1 THE CONTEXT: CHOICE, VOICE
AND PUBLIC SERVICE REFORM
1. This Report assesses two key aspects of the Government's
programme for public service reform—its policies on choice
and voice. It is the product of an inquiry that began in the Spring
of 2004 with the publication by the Committee of an Issues and
Questions Paper seeking written evidence on some of the main themes.
This was followed by a round-table discussion with advocates and
critics of choice-based policies which allowed the Committee to
draw out issues for the inquiry. The National Audit Office (NAO)
carried out some qualitative and quantitative research for the
Committee on the operation of choice-based policies and public
attitudes to choice in Birmingham. We also visited a school, the
City Council and a primary care trust in Birmingham during January
2005, when we also took formal oral evidence. This visit, along
with one to Washington and North Carolina in April 2004, gave
us an invaluable insight into the place of choice and voice in
the lives of those who use and provide a range of public services.
In total, the Committee received 25 written memoranda and took
oral evidence from a total of 30 witnesses, including three ministers,
over six sessions.
2. The historical context for the current debate
on public service reform goes back at least as far as the creation
of the modern welfare state in the years after 1945. This saw
the establishment of a broad and long-lasting consensus that whole
areas of activity, previously in the private sector, should now
be regulated or directly owned by the state in the public interest
to secure both efficiency and equity. The most notable achievement
was, of course, the creation of the National Health Service. The
1970s, however, began to see a breakdown of this consensus. This
was followed in the 1980s by a determined attempt by government
to withdraw from some large areas of state control or intervention,
and the development of a more market-led approach in others.
3. Variations to the post-war model of provision
of public services have tended to involve either target-setting,
benchmarking and performance-related pay; or competitive tendering
and external contracting for defined, often stand-alone, services
ranging from cleaning to IT. Both of these approaches are now
well established as part of public service reform. The Committee
has in the past few years examined many aspects of this reform,
including the culture of performance targets and league tables.[1]
4. The third variant, less developed but increasingly
important in the debate on the public services, is choice, often
defined as giving individuals the opportunity to choose from among
alternative suppliers, whether or not entirely within the public
sector. Another approach, also prominent in recent years, is to
give users a more effective say in the direction of services,
by means of representative bodies, complaints mechanisms and surveys
of individual preferences and views—in short, to give users
a stronger "voice".
Our approach: putting the user
in charge
5. In this Report we assess the effectiveness of
the Government's plans for choice and voice in public services
using a straightforward test: to what extent do their policies
give people greater control and power over the services they use?
It is only by making services responsive that such power and control
will pass from the provider to the user, and to the citizen. Peter
Hay, Strategic Director, Social Care and Health Directorate, Birmingham
City Council, summarised this very well when he gave evidence
to us during our visit to the city. Asked what vulnerable people
in social care really wanted from their services, he said that
they especially valued:
"being more in charge—I am not sure
it is necessarily choice, but certainly control is the important
bit. Most users talk about being more in control of the arrangements
in their lives than making a choice, because most of them would
choose not to be in that situation".[2]
6. We examined in particular detail three services
where the debate on choice is especially lively—health,
secondary education and social housing—but we believe that
much of our analysis can also be applied more widely. Our intention
throughout is to identify themes which are common to a number
of public services, although some of our recommendations will
have special application in particular fields. In the next chapter
we describe in more detail the Government's plans to introduce
more choice and voice in public services.
1 Public Administration Select Committee, Fifth Report
of Session 2002-03, On Target? Government by Measurement, HC 62-I
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2
Q 387 [Hay] Back
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