28 September 2007
The Blairite era of public service reform was seemingly declared dead at this year's Labour Party conference, held in Bournemouth on September 24–27, as the language of choice and markets was banished in favour of a commitment to 'personalised' services.
But the new prescription for public services to be 'accessible to all, personal to all', first delivered by Gordon Brown and then echoed by other ministers, has sparked questions about the future role of the private sector in providing services and the use of competition to promote efficiency.
At the same time, doubts have been expressed about whether this week's striking shift in rhetoric necessarily reflects a deeper change in thinking about the nature and direction of public service reform.
Public Finance understands that, privately, ministers have been offering reassurances that the notably more conciliatory language being used is merely an attempt to mollify critics and improve, in presentational terms, the reform agenda. It does not signify a rethink over the speed or direction of public sector reforms.
'What they're saying in public is very different from what they're saying in private, which is that it's business as usual,' a source told PF.
Nevertheless, business leaders are seeking clarification over the impact that the pledges made by the prime minister and Health Secretary Alan Johnson will have on companies involved in, or preparing to enter, public sector markets.
Neil Bentley, director of public services at the CBI, told PF his members had been 'unnerved' by the government's abrupt change of tone on reform.
'The complete absence of discussion around choice and competition has been unnerving, but what has become clear is that they are still talking about reform, but doing so in a new way,' he said.
'While the narrative is changing, we need to see a continuity in the message: to the private sector, so they know the markets are still there and can plan and allocate resources; and to the public sector too, so they understand that the reform agenda continues. That message needs to come through much more clearly.'
By contrast, trades union leaders, who inflicted a series of embarrassing conference defeats on Tony Blair in recent years over the reform agenda, were enthusiastic about the government's change in rhetoric.
Dave Prentis, general secretary of the largest public sector union, Unison, said Brown had been a 'breath of fresh air'. But he added that the rhetoric would now have to backed up with deeds.
'Gordon now has to take action to deal with the issues that are between us. He could start by scrapping the markets and competition that are ruining our public services.'
GMB general secretary Paul Kenny said: 'It was good to see from the prime minister a recognition of the values promoted by the trade unions on issues such as… improvements in the NHS, the education system and the need for a massive boost in social housing provision.'
Addressing the conference on September 24, Brown vowed to transform public services so that users could be treated 'not as a number, but with respect'.
And he sought to establish himself as the defender of the health and education services, telling delegates: 'I will not let you down. I will stand up for our schools and hospitals. I will stand up for British values. I will stand up for a strong Britain and I will always stand up for you.'
The following day Alan Johnson picked up the theme of personalised services, arguing that the NHS had to become more patient-friendly. Citing GP services, which have been a source of bitter complaint among the public, he said they would have to open for longer and at weekends to meet the needs of service users.
'GP surgeries should be open at times and in locations that suit the patient, not the practice,' he told delegates. 'Pharmacies, sports centres and high street walk-in centres can do much more to provide primary care effectively and conveniently.'
The aim had to be to create an NHS that was 'clinically led and locally driven'.
But Liberal Democrat health spokesman Norman Lamb poured scorn on the pledges made at the conference.
'Alan Johnson has failed to answer the fundamental question of where Gordon Brown is taking the NHS. The health secretary has not explained how more personalised care will be delivered, or what the role of the private sector will be in delivering it,' he said.
Independent regulators promised for health and education
The regulation of education and health is facing a shake-up after Ed Balls announced the creation of an independent arbiter of examination standards and Alan Johnson began sketching out the remit of the Healthcare Commission's successor.
In his conference address on September 26, Balls, the children, schools and families secretary, said he would split the standards-monitoring and curriculum-setting functions of the Qualifications and Curriculum Authority.
Standards monitoring would be handed over to a new regulator, which would be independent from government to enhance its credibility and boost public confidence in the exam system. The new regulator will report to Parliament, rather than to ministers.
Balls told delegates that the move would settle 'once and for all, the sterile debate about dumbing down' that accompanies the publication of GCSE and A-level results each summer.
'I want to end young people being told that the GCSE or A-level grades they are proud of aren't worth what they used to be,' he said.
The regulator, which will require legislation to set up, will assess the value for money of the public funds invested in the provision of qualifications; accredit existing and new qualifications; monitor standards; and regulate the awarding bodies.
Chris Keates, general secretary of the National Association of Schoolmasters/Union of Women Teachers, backed the move as a way of silencing the 'serial detractors'. But she warned: 'It will be vitally important for us to ensure that it does not become an inflated and unaccountable system that overburdens students and staff.'
The previous day, Health Secretary Alan Johnson outlined plans for the new health regulator to be given tough powers — including the ability to levy fines — to enforce hygiene standards in hospitals.
The new regime, designed to root out killer bugs such as MRSA and C-difficile from hospital wards, would apply to private as well as NHS hospitals, Johnson confirmed.
'To ensure patients' safety I want a regulator with the power to close, clean and then reopen wards if necessary,' he added.
Gershon agenda is 'damaging local cohesion'
The government's efficiency drive is damaging local services and undermining local authorities' role as guardians of community wellbeing, according to a study by the New Economics Foundation, launched on September 26.
Lisa Sanfilippo, author of Unintended consequences, told a fringe event that the Gershon agenda was hobbling the government's other policies relating to communities.
Sanfilippo instead called for a radical rethink and the adoption of a 'public benefit' model, which would allow value for money to be judged against much broader criteria than just efficiency .
'Market solutions are good for market problems. But when it's about something more than that we need to think in more complex terms,' she said.
But Paul Coen, chief executive of the Local Government Association, argued that as the guardians of £80bn of taxpayers' money each year, councils had a responsibility to ensure 'expenditure is applied to best effect'.
He told the audience that such financial discipline would be even more necessary, as the LGA's own assessments showed town halls would need a funding increase of 2% in real terms a year just to maintain existing provision in the face of various cost pressures.
An annual rise of 4% would be required to fully fund its costs in the period ahead, Coen said.
But he revealed his pessimism at the likely outcome of the forthcoming Comprehensive Spending Review, due next month. 'We know that we're not going to get either of these figures.'
Against such a backdrop, he said, authorities would need to adopt 'a rigorous approach to traditional efficiency issues, and the highest levels of efficient operation that we can muster'.
PFsep2007
