Memorandum by the London Borough of Camden
(CVP 14)
INTRODUCTION
Camden welcomes PASC's interest in exploring
the notion of choice in public services. At the national level,
this debate is attracting much attention and comment at present,
especially since it was highlighted by the Prime Minister as one
of his four principles of public sector reform. The concept of
"choice and voice" is also extremely pertinent at the
local level, to the London Borough of Camden and all local authorities
who deliver key public services such as housing, education, and
social services and who work in partnership with a wide range
of other public service providers, such as primary care trusts
and mental health and social care trusts. Local authorities are
big players in the public sector, accounting as they do for around
25% of public expenditure. They have an important community leadership
role, as well as being a significant employer in the UK.
Based on its experience as a provider, coordinator
and facilitator of a complex range of public services, Camden
remains unconvinced that choice should be a fundamental principle
of public service reform. The evidence base for the contribution
of choice to improving public services, especially the merit of
giving people a choice between providers, is weak. Recent MORI
research in the UK indicates that whereas "choice" in
public services is potentially popular, there comes a point where
too much choice stops being perceived as beneficial to the customer.
Much cited US research on choice (for example, by Schwartz) looking
at products, brands and consumer options also indicates that it
does not necessarily make people happy nor does it increase their
quality of life.
Although research on consumer choice is thought
provoking, to directly correlate it with choice in public services
is unrealistic. In reality, the degree of choice that is desirable
and sensible in public services will vary depending on a whole
host of factors. For example, users of public services do not
necessarily want to have to shop around and take a consumerist
view during times when they may be especially vulnerable through
illness, infirmity and other challenging life events. In all circumstances,
but particularly when dealing either with medical or statutory
services (such as social services or the criminal justice system)
we would argue that the quality of the interaction between the
service user and the staff providing the service is far more important
to get right than offering a choice of provider. We believe that
tailoring the service to suit the needs of the individual at the
time—rather than worrying about whether they could choose
who provides it—is far more important as a way of improving
public services.
In our role as the local tier of government,
a point we would also make is that political choice, and choice
made through democratic representatives, need to feature in this
debate as well. Governance of public services means reconciling
many interests, and diverse and potentially conflicting individual
choices.
The comments below address some but not all
of the Committee's specific questions and our points are illustrated
with examples where relevant.
DEFINING WHAT
CHOICE MEANS
IN THE
PUBLIC SECTOR
We feel clear definitions would be useful, but
may be hard to achieve. In terms of individuals and their local
authority, choice can mean a wide range of different things. For
example, choice of providers (like a tenants' ballot on who their
landlord should be); a consumer choice (whether to use the local
public swimming pool or not, or private alternatives); a choice
of schools but within limits of practicalities, admission criteria
etc as well as the levels of information and assertiveness of
parents; or tailored options of intensive care or support services
including direct payments for buying services.
There are many positive uses of choice and customer-orientation
in relation to council services and Government should recognise
that the debate has long since moved on from "you can have
any colour front door you like as long as it is council green".
It is of concern that some senior figures imagine local authorities
still to be in such a paradigm. We have already become much more
responsive to preference and treat people more as if they were
customers even in those services where they do not have alternatives,
or their contact is involuntary. For example, Camden is a member
of the Home Connections Choice-Based Lettings (CBL) service, covering
six London boroughs and five housing associations. Here, choice
is defined primarily as delegating decisions, previously made
by the council or landlord, to the customer. A significant element
of power and control has been handed over to the home seeker.
Importantly this allows the customer to choose not to make a bid
as well as to make a positive decision to bid for a home. And
a choice not to make a bid for a particular property does not
prejudice the customer's chances of successfully bidding for another
property at a future time.
There is also, with CBL, a limited degree of
choice of provider—council or housing association homes.
Home seekers are increasingly offered a greater choice of location—both
within a borough's boundaries and across London as we experiment
with more cross-borough lettings. Camden also offers home seekers
assisted opportunities to rent or buy in the private sector. We
have used CBL to promote our Housing Options service that includes
grants to help people buy a home if they vacate their existing
Council home and rent in advance and a deposit if they are homeless.
Other aspects of choice in using the service are the convenience
offered by a 24x7 service, multilingual information channels and
the choice of channel itself.
CHOICE AND
EQUITY
It should be recognised that the full market
model cannot apply to public services. The concept of a "customer"
does not adequately define the nature of the relationship and
we should take care before we too readily transpose such a private-sector
notion on to public services. One important factor is that choice
in the private sector works both ways—providers choose their
customers as much as consumers choose products or services. Public
services cannot choose users in the same way. Even if we substitute
public satisfaction or public benefit for the bottom-line profit
measure, we cannot only serve customers who are more easily satisfied
or cherry pick children who will achieve good exam results. We
also often find ourselves "demarketing" services or
scarce resources such as housing, rather than aiming to increase
take-up or customer numbers.
For a diverse, inner-London Borough such as
Camden, increasing social inclusion and tackling inequalities
are at the heart of everything we do. The big questions are about
deciding where and for which services we should develop more choice
(of provider, of means of delivery, of levels and type of service,
of opt out or vouchers, of extra service for extra payment). We
recognise that in some services, individual choice may not be
the key issue—what is more important is equality of standards,
availability, supply, care, tailoring, and the greater public
good. Individual choices cannot necessarily be relied on to promote
community cohesion and equity. These decisions rest on questions
of leadership, long-term thinking (for example balancing sustainability
with immediate consumer demands), and efficiency and extra capacity.
VOICE AND
PUBLIC SERVICES
Local government uses a whole range of mechanisms
to increase people's sense of agency and empowerment in their
interaction with services. Direct payments in social services
provide one example of co-production, which enables users to choose
and take control of the care provided to them in their homes.
Family group conferences in social services provide a further
example of users working together with professionals to seek joint
and workable solutions to problems. In housing, the choice-based
lettings scheme similarly allows service users to behave more
like consumers and we know they relish the opportunity to make
choices previously decided by gatekeepers.
With regard to more traditional methods of "voicing"
opinions on services, local authorities, including Camden, have
gone far beyond complaints systems to much more sophisticated
ways to find out people's preferences and needs. Polling, qualitative
and deliberative techniques are all used to test what matters
to people, perceptions of service quality, customer care and so
on. In Camden we are about to launch a new Citizens' Panel which
will offer many different opportunities to feed in views or get
more actively involved, in a variety of ways. We have also recently
consulted very extensively on a children and young people's strategy,
which means that our partnership work in this area is very closely
aligned to what young people see as important.
DEVOLUTION AND
DIVERSITY
The nature of collective, representative and
individual choice is another important dimension.
In terms of direct participation in services
and how they are governed and designed, it is true that the ballot
box is a blunt instrument to gauge support for the direction and
priorities of all individual public services. Other ways to involve,
consult and to encourage participation must be developed, and
as cited above, we are doing a great deal of that. But there must
still be scope to expose different approaches to service delivery
and to local priorities to the vote. This is where local autonomy
comes in, and it cannot be argued away because of post code lottery
issues. There should be national minimum standards but then Government
needs to let go, so that services can be more diverse and people
can choose difference.
A particularly striking example of the limitations
of choice in Camden, exercised through the ballot box, is Camden
tenants' decision in January 2004 to reject an Arm's Length Management
Organisation (ALMO) to manage its housing stock. This has left
the Council with a £283 million funding gap and little hope
of achieving the Government's Decent Homes Target by 2010. The
current position is that Camden is a Council with a three-star
housing management service (as rated by the Audit Commission's
Housing Inspectorate) which will have to scale down its capacity
and will be unable to invest in the necessary internal and external
works to meet the Government's target. The rigidity of ODPM's
housing policy, which will not allow funding flexibility for high
performing local authority housing departments (except via the
PFI, ALMO or stock transfer routes), sits uneasily with the principles
of choice and diversity which are concurrently being espoused
by No 10. Camden is, of course, working proactively and co-operatively
with the Government to think through this dilemma. But a dilemma
it most certainly is and our housing need remains as great as
ever.
CAPACITY IN
THE PUBLIC
SERVICES
For some services, there is a real balance to
be struck between cost and offering choice. For example, efficiency
gains through the growing number of e-government channels are
hampered by the need to maintain traditional channels at the same
time. We cannot apply the internet banking business model to our
services, although we can develop new channels and encourage more
people to use them over time.
Public expectations are high, and can be summed
up as wanting tailored, responsive services but at mass-produced
prices in terms of taxation. This is a challenge.
London's lack of public sector housing and affordable
homes also present a capacity problem which acts as a severe constraint
to the exercise of choice. For example, approximately 14,000 applicants
are on Camden's housing waiting list, of whom about 4,000 actively
chase around 1,400 annual vacancies in Camden—with the latter
figure set to continue its decline as a consequence of people
exercising their right to buy. Camden's annual residents' survey
for 2004 confirms this worrying trend in housing market capacity.
Significant increases in concern were registered in the last year
about lack of affordable housing (up 5% this year). Tellingly,
there was more concern in Camden than London wide about homelessness
and lack of affordable housing and less concern about the level
of Council Tax, traffic congestion and the health service. This
is stark evidence of a rising problem for Camden, and the whole
of London and the South East.
Councillor Dame Jane Roberts
Leader of the Council
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