David Boyle, Leader of the Independent Review of barriers to choice in public services, writes for the ResPublica Fringe magazine
Choice? What does it mean? And in practice, do we actually
get it when it comes to the public services we use? If you happen to have
children the state school system, then more than 85 per cent get their first
choice of school. That’s a success, but what about the ones who didn’t? What
did they feel and is there anything that can be done about it in future?
Those are the kind of questions I
have to answer over the next few months as Independent Reviewer for the
government, and there is no doubt that it is a difficult debate. For one thing,
the word ‘choice’ has become rather politically contested. Is it a method of
driving up the quality of our schools and hospitals by forcing them to compete
for clients? Or is it a conspiracy to hand over public services to the private
sector? Or is it, as many people have told me, something they don’t actually
want – they just want their local school or hospital or social care package to
be good? And then again, what if it isn’t any good?
The other reason the debate is
difficult is because nobody has much idea what people are actually doing with
their choices. People have been given the right, in some circumstances, to
choose hospitals or GPs, hospitals, schools or social care packages, and other
services too – but do they actually choose? In practice, do they get the choice
they want? Or does something stop them?
There have been hundreds (maybe
more) of pieces of learned research about the theory of choice and competition
– but remarkably little about what people are doing with their choices. That is
why the government has asked me to find out, to run a review – independently of
Whitehall departments – to see what is really happening on the ground. I know a
little about this myself. I had to fight an appeal to get my eldest
child into my local school. I’m currently battling with my PCT to get a choice
of consultant for chronic eczema. So I’m under no illusions that choice is a
simple matter of just asking. I’m also aware that, even where there isn’t a
choice, people still tend to choose – if they can afford it. House prices rise
around the best schools, even perhaps the best healthcare, and then choices
become unaffordable to anyone without the correct income.
That’s another question. In
practice, who gets the choice? Is it everyone, or is it so far only the preserve
of articulate, sharp-elbowed people. I have no ideological axe to grind here.
I’m neither a rabid free marketer, nor am I one of those people who think
everyone should be happy with what they are given.
But I’m aware that, behind the
choice debate, lies questions about the culture of services, which can still
sometimes treat people with disdain when they are too big, inflexible and
impersonal – in the private and public sector alike. But I do have one bias. I
believe that we may get to the nub of the question from successful stories
about choices offered and used, rather than just from stories like mine where
it was denied. You have to meet people, face to face if possible, and ask them.
So if you have anything to tell us
about your own experience, do come along to the event, 'Choice in social care: Making care personal'. But if you can’t make it, it would
still be good to hear from you. You can write to me direct at email@example.com
This article has been published in the ResPublica Fringe magazine, a collection of articles and essays from our party conference partners.
David Boyle will be speaking at ‘Choice in social care:
Making care personal’, a ResPublica public fringe event co-hosted with Home
Instead and KeyRing at Liberal Democrat Party conference: Tuesday
25th September, 12.30pm – 1.45pm, Holiday Inn Brighton. A corresponding event will take place at Conservative conference.