory councillor. He passionately believed in our community hospital. (He also professed to not knowing, or caring, what the Big Society was about.)

Yet when we find that a private company "contests" the hospital's provision of, say, cataract surgery (something they do rather well, and hence make a PbR surplus) and takes that service away from the hospital, and its subsidy for other vital services, what will he say then?

Don't assume that this policy has the support of all Conservatives. Indeed, this is likely to be highly unpopular.

Nick said...

Cameron's article (at least in the meaning that was briefed to the Telegraph) appeared to directly contradict the speech given by Clegg to the Public Services Summit last week. Someone isn't being straight with us...

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