The PM’s launch of the open public services white paper has created a wide range of challenges to the way services are delivered
‘This is the new era of open government’. These words were not spoken today by David Cameron at today’s launch of the open public services white paper, but by Jim Hacker MP, the fictional minister for administrative affairs, in the first episode of Yes Prime Minister in 1980.
The quote serves as a reminder that over the last 30 years public service reform has been underpinned by some common, perhaps clichéd themes. Successive governments have repeatedly told us they will make public services more ‘citizen centric’, will ‘open up government’ and provide more ‘choice’ for service users. So is Cameron’s promise today to ‘release the grip of state control and put power in people’s hands’ any different? Does today’s white paper mark a break from the past or continuity? What new directions or policy specifics are hidden in its 58 pages?
It is now commonly accepted that provision works best when it is wrapped around the individual rather than delivered as a series of separate services. Under the mantra of ‘joined up government’ the Labour government developed a whole suite of mechanisms to encourage the integration of services, from local partnerships and one-stop shops to pooled budgets and shared targets. But as Total Place illustrated, even with an extensive array of mechanisms to join up government, significant gaps and areas of duplication still exist in service provision.
Today, the ambition to integrate services is still evident, but the old infrastructure is being disbanded. Joining up will happen at the lowest possible level and, where possible, individual users will join up services by buying them with personal cash budgets. Of course, personal budgets are not new. The 2001 Health and Social Care Act made it mandatory for local authorities to offer direct payments to individuals eligible for social care. But they are now seen as the primary method for integrating public services.
Personal budgets are just one aspect of a quasi-market theme that runs throughout the paper. The government has today promised to increase the diversity of provision by opening commissioning up to a range of voluntary organisations, private companies, mutuals and social enterprises. At first glance this appears a natural continuation of a long history of contracting out public services. But the white paper marks a radical change to the design of government contracts.
Under Labour, providers were either paid a set amount to deliver a service, or they were paid on the basis of the volume of their activity. In the future, providers will continue to be paid for their results, but the results that matter will be the outcomes they achieve. At the extreme, this means no outcome, no payment. In the criminal justice system, for example, if organisations do not manage to reduce re-offending, then they will not be paid.
The scale of the ambition to diversify provision appears to have increased. Whilst choice and competition underpinned the New Labour project, the actual changes in the pattern of provision varied. The private and voluntary sector currently provides about 5% of NHS healthcare whereas around two thirds of local authority funded social care is provided by non-state organisations. If David Cameron’s ‘vision for open public services’ becomes a reality, the welfare economy could become considerably more mixed in the future, with a notably increased role for mutuals and social enterprises as well as traditional voluntary and private sector providers.
There are also striking differences in the approach to keeping public services accountable. Gone are the 1999 public services white paper’s promises to ‘monitor performance’, ‘set new targets’ and ‘intervene’ where services are failing. In their place, transparency now dominates. We will be able to know more about the performance of hospitals and schools and make more informed choices about which services we choose. Coupled with fears of being ‘named and shamed’, the government hopes this transparency will create a stronger accountability relationship between providers and users. The idea is to shift from ‘bureaucratic’ accountability to ‘direct’ accountability.
Alongside ‘direct’ accountability there will be more ‘democratic’ accountability including police and crime commissioners, elected mayors and greater powers for parish councils. These policies, in particular elected mayors, are familiar, but there are now a greater array of ‘democratic’ options on offer.
It is hard not to conclude that the white paper is both incremental and radical. It is also extremely challenging in a time of expenditure reductions. As the Institute for Government’s briefing note on the White Paper suggests, the government will have to overcome a wide range of challenges if it is to realise its radical vision for public service reform.
Kate Blatchford is a research analyst at the Institute for Government. This post first appeared on its website
The failure of Southern cross is hardly an auspicious start for the coalition’s introduction of this white paper.
I find it unbelievable that people in need of care will be expected to “join up services by buying them with personal cash budgets.” If I need hospital treatment, I’m hardly likely to troll through tables to decide which hospital is best for my condition and then to calculate whether my “personal cash budget” will stretch to meet the fees!
Once again this government is showing a complete lack of imagination and inability to empathise with the general public. The other day Cameron and his cohorts complained that “Hard-working parents” were forced to give up a day’s work to look after their children” when the teachers struck. Now these same parents are encouraged to set up “Free Schools” for their offspring!
How many more bad ideas are these airheads going to come up with?
They scrapped the Ark Royal and its Harrier force and then decided to bomb Libya.
They are relying on the French to provide carriers for the next ten years (is that all?) but have decided to contribute to development costs and then buy American F35 aircraft, rather than European.
They have been forced to backtrack on their plans for dealing with Forestry Commission pensions.
They have been forced to rethink their much heralded plans for the NHS.
And now the Culture Secretary has “decided to seek advice” on Murdoch’s total acquisition of BSkyB.
Cameron says that it’s “being strong” to listen to “Public Concerns”.
Who does he think he’s kidding?
I attended David Cameron’s launch of the ‘Open Public Services’ White Paper this afternoon. As the Prime Minister said, a huge implementation challenge will be for the Civil Service to take some risks, try new things, be creative and innovative rather than always play safe.
The thing that Mr Cameron seems to have forgotten is that we, the public, instinctively hate ‘post-code lotteries’ of provision and that his proposals will inevitably lead to a whole range of quality and efficiency of provision. Some will be run well for years, some will be run well until the initiators move on, some will be run by well meaning but incompetent people and others will be run by rip-off merchants.
When things go badly the press will immediately expect the likes of good old local government to pick up the pieces even if it has long since lost the budgets and the expertise to do so.