So much bold rhetoric about choice, but so little desire to transform the public services

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The Independent Online

The Government and the Opposition have reached the same enlightened conclusion: the only way to drive up standards in public services is to hand over a degree of control to their users. It is called "choice", and our airwaves are full of politicians arguing about who can deliver more of it. While it is gratifying to observe so many politicians coalescing around an idea that was beyond the pale just a few years ago, the reality of the various proposals on offer indicates that the dawn of genuine choice in education and health remains some way over the horizon.

The Government and the Opposition have reached the same enlightened conclusion: the only way to drive up standards in public services is to hand over a degree of control to their users. It is called "choice", and our airwaves are full of politicians arguing about who can deliver more of it. While it is gratifying to observe so many politicians coalescing around an idea that was beyond the pale just a few years ago, the reality of the various proposals on offer indicates that the dawn of genuine choice in education and health remains some way over the horizon.

Today the Health Secretary, John Reid, will present his White Paper on reforming the health service to Parliament. The advance spin proclaims a "new generation" of public service provision where hospitals offer "personalised" health-care plans and the disenchanted middle classes flock back to the NHS from the private sector. Such sentiments are commendable; the trouble is, we have heard these promises too many times before. Last year's Foundation Hospitals Bill, which could have been useful in shaking up the health sector, was badly watered down by the time it reached the statute book. And over the past four years, although Gordon Brown has lavished billions on the NHS, there has been little desire to perform the surgery needed to ensure that our money is wisely spent.

Mr Reid now says he wants to give patients a guaranteed choice of at least five hospitals if they need an operation. This is a promising start. But why has it taken so long to reach this point? Why just five? And what guarantees can he offer patients? It is not encouraging that Mr Reid also intends to shower the NHS with waiting-time targets; Labour has still not learned that what the NHS needs is less bureaucratic interference, not more.

Tony Blair has asked the public to judge him on his record in improving the public services at the next general election. Well, the jury is out: there are signs of improvement in our schools, but the health service remains on its sickbed and the transport system a disgrace. When polling day arrives, many voters will be wary of all these endless promises that things will get better eventually.

So what of the Tories? They have a difficulty of differentiating themselves from a government mouthing the right platitudes and heading, albeit slowly, in the right direction. The key question remains the issue of whether a monopoly, state-run provider of health care can ever deliver genuine choice. Michael Howard offered a pledge to tackle this, transforming the role of the NHS from a provider to one of a guarantor and funder of health care. A radical statement - but Labour ministers, it should be noted, have made similar bold statements.

The Tory solution, however, looks suspiciously like a subsidy for wealthier patients. Their "passport" policy (rather hastily renamed "right to choose" after confused voters wondered if they had to go abroad to benefit) offers to refund part of the cost of private operations. It is right to try to use the private sector to help reform the public sector. But this assists only those who can afford to pay to go private, while doing little to help the less well-off or to confront the inherent problems of a sclerotic NHS. Their ill-defined proposals for school vouchers are also flawed, again due to a similar lack of daring.

This newspaper has long argued that the principle of choice is crucial in forcing complacent public service providers, hospital managers and head teachers alike, to raise their game. It is encouraging that politicians of all hues now accept this fact. But there remains a lack of vision, with too much incremental change, too few fundamental reforms. And for all the rhetoric, there is not a substantial difference between the approaches of the two parties, beyond the Tories' acceptance of the role of the private sector. Until there is a little more conviction and belief in the idea of empowering the users of the public sector, Britain will be left with under-performing public services - and no choice but to accept it.

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