The 2020 Public Services Trust Blog

The RSA hosted a packed lecture yesterday from Andrew Lansley, Shadow Secretary of State for Health.  He talked on the subject of ‘Improving Health Outcomes for All’, sketching out a blueprint for a future Conservative Party policy agenda. 

Overarching themes were ‘responsiblity’, ‘reform not reorganisation’, ‘choice and empowerment’ and ‘efficiency’.  Some were better explained than others.  Anyway, here are my quick reflections on the main points:   

Empowering Frontline Professionals

The Shadow Secretary placed considerable emphasis on the need to empower frontline professionals – the most obvious example being GPs who, under Conservative plans, would be far stronger guardians of quality control, holding hospitals (for example) to account.  Questions here concern potential variation in service levels, and the potential capacity of GPs.      

From Targets to Outcomes

This shift of responsibility downwards would be representative of a broader move towards an outcomes-driven approach to public services.  Mr Lansley was unequivocal about the need to do away with top-down ‘tick box’ targets, and towards broad public health outcomes.  But as Matthew Taylor notes, one danger is that broad outcomes can simply become umbrellas for ‘proxy targets’.  And some targets may be necessary - does the Shadow Secretary’s position risk throwing the baby out with the bathwater?

Choice & Competition

The Shadow Secretary talked about the need for more and better in this area, as a means to make essential efficiency savings, and to drive up quality. There is broadly consensus across parties on this.  But this will be contingent upon…

Access to Information

The lecture set out access to good quality, comprehensive information as key to making a choice agenda work.  But as my colleague Matt Grist pointed out, Robert Shiller and even George Osborne have recently spoken on the need to get past the assumption of rational, economic decision-makers.  I can’t help feeling that more thought needs to be given to appropriate choice architecture in this area. 

James Purnell spoke at the 2020 PST yesterday, giving his take on the future of welfare in Britain.  I thought he spoke well and had some sound ideas, even if the gathered press seemed more interested in his denial of alleged tax avoidance…

His vision was of a ‘proactive welfare state’:  “An active welfare system alone simply requires people to work.  A proactive Welfare State seeks to create those jobs and opportunities.  It is based on supportive conditionality and it requires up front investment.” 

This effectively means more active labour market policies, and an emphasis on lowering the barriers to work.  To this end, the Secretary of State argued that “universal childcare is the foundation of the Scandinavian welfare systems which progressives in the UK rightly aspire to.  In these countries support is both more generous and more conditional, where investment in people is the route to higher employment and lower child poverty.“

But as my colleague pointed out after the speech, the trade-off for this (in Scandinavia at least) is public acceptance of a higher level of personal taxation.  Whether the UK is ready to go down this road is certainly up for debate…

One other phrase that stuck in my mind during the speech was ‘supportive conditionality’.  The Secretary of State argued that welfare conditionality was necessary, but should be cushioned by a raft of supply and demand-side measures – matching “responsibilities to real power and opportunities.”  This is a re-balancing act that gets to the very heart of the relationship between citizen and state in all kinds of areas, not only welfare.     

Conditionality has always been a loaded phrase for those working in international and development politics.  So I was intrigued to see an article in World Politics Review (published the same day) on the new, relaxed ‘International Monetary Fund 2.0’. 

The article suggests that the IMF is “repositioning itself as a lender for crisis prevention more than crisis resolution. The fund (has) created a new lending instrument known as the Flexible Credit Line…aimed at reassuring international investors by injecting essentially condition-free equity into qualifying countries with strong records of macroeconomic performance. “

A cynic would suggest the Fund is simply taking advantage of a captive new western market (or indeed serving the very countries that capitalise it), but, apparently, “conditionality reforms for lower-income countries are planned for release this summer.”

Lessons from both Purnell and Strauss-Khan?  One is that conditionality can only work when responsibility and agency are shared.  There will generally be a sharp power imbalance between those who need welfare support, and those institutions who are delivering it – but the whole point is that this support should start to redress this imbalance, affording citizens (or even states) the means to demand more and better from themselves, or even leave the system altogether.

I’m eagerly awaiting one of the most exciting ideas on the policy scene soon to come out of Demos. Philip Blond’s ideas on recapitalising the poor.

“Follow the money. Always follow the money.” One of the best lines in movie history from All The President’s Men. Deep Throat gave us a lesson that all politicians have now as an axiom – if you want the truth, follow the money.

What Philip and Richard Reeves are recognising explicitly is that if we really want the poor to have power, the answer’s money. It’s not a new idea – ippr did a great piece of work on asset based welfare a few years ago. But the closest it got to policy was the Child Trust Fund. Might Philip hit third base with this one?

And, if it does make it into policy, what will it mean? See the Demos blog for a really good debate on this. Meanwhile, Conservative policy on schools includes a pupil premium – proper money which will follow poor kids and so give them power for the first time in the school system. Follow the money.

It makes you ask what we’ve been doing so far – finding ways of making the welfare system work for the disadvantaged, or simply finding ways of managing them at a convenient arms length.

At the 2020 we have sessions coming up with Alan Milburn on social mobility, and Philip Blond on the implications of his ideas for public services. It will be very interesting to hear what they have to say.

There is another important story that lies behind the expenses crisis that has engulfed Parliament – the ability of public services to promote its success to the people it serves.

The focus on efficiency in the delivery of public services has intensified in recent years. The public demands better services and government has responded. Waiting lists have been cut, class sizes reduced and social housing renewed. But we have also seen growth of jobs, salaries and support services, such as public relations. This was sustainable in the good times, but more difficult to justify in a recession.

Some politicians appear to be responding to this crisis by burying their heads in the sand (or their expenses form) and pretending that it doesn’t exist, others are calling for hasty cuts in existing services. Neither approach is appropritate for these unique times.

In the same way Barack Obama has engaged the American people to justify his fiscal stimulas package politicians in the UK need to make a case. Government on every level has to respond to the public mood. This does not require a massive government PR campaign. It does mean smart tactics to win advocates and make better use of our existing resources.

But unless we challenge our organisations to act in a way that catches the new public mood, the corrosive impact of waves of media coverage about wasteful spending will damage the reputation of government for a generation. This in turn will reduce public trust and diminish the ability of public servants to build stronger communities, attract inward investment and build trust in public services.

I went to see The Specials last night at the Brixton Academy. Me, my mate Stu, and a sea of middle aged rude boys and ex skinheads. It was great.

It sent me right back to the late seventies and early eighties, that period of desolation and decline: the concrete jungle, the ghost town, the fighting on the dance floor. The Specials summed up a generation of alienation and blight.

But was well as being brilliant, they’re a good reminder that how we deal with the current recession isn’t just a question of co-payment, effective targeting of services or innovative outsourcing arrangements. It is about how we all live our lives in our towns and villages. And we need politicians brave enough to be talking about the big stuff, the social stuff. When Margaret Thatcher said there was ‘no such thing as society’, she made it so. And so The Specials, playing back what ‘no society’ meant down on the ground.

In recent years politicians have worried about their ability to have a big effect, their powerlessness in the face of global forces and complex society. But they are more important than they sometimes think they are. They can create a positive vision, big politics.

Maybe the real judgement on today’s politicians won’t be in the history books, but the band that sums up the naughties.