The illusion of choice
May 16, 2012 2 Comments
Last year’s Open Public Services White Paper set up free schools and the Payment by Results Work Programme, among other changes. It also proposed establishing a framework for choice in health services, adult social care, early years services, schools and further education. Government departments are drawing up Choice Frameworks, to outline what choice should be available, who is responsible for providing the choice, what quality and inspection measures will be in place and what support people will have to make informed choices and complain if things go wrong.
Since choice became one of New Labour’s mantras, there has been a continuing over-optimism across public service reform about the power of choice alone, to the point where you could be forgiven for thinking that choice is a goal in itself, rather than a way of improving better services.
If you ask people if they want choice in services, they say ‘yes’. but if you are asked if you want A) a choice of services of varying quality, some of which may be at capacity, or B) no choice but a guarantee that all services are good enough, which option would you go for?
People who see choice as a good thing often have a high level of faith in the power of free markets to self-regulate and to improve to meet consumer demand. They are, therefore, often less keen on the idea of intervening in the marketplace to shape what is on offer: after all, the point is that individual choice will play the role previously played by governments, commissioners, inspectors and all the rest of the traditional service sector.
But the introduction of personal budgets and Direct Payments in social care has shown us that introducing choice without increasing the diversity of providers in the marketplace can mean that my choices are rather theoretical. In fact, the chooser can easily become the chosen. This happens in the choice of schools, where you may need to be rich enough to move next to the best local school, or to find another way (such as regular church attendance) of meeting the school’s criteria , rather than schools competing to meet yours. In social care I may find I have complete control of the money allocated to me, but only a small range of large, traditional providers from which to choose.
So choosing, thought of as being powerful and active, becomes passive and limited without the state taking strategic action, or helping groups of service users and their families to take that strategic action. This is arguably the thinking behind free schools, which can be set up when groups of parents get to together to commission them. The risk being that removing resources from existing schools can do more harm than good in the context of large, building-based services with captive audiences, which is what schools are.
In social care, citizen-led commissioning is in its infancy, but perhaps carries fewer risks, because services tend to be smaller scale and so resources can be shifted and services decommissioned with less impact (although many affected by clumsy day centre closures, for instance, would I’m sure disagree). The forthcoming social care White Paper is also likely to talk about the need for the choice agenda to be matched with a responsibility agenda. This is often heard (and sometimes in other contexts meant) as judgemental or punitive, because ‘responsibility’ is too often considered in purely financial terms (do you contribute more in taxes than you cost to the taxpayer). But the best solutions to social problems and support needs are those which are genuinely co-designed and co-owned by the people affected by them. This does not mean shunting risk onto individuals and families without any consideration or shared decision-making, but it can mean helping people and those around them to find more fruitful partnerships and supportive networks.
Reformers in the public service sectors currently drawing up their Choice Frameworks could learn much from the social care sector. The Royal Society of Arts has just published a paper on this subject called Personalisation: lessons from social care, in which I set out these lessons in more detail.