On being taken seriously: part III

by Stephen Tall on February 26, 2006

John Rentoul’s column in the Indy on Sunday is usually worth reading, if only to find out what is the current Blairite line on any given issue. Today is no exception, except that I agree with him.

Rentoul highlights approvingly a speech made last week by the implausibly named Julian le Grand, Tony Blair’s former health policy adviser. Entitled ‘The Blair Legacy? Choice and Competition in Public Services’ it is, as you might expect, a staunch defence of Tony Blair’s attempts to introduce market reforms to improve our public services. It is well worth reading in full here, but below are a few, ahem, choice extracts. (The headings are mine.)

Why markets empower individuals

Chaining people to their local GP practice, hospital or school meant that providers who offered a poor or a tardy service could continue do so with impunity; for those badly treated had nowhere else to go. Giving providers a monopoly has never been a good way to improve a service of whatever kind; and the ‘old’ health service and school systems were no exception. …

What is needed instead is a system with incentives for reform embedded within it. Then providers will automatically provide a high quality service without having to be told to by the top. And these incentives should come from the users of public services: for, at the end of the day, it is the user’s needs and wants that have to be satisfied, and he or she is the ultimate authority on what those needs and wants are.

Choice is popular with most people…

In fact, contrary to … much anti-choice propaganda, choice is popular. Results for the latest British Social Attitudes Survey (22nd report) are even more revealing. In total, they showed a similar picture to the surveys. Asked whether patients should have choice of treatment, hospital and outpatient appointment time, 65% of those surveyed thought that patients should have a great deal or quite a lot of choice of treatment, 63% of hospital and 53% of appointment time.

… and especially popular among society’s most disadvantaged

this study also broke down the results by gender, social class and income. And these results many will find quite unexpected.

• 69% of women wanted choice of hospital; 56% of men.
• 67% of the routine and semi-routine working class wanted choice, compared with 59% of the managerial and professional class.
• 70% of those earning less than £10,000 p.a. wanted choice, but only 59% of those earning more than £50,000.
• 69% of those with no educational qualification wanted choice, compared with 56% of those with a higher education qualification. …

These results – sustained majorities for choice, especially among the disadvantaged – are not even confined to this country. The Joint Center for Political and Economic Studies in the United States conducted a National Opinion Poll in 1999 on education support for vouchers and school choice.

It found that:

• nationwide, 52 per cent of parents, and 59 per cent of public school parents, supported school choice.
• 60 per cent of minorities supported vouchers.
• 87 per cent of black parents aged 26-35 and 66.4 per cent of blacks aged 18-25 supported vouchers. …

So in general it is the poor, the dispossessed and the disadvantaged who want choice more than the allegedly rabidly pro-choicemiddle class. Nor, on reflection, should this be surprising. Because it arises from the fact that the middle class already do well out of the unreformed no-choice NHS and education system. With their loud voices, sharp elbows and, crucially, their ability to move house if necessary, the middle class get, as we saw earlier, more hospital care relative to need, more
preventive care, and better schools.

The question for those who oppose the choice agenda

I think it is legitimate to ask those who question this proposition whether they really believe that having local monopolies is the best way to achieve good local services. For, in rejecting choice and competition, that is implicitly what they are advocating.

Why choice could save the welfare state

The Government is pumping a massive amount of resources into public services. It is essential that this investment pays off – and is seen to pay off. But, if public services were left unreformed, the investment would not succeed. And in that case taxpayers would legitimately ask why they were pouring resources into services that were not delivering. And the result could be irresistible pressure to cut taxes and ultimately to dismantle the welfare state.

I have argued on this blog before that the Lib Dems’ knee-jerk opposition to the ‘choice agenda’ is short-sighted.

Local accountability and decent funding are vital for successful public services: but so too is the right of the public to exercise choice over the service they receive, and which their taxes are paying for.

Liberals who believe that individuals and communities are best placed to run their own affairs should aim to break down monopolies wherever they exist, whether in the public or private sector. That is the best way to improve standards, and the best way to deliver social justice.