The government wants us to have more choice in public services. But as David Boyle explains to Jess Bowie, in reality there are numerous obstacles stopping disadvantaged people from choosing their preferred service provider
‘Choice’ is a word we hear a lot from ministerial mouths. Almost invariably, it accompanies references to the government’s Open Public Services agenda, which aims to diversify the provision of public services; and it’s also found alongside discussions of open data, where the theory is that providing more information about different service providers will give people the means to pick their preferred delivery body. But the idea of choice is a nuanced one, and having the right information is only half the battle: government must also give people the help they need to access and understand this information. In recognition of this, the Cabinet Office asked David Boyle, a fellow of the New Economics Foundation, to conduct a review into choice in public services and the barriers that prevent people – particularly the most disadvantaged – from selecting their favourite provider.
Boyle, who reported his findings at the end of January, isn’t your stereotypical economist. Rather than dusty tweeds and elbow patches, he turns up to our interview in a Barbour and with a head of spiky hair – which, it turns out, is a perfect complement to the lively enthusiasm of his personality. With winning modesty, he asks CSW’s photographer to try to avoid letting him look “too mad” in the pictures – but when we turn to his report, he gets serious.
Asked why his review was necessary, Boyle says: “There’s been a lot of rhetoric about choice, and not an awful lot of understanding about what was happening on the ground. So the key issue we were looking at was simply a factual one of what people were doing on the ground.” Boyle and his Cabinet Office team decided early on to concentrate on schools, healthcare and social care, and set about meeting service users, professionals and interest groups from across the country to discover how people exercise choice in public services. His research gave rise to three key themes. First, how can the system give service users more opportunity to exercise choice? Second, how can service users navigate the choices before them? And third, how can we make services responsive and flexible enough to support people in a more confident use of choice? These questions apply particularly to disadvantaged people, who might be less able to overcome bureaucratic barriers, make use of the internet, and travel to reach their preferred services.
For Boyle, ensuring that people understand the choices on offer is as important as the very existence of those choices – and this dual concern is borne out in his report. On social care, for example, he not only recommends that a national website of registered social care providers – plans for which are being developed – should offer “comparable information about the quality of individual providers, according to measures that are meaningful to service users”, but also that local authorities have a duty to signpost social care users towards independent advice about how best to spend their personal budgets.
Boyle explains another of his key themes – more flexibility in public services – with the example of a woman he met who has muscular dystrophy. Every six months she makes a two hour-round trip to see her consultant. “The doctor says: ‘How are you?’ She says: ‘I’m fine’, and she goes home again. What she really wants is to see the doctor when she’s not fine,” Boyle says. “But she can’t, because his timetable is full of appointments at regular, set intervals because that what the procedures say.” Boyle argues that if the woman could instead chat briefly to the doctor by phone or Skype “once every nine months or something”, while also having the option to go to see him when she’s not feeling fine, she would end up with a better service. What’s more, such flexibility in the system “could potentially release huge resources”.
Boyle says the ministerial reaction to his review has been positive, although a formal response won’t be made until some time this month. Assuming the government is keen to act, what would he like to see from civil servants working in the departments that would be most affected by his recommendations?
“Well, I hope they will use this to start thinking about choice more broadly,” he says, adding that while civil servants working in policymaking will be affected, implementing his review will primarily be about trying to shift attitudes among managers and frontline staff on the ground. Boyle adds that civil servants working in procurement and commissioning might also be affected: “I think [they] will in the medium term, because one of the subtexts of this whole area is how you benefit from some of the lessons of the ‘co-production’ agenda. The co-production agenda is about how you’re working as equal partners in the delivery of services with the people that are benefitting from them, and I think there are challenges then for the way you commission services.”
One key concern for hard-pressed public sector workers, of course, is whether implementing Boyle’s review will further increase already-heavy workloads. But Boyle insists he is not trying to add another layer of bureaucracy: “I hope not, because I thought very hard about where the levers are in these things,” he says. “Obviously there needs to be a shift in bureaucracy, but the way forward is not always to increase bureaucracy; it’s sometimes to increase the flexibility and the manoeuvrability in the relationship between service users and professionals.”
So what is required to implement the review? Will it need legislation? “It requires enthusiasm,” Boyle says with a laugh. “In the end you can’t get enthusiasm by changing the law. You get enthusiasm by taking hold of an agenda at every level and running with it; and capturing the imagination of frontline staff about what more flexibility means; and understanding that if you [support choice] effectively, the resources will be there to provide it.” And this, he believes, is precisely why the agenda makes sense for civil servants: “In the end, this is about effectiveness... because the bottom line is how you make public services more effective. And if you make them more effective, then of course they will cost less; but in a sense, that’s less important. They need to be more effective for the people who are using them, and that’s in everybody’s interests – civil service included.” Improving the effectiveness of public services is, he says, “the subtext of what the review is all about.”
Of course, taking hold of an agenda and making sure government runs with it at every level is quite a challenge, which is why Boyle’s final recommendation is for the appointment of a prime ministerial adviser on broader choice in public services: somebody with the experience and influence to ensure these ideas can be rolled out in practice.
David Boyle’s suggestions are both sensitive and sensible: they offer a way to shift the power of choice back towards people – particularly those least able to articulate their needs – without an expensive overhaul of the system. Despite his unruly hair, this economist comes across as anything but mad.