ippr's Jonathon Clifton argues David Cameron’s reforms to public services risk being undone by the weak accountability structures he is putting in place.
David Cameron’s reforms to public services risk being undone by the weak accountability structures he is putting in place. Over the last few months, the government have made a bewildering array of announcements on health, education and criminal justice. Perhaps recognising the need to take stock of all these changes, the prime minister today set out his stall on public service reform more generally.
This wasn’t a policy speech – rather setting out the grand narrative from which individual policies flow. That narrative is an increasingly familiar one:
1. Letting people choose their services from a wider range of private, public and third sector providers gives citizens more power, and the resulting competition can drive up standards;
2. Freeing public service professionals from central government targets and bureaucracy will enable them to innovate and be responsive to people’s needs;
3. Services should be held to account by the people who use them, not central government – so there needs to be data transparency which citizens can use to make their choices and push for change.
Citing New Labour’s experience (he’s clearly read Blair’s memoir and taken it to heart), Cameron argued that Blair had been right on choice and competition but that he had failed to adequately hand power down to service professionals. His speech was peppered with personal references to teachers, doctors and nurses. If only professionals were free, he argued, we would have better public services and a big society.
While claiming to have learnt from Labour’s experience, Mr Cameron’s speech failed to take account of two lessons from the past.
First, while in a perfect world service professionals work entirely in the interest of service users, in reality this is not always the case. Tensions exist between patients and doctors (see how hard it has been to encourage GPs to open out of office hours); between schools and communities (it took the Extended Schools programme to ensure schools provided care and activities to enable parents to work); and between the police and residents (patrols that keep the public happy don’t necessarily cut crime).
Recent research from ippr revealed many professionals were resistant about the idea of engaging with service users to build a ‘big society’. Empowering professionals is not necessarily the same thing as empowering the service user, as Mr Cameron appears to claim.
Second, transparent information and the ability to switch to a different provider do not necessarily empower the public to hold their services to account. The volumes of data released by the government can be meaningless and taken out of context (see for example Perry Common School which was wrongly interpreted as spending vast amounts on back office functions in recently released school spending data).
What’s more, without intermediary bodies such as local authorities and the Audit Commission to hold services to account, citizens are left smaller and divided in their ability to challenge for improvement. And while the ability to choose a different provider might provide some impetus for change, the reality for most is that switching school or hospital is limited – driven by what is nearby and a known quantity. There are therefore limits to what choice and transparency can achieve.
These two lessons mean Mr Cameron should be wary of falling into the trap of devolving power to public services, but not putting in place clear mechanisms for holding them to account. Relying on choice and competition is not always an appropriate or effective way of holding services to account for how they perform.
Without clearer lines of accountability, supported by local democratic institutions and central government, there is a real risk that public services will not receive an impetus to improve.
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