Steve Richards: The new orthodoxy: we need choice in public services - to help the poor

Who exactly is being empowered by the autumnal fashion sweeping through the political parties?
Click to follow
The Independent Online

Choice in market-led public services is the political fashion of the autumn. In their forward- looking modernity, the advocates of choice are the equivalent of the glamorous models parading the latest seasonal gear in the glossy magazines. No other political look will do this year.

They are in the ascendancy in all three parties. Even in the tribal conference season, there is a consensus between them about why they seek reform and how they want to bring it about. Their means is the introduction or expansion of markets. Their aim is an improvement in delivery, particularly for the poor. Ministers argue that they want the disadvantaged to have the same choices as the rich. Conservative candidates in the leadership contest claim the same noble purpose. All are acting on behalf of the poor. If they were models for a glossy magazine, they would be wearing the same outfits.

There are important differences, of course. Most senior Conservatives have already fallen into the fatal trap of promising tax cuts four years before the next general election. At least the "modernising" Labour ministers and Liberal Democrats do not make such a premature pledge. More far-sighted Conservatives also accept that public spending might have to rise in the short term. But most on the right are in denial about the pivotal importance of public investment.

Quite a lot of them cite Sweden as a model for the provision of less monolithic public services. They ignore the fact that those services have also benefited from a high level of public spending for decades. As Britain catches up belatedly with the expenditure levels of more civilised countries, they cannot wait to cut back drastically and still expect to achieve a Scandinavian paradise.

But in one significant respect the right is more coherent than their fellow travellers on the centre-left. The logical consequence of devolved market-led services is that ministers cannot be directly responsible for higher standards. The Conservative leadership contender David Davis was quite open about this in a BBC interview yesterday. He admitted that the first time there was a crisis of sorts in a reformed public service there would be a problem for him as prime minister. Opponents and the media would blame him. He would argue it was not a matter for the government. Would Labour and Liberal Democrat politicians dare to do the same in relation to schools and hospitals? I doubt it. There are huge risks of such an approach, politically and in terms of social cohesion.

In spite of these important differences between the right and the crusaders from the other parties, there are many similarities. The language is more or less the same. The changes are aimed at giving the disadvantaged the same choices currently only available to the well off. They argue that if parents and patients become empowered, schools and hospitals would become more efficient and consumer friendly. A parent or a patient will like the sound of this. Who is against their own empowerment?

But who exactly is being empowered as a result of the autumnal fashion sweeping through the political parties? I do not defend poorly-managed hospitals or badly-run schools. I despair that it is impossible still to see a GP at weekends when most Europeans are allowed to fall ill on a Saturday or Sunday and visit a local surgery. I have no sentimental attachment to a health system that treats some hospital patients with a complacent disdain. And yet I do not see how the new orthodoxy empowers parents and patients. It is the providers that are being empowered and not only the efficient ones.

Take the case of the city academies. Defenders point out triumphantly that these schools are heavily oversubscribed. But what about the parents who fail to get their pupils in to these generously funded schools? Do they feel they have more choice?

Ministers argue their aim is to raise the standards of all schools. But those who do not get into the academies will be rejects that get their second choice. The second-choice school will become known as the one that takes the rejects of the academies. In such a marketplace, the head teachers of the well-funded new schools are empowered to choose. The parents are left keeping their fingers crossed that they will be one of the lucky chosen ones.

In the case of health care, there is the obvious point that genuine choice is only possible when there is a surplus of hospital places. Equally important, there must be a surplus of good hospitals. No patient wants the choice between a good and an under-performing hospital. Ministers argue that the competition for patients will lift the standard of all hospitals. In effect, incompetent managers face the possibility of their hospital closing if they cannot attract patients.

But it will not work quite like that, as the "modernisers" admit. They argue that a new team of managers would take over when a hospital is threatened with closure. I am attracted by this argument in the sense that none of us should tolerate public institutions that are overstaffed by incompetent managers. But where will these new managers come from and how long will it take for them to take over? The management of health care requires a degree of specialist expertise.

This was one of the problems with the privatisation of the railways, admittedly a more revolutionary reform. Managers appeared from nowhere with no sense of how the railways worked. And will not the more entrepreneurial managers head for the expanding private sector where fewer demands are made in terms of training nurses and doctors?

When I pose these questions to the advocates from the three parties, I tend to get a general answer that I do not altogether dismiss, that something had to be done - carrying on with the status quo was not an option. They also argue that higher taxes are out of the question so new mechanisms must be found to deliver a better service.

Indeed, the context is problematic. Later in this parliament, just as spending reaches the level of the European average, it is set to fall again. Ministers were very careful at the last election not to make a commitment to keep public spending at the EU average. They promised to reach the average knowing it would then fall. They will climb the mountain, take a bow and then start to climb back down again. How some Conservatives can pledge tax cuts and to improve services in such a context is beyond me.

The fashionable cry of choice is being made on the grounds that nothing much was working, which is not altogether true, and that no party dares to put the case for higher taxes, although that is part of the reason why public services work in the much cited Sweden. The political models are wearing clothes this autumn that are not as well made as they seem.