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 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 the document’s 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 personal budgets are now seen as the default option 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 personal social services are 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 enterprise as well as traditional voluntary and private sector providers.
Making services accountable
There are striking differences in the approach to keeping public services accountable. Gone are the 1999 public service 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, particularly elected mayors, are familiar, but there are now a greater array of ‘democratic’ options on offer.
The incremental revolution
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
For more comment and reaction from the Institute for Government on the Public Services white paper, read our article Opening up Public Services