Most politicians now accept that citizens should have a choice over how they receive their services. But the debate is still bogged down by a tendency to use loose terminology, so that the same words have different meanings
The centrality of choice to current public service reforms is testimony to how far we have all travelled over the past 30 years. Once choice was considered irrelevant or, even, sinister; now the main political parties fall over themselves to be its champion.
But this apparent consensus should not disguise the huge amount of work still to do before choice is real for many citizens. A new report from the Management Consultancies Association Choice in Public Services: Making choice real sets out to answer some of the harder questions that policy-makers and service deliverers are grappling with.
For choice is not a simple proposition. If it were straightforward, we might well have done it by now. And, crucially, there would be clarity about what we mean, and the differences it should make.
The coalition government’s vision is both radical and attractive. As it set out in the 2012 report on Open Public Services:
'We have only begun to achieve the changes that will be required before we can truly say that open public services deliver effective choice to citizens, are decentralised to the most appropriate level, are supplied by a diverse range of innovative providers, ensure fair access for all citizens, and are transparently accountable for the service levels and outcomes they deliver'.
The aim is clearly to embed greater choice as deeply as possible. But this debate is still bogged down by the tendency of both advocates and sceptics to use their language loosely, so that the same words come to mean different things.
After all, it is common sense that choosing what type of car to buy, where to buy it, and where to drive it are different choices. They may be related or have no mutual bearing at all. It is certainly misleading to talk about them as if they are all the same thing.
The MCA report recommends a new typology of choice, using concepts such as ‘horizontal’ and ‘vertical’ choices. Horizontal choices are where users can select from different suppliers of a particular service (such as choosing a new GP or care provider) and vertical choices are where people choose from a menu of service options that are available.
While this language may need to be adapted, it is important that we all come to understand and acknowledge the differences; these distinctions will help create good policy, dispel muddled thinking and increase public understanding and support for reform.
The report also proposes a new system of Choice Concordats. These would set out, for each service or public institution, the choices that it offers, and the reciprocal responsibilities that it demands of citizens. The information that citizens receive about their choices – relentlessly offered – must be thorough and accessible.
Equally, users may need to be open as well. Citizens may only be able to access richer and more personalised services if they are prepared to share more information about themselves or their circumstances. The Concordats should spell out what we could all gain from greater openness.
While this report is primarily intended as a submission to David Boyle’s review on barriers to choice for the Cabinet Office, we hope that it will make an influential contribution to wider policy and management debates. Few ideas in public policy have as much power to do good – or to wreak havoc – as choice for the citizen.
Alan Leaman is chief executive of the Management Consultancies Association
