Public services could be more effective, less expensive

I wrote last week about the emerging new kinds of public service organisation, and got quite a response. I didn't write about it before, but I'm constantly struck by the gap between the way public services have been run since the Blair-Brown years - like assembly lines - and the lessons from the most innovative enterprises emerging in the USA, which genuinely understand their staff have something to offer beyond mere obedience.

But fascinating new research from Birmingham University seems to demonstrate something of what I've been saying about scale. They have spent the past two years studying micro-enterprises in social care.

There are opportunities under the new Care Act, one of the legacies of the coalition years, to encourage micro-enterprises, because they tend to be more innovative, more personal and more flexible.

What I hadn't realised until I read the research (thanks, Alex), was that they are also more cost effective.  This is what the research summary says:

"The distinctive contribution of micro-enterprises appears to be the ability to offer more personalised and valued care without a high price tag. Price data provided by all of the organisations in the research indicated that the hourly rate for micro-enterprises was slightly below that of larger providers. As we indicated above, this was not at the expense of quality, as responses on personal control and use of time ... were at least as positive as for larger providers. With the larger providers it was easier to identify trade-offs between price and quality: the cheapest prices were offered by those that conformed to the 15 minute care visit model, and the people who used these services reported high rates of turnover among care staff. At the more expensive end of the market, larger providers were able to match the micro-enterprise offer more closely, providing longer care visits and better staff continuity."

This is important. It is a continuing mystery that there are models available for problem areas of public services in other parts of the world, which are actually more cost-effective than the problem models that dominate the UK - yet we are only tiptoeing in that direction.  

Here are three of them:

1.  Micro-enterprises in social care. See above. They exist in ever greater numbers in the UK, but policy-makers seem somehow to overlook them.

2.  Co-operative nurseries, considerably less expensive than conventional ones, but using some parent energy and knowhow, as they do across Scandinavia and North America, but barely here.

3.  Local area co-ordination, also in social care, the informal solution from Western Australia, and working very well already in Middlesborough, Derby and some other places, but being rolled out ever so slowly.

So here's the question, and it is one I try to answer in my book The Human Element. Why, despite the austerity years, are UK public services so staggeringly stuck?  And why are big changes not even advocated by the Left or Right?

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