Memorandum from Professor Andrew Gray
Professor Gray is Emeritus Professor of Public
Management (Durham), Editor of Public Money and Management,
Vice Chair of County Durham Primary Care Trust, and Visiting
Professorial Fellow at the North East Public Health Observatory.
RELATIONSHIPS OF
CONSUMPTION: CITIZENS,
CLIENTS AND
CUSTOMERS OF
PUBLIC SERVICES
1. This paper argues that the attempt to
re-badge all service users as customers is inappropriate
and, whatever its good intentions in drawing attention to those
users, is conceptually flawed and practically risky.
2. The conceptual flaw lies in the way the
specific relationship inherent in being a customer is distinct
from other important relationships in the consumption of public
goods and services.
3. The practical risks for policy, provision
and consumption lie in establishing inappropriate relationships
that can and do undermine the proper provision and consumption
of those goods and services.
4. The style of this memorandum reflects
the issue as both inside and outside the tent of practical service
delivery. We have here a practical problem in search of a practical
solution. But we also have the potential for its understanding
and solution to be informed by academic reflection. Unfortunately,
as with many other once powerful conceptual tools such as bureaucracy,
governance, quango and quality, both the theory and practice of
public administration have allowed the term "customer"
to be hijacked by those who wish to use it for their own interests.
5. This memorandum attempts to recover some
clarity for the benefit of services and their users and is submitted
as a basis for answering all the questions set out in the Committee's
paper on Issues and Questions.
1. In July 2004, the Secretary of State
for Health announced NHS Live, a year-long programme to encourage
innovation in the National Health Service. He signed up 350 NHS
trusts and six firms to work with patients and staff to improve
the "customer experience" in hospitals, health centres
and social care. The firms contributed about half the £4
million project costs and the time and expertise of their "customer
relations" specialists. For Mike Farrar, the NHS project
leader, "we are making good progress on improving health
outcomes and delivering targets. Now we need to do better on improving
patients" experience and staff involvement. We want to see
the patient as a "customer" (Guardian 3
July 2004, emphases added).
2. This talk of customers in public services
has become widespread. Government organisations of all shapes
and sizes are awash with "customer first" initiatives,
"customer relations departments" and job advertisements
that call for candidates to "champion a customer centred
approach to service delivery" (Solace advert for Chester-le-Street
District Council, 1 September 2004). At the back of Newcastle
Civic Centre, for example, there were until recently huge white
plain letters proclaiming the Customer Service Centre. Nowadays
there is a more tasteful etching on the entrance doors, a symbol
perhaps of the institutionalisation of customer service in local
government. If you pass through the doors and exercise your customer
rights, however, you might be in for a surprise. Try telling the
officers there that you do not wish Newcastle to collect your
rubbish but would prefer Gateshead to do it or that you do not
intend to pay that part of the Council Tax allocated to an education
service you no longer need. You will receive a polite but firm
explanation that as a resident you get and pay what the Council
determines.
3. Something similar happens if you try
to act as a customer of the NHS. If you seek an appointment with
a general medical practice you will be asked if you are registered
with the practice and you can only register with the practice
if you are within its practice boundaries. If you try to book
an outpatient appointment or an elective procedure at a particular
hospital you will have to be referred by a clinician on behalf
of a primary care trust (PCT) that has a contract with that hospital.
No contract means no referral and no admission. You get what your
PCT determines.
4. You do not have to be a world-weary cynic
to ask if this is another gap between political rhetoric and management
reality or, more interestingly, if there is a conceptual fault
line in government thinking. So, where is all this talk of customers
coming from? Is it appropriate for all users and consumers? This
memorandum describes sources of the customer metaphor, compares
its model of service relationship with other consumer models,
and explores the risks for services and their users.
Where is all the customer talk coming from?
5. The Conservative reforms of the 1980s
and 1990s and many of the utterances of the reform units in New
Labour's Cabinet Office have included an increasing encouragement
to express the user as the "customer". For Wendy Thompson,
then Head of the Office for Public Reform, "the most important
test of public services reform is what customers think" (Public
Finance, 12 July 2002). Through a decade or more, it has become
politically correct to speak of the service user as the customer
and place to one side the service's societal function. The press
of course, has followed suit. Thus the Guardian published
a special supplement on Customer Care: transforming customer
relations in local government (17 March 2004) and its public
services editor, David Brindle, wrote of customer satisfaction
in the passport service (7 September 2005). Did he not even consider
whether customer might not be the appropriate term for such an
exemplar of the citizen relationship?
6. Public servants may find this customer
service metaphor valuable in drawing attention to and remedying
the traditional neglect of the public in public service provision.
The term also has the modernising appeal of the private sector.
Yet its indiscriminate use to embrace the totality or even a significant
part of service relationships with consumers shows a lack of understanding
of its meaning and implications. We might have expected academic
reflection not to fall into such uncritical customer usage. And
some has not. Jane Fountain, for example, identified paradoxes
in using customer service as the paradigm (2001). But she has
been in a minority. Sadly, the special issue of Public Management
Review (2005) on "Service Charters and Customer Empowerment
in Public Services" is more typical; not a single article
questioned the conceptual foundations of service consumption.
Such a lack is consistent with the public management literature's
tradition of accommodating rather than shaping issues (Gray and
Jenkins 1995).
Addressing the neglect of public in public service
provision
7. Lest it be thought that the critical
stance here is a defence of the status quo, let us be clear that
the public sector has indeed been culpable of neglecting those
whom it is established to serve: members of the public. How did
this neglect come about? First, the development of state services
from the earliest efforts in defence, foreign relations, the regulation
of trade and public order through to the modern welfare state
has been generated by a concern for the population as a whole
rather than individual citizens. Moreover, the state's manifest
successes in world wars and economic depression have also been
population based.
8. Second, the processing of these services
has emphasized equity of access and provision, supported by rules
that enshrine the generics of populations rather than the specific
needs of the individual receiver. Bureaucracy, in the best sense
of the term, is not an instrument for discriminating finely between
needs let alone wishes of receivers.
9. Third, public service provision has been
developed in the interests of providers. The rules encourage ritualistic
application (with benefits of certainty and predictability for
both providers and receivers). For the clerical and executive
administrators of the rules, success has depended on applying
these rules as specified (the rule of law) rather than identifying
specific needs of receivers that might require provision outside
the rules. The development of professionalised services such as
medicine, teaching and even social work has been founded on the
expertise and advances made by those professionals who thus have
come to dominate the specification of the service and who should
receive it in what circumstances. This is not against the interests
of specific receivers but neither is it focused on them.
10. Together these forces have favoured
populations and providers rather than individual receivers. In
a conservative and relatively deferential regime, these forces
were not challenged. Indeed the consequences appeared contingent
responses to specific sets of environmental needs. However, in
the face of changing and more individually expressed needs at
the end of the 20th century, including in universities and the
health services, they have indeed been challenged. But will treating
all users as customers put this right?
So, what are the relationships of consumption
in public services?
11. What exactly is a customer? As pointed
out in Public (November 2005: 27) historically a customer
was one who made a habit (ie a custom) of patronising an establishment
(an 18th century coffee house perhaps). Nowadays habit is less
prominent than patronage in definitions in the literature and
practice of business. The customer is one who, on the basis of
expectations, pays for and receives a specified product or service,
has the right to choose both the product and the provider and
to receive the product as specified once paid for (the customer
is always right). In return, the provider may differentiate
and discriminate between different customers, target some and
exclude others (we reserve the right to refuse admission).
Thus reciprocal and discriminating choice is inherent in a customer
relationship. It is found only rarely in what are usually necessarily
monopolistic public services.
12. Where service content is differentiated
between users it is usually on the basis of a professionally adjudicated
need or potential to benefit from the service. Here the provider
(such as the doctor, teacher, social worker) rather than the user
is the expert and in this capacity controls access to the service
(trust me I'm a doctor). The service relationship itself
is founded on personal interaction and a shared desire for a particular
outcome. In turn, this outcome is dependent on mutual participation
or co-production (ie by provider and consumer). Thus, participation
in the service is necessary to gain its effects (keep taking
the tablets). In such relationships, the users are termed
clients or variants peculiar to particular services (eg patients
and students). In contrast to customers, clients are common to
public services especially those that provide personal welfare
in health, social care or education.
13. Where public service is intended to
be undifferentiated, the use of the term citizen is more applicable
than those of customer and client even though as a relationship
it is perhaps more complex than either. It is based on equity,
rights, and universal access (equality under the law).
Thus everyone has the same right to receive the same service at
the specified and regulated common standard and providers must
not differentiate (ie discriminate) between citizens except in
specified regulated circumstances (no postcode lotteries please,
we're citizens). To the providers, however, the citizen is
not comprehensive but partial. Thus a young person is to the Department
of Health an object to protect, to the Department for Education
and Skills an object to invest in, to the Home Office an object
potentially causing anti-social behaviour! Moreover, the citizen
interest has at least three personas in the relationship: in tax
paying and voting (which demands public accountability), in social
justice (which demands that social and human needs are met) and
in community engagement (which requires the creation of conditions
that enable participation by all groups within society). These
relationships give the citizen a range of opportunities for both
shaping and gaining redress from their services.
So what?
14. These reflections suggest that the practical
relationships of public service and its users are significantly
more complex than may be embraced by the single term "customer".
The practical examples are legion. You may recall a television
documentary on the late Mr Edmund Trebus, an octogenarian resident
of Haringey. He had a habit of collecting other people's unwanted
possessions from fridges to clothes and old biscuits. His compulsion
had driven out his children and eventually even his wife as he
filled not only the whole of his five bedroom house (save for
a space for him to lie down in his pantry) but also his considerable
garden to a depth of several feet. On the complaint of his neighbours,
a public heath hazard was declared and Mr Trebus found out what
it was to be a citizen with obligations to the community (at one
point even spending a night in the cells after refusing to let
contractors clear the "possessions"), a client (in receipt
of advice from the environmental health department and social
services on what he could do in co-production to improve his conditions)
and a customer (or at least potentially so for there is no record
of him having ever paid for the services provided including by
builders!).
15. Moreover, a failure to appreciate and
manage the different relationships appropriately runs several
service risks. First, there is a policy risk. Offering choice
in circumstances where users are not able to exercise it, for
example, may aggravate rather than ameliorate inequalities (to
those who have shall be given). As with Isaiah Berlin's two
concepts of liberty, the opportunity for choice is not the same
as the capacity for choice. Thus those who will benefit from extending
choice of schools may be the informed and vociferous middle classes
rather than the disadvantaged, those who will benefit from e-government
may be those equipped with both the kit and the know-how to exploit
the new technologies.
16. Second, there is a provision risk: providers
can treat consumers inappropriately and thus fail to deliver effectively,
even at all. For example, providers may come to regard discrimination
between users as legitimate (we select and exclude). Thus
schools seek not only to exclude unruly pupils, but also select
new entrants (a provision of the government's new education proposals)
and, more subtly, prevent from taking public examinations those
who grades may not meet the target the school has set itself in
the league table stakes.
17. Consider also the case of the Television
Licence Agency, managed by a private company (Capita plc) as agent
of the BBC. Its customer services department (sic) deals with
the public (including offering them £10 per head when they
complain about receiving threatening letters for not having a
TV licence when they do not have a TV!). Capita treats the public
as a revenue stream for its performance related contract not as
citizens in a statutory relationship with the BBC and possessing
rights under the law. Capita's actual customer is, of course,
the BBC.
18. Third, there is also a consumption risk:
users may develop unrealistic and even improper demand of provision
(we want it all and we want it now). Generational difference
may be important here. Those who grew up as welfare services were
being newly provided display more acceptance, even gratitude,
for what they receive. Those who have been born into them are
more demanding and display more assertive and even aggressive
and bullying behaviour against providers.
19. These risks are not just theoretical.
They are manifest and intensifying as public services come to
be provided through more varied mechanisms, including in the private
and voluntary sectors. Yet, providing services in the interests
of their publics rather than their providers is a worthy ambition.
It will not be realised, however, simply by re-badging users.
On the contrary, it will almost certainly be damaged. Rather,
it requires recognition that consumers have a variety of relationships
with their public services. On the basis of these distinctions,
each service can then be designed and managed in ways appropriate
both to its state function and its consumers' needs and aspirations.
CONCLUSION
20. Both from academic and practitioner
points of view there appear to be problems in current provisions
and the prospect of great gains from more deliberate consideration
of the nature of the consumer relationship in public services.
As an academic who has explored public service relationships with
consumers, I am dismayed by my own discipline's failure to protect
and develop its conceptual tool kit. I also find the government's
present collection of policies and instruments, however well intentioned,
conceptually flawed. As a practitioner, if that is what you can
call a Primary Care Trust Board member, I find them contradictory
in practice. What I seek is a more robust conceptual basis on
which to manage services in the interests of users and consumers.
I look forward to the Committee's report.
REFERENCES
Fountain, J E, 2001, "Paradoxes of Public Sector
Customer Service", Governance 14/1, 55-73.
Gray A G & Jenkins W I, 1995, "From public
administration to public management: reassessing a revolution"
Public Administration 1995, 73/1, 75-99.
Public Management Review, 2005,
"Service Charters ad Customer Empowerment in Public Services",
Ed A Cheung, 7/3.
January 2007
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