Thursday, 11 September 2014

Public services really need to be flexible

I note in passing that the new Lib Dem policy paper on public services has now been published. Before I go on, I should issue one warning about it. The name is nearly as long as the paper.

I also need to be transparent about this. I spent many a wintry and spring evening on the committee which wrote the report, and having now re-read it some months later, it is rather better and more coherent – and more radical – than I had remembered.

Lib Dem watchers will know that it wasn’t all plain sailing, or all sweetness and light either, but my friend Jeremy Hargreaves did a huge job pulling it all together, and herding us into vaguely the same place and I didn’t envy him (whatever I might have said at the time).

I write about it now to flag up what is, I believe, a tremendously simple and important proposal: the Right to Request Flexible Service Delivery. This is what the report says:

“An example would be a social care user who might want to request that the support to put them to bed for the night be provided in the evening, and not at 5pm, simply because that suits the service.”

You might add that it would apply to secondary school pupils whose reasonable choice of A level subjects has been stymied by the timetabling arrangements. Or the long-term patient who wants a consultant who will let them ask lots of questions, and many other small flexibilities.

It seems simple enough, and it won’t solve everything. But it is one of those proposals that can give more power to service users, without having to go through an exhausting and expensive structural re-organisation, which never quiet achieves what you want anyway.

It is also a simpler and potentially more powerful route than legislation to give people a legal right to choose. But it would have a similar effect of shaking up the system from the inside.

It was something that I proposed in the Barriers to Choice Review report which I wrote for the Treasury and Cabinet Office last year.

Despite what people say, and as I discovered for myself during the review, ‘choice’ is an extremely popular concept among people, but they are hazy about what it means.

There are, of course, a whole range of ways in which service users are given a choice – two of them are used by the Department of Health alone (the NHS and social care use very different systems).

The difficulty is that, sometimes, formal systems of choice, especially those invented by economists, can render the service even more inflexible than it was before. What people really need is more flexibility to ask for what they need, not what the economists deem is relevant.

That is why the right to request service flexibility is potentially such a powerful tool. It breaks out of people’s set views about formal choice and gives them a far broader choice of options, no matter how inflexible the systems are.

It would be modelled on the Right to Request Parental Leave. Service providers would not be obliged to meet your request, but they would have to explain publicly why they can’t.

It is also an antidote to pile-it-high-assembly line services, which claim to be cheaper but actually just spray costs elsewhere in the system.

I believe it is a human solution in a giant, inflexible system, and much more inflexible thanks to the Blair-Brown years. I hope the party adopts it.

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