For much of the past century, public services have been managed as producer monopolies, and success has been measured by the growth of inputs – police numbers, hospital bed numbers, infrastructure spending – measures that have little meaning to end users. Even when they do try to understand the needs of service users, producer monopolies don’t always get it right. The question is how can we reorient the public service economy so that it focuses on service users rather than producers? The following are five big ideas being explored throughout the industrialised world to explore this objective.
1) Choice
The first and most obvious of these is choice. For obvious reasons, producer monopolies aren’t particularly enthusiastic about consumer choice. In the UK, for example, there has been vigorous opposition from producer interests. They have argued that what the public wants is not choice itself, but the benefits that choice brings. They have argued that choice is largely a game for the middle class, and would contribute to greater unfairness in society. In fact, the research has consistently shown that the public does value choice for its own sake. Choice (or rather the possibility of not being chosen) also creates powerful incentives for providers to upgrade their service and to anticipate users’ requirements.
Vouchers are the conceptual framework through which we must approach this issue, even though politicians will engage in verbal somersaults to avoid using the ‘v’ word. Vouchers may be explicit (using physical objects such as food stamps or smart cards), or implicit (with providers being compensated by government based on the number of eligible users they attract); prospective or retrospective.
They may be universal, such as the Australia’s Medicare card, which ensures basic health services to every Australian, free of charge; or targeted to a specific section of the community. They may be used to extend services to the disadvantaged, as with the UK’s Home Access programme, which enables families of qualifying school-age children to purchase computers and support contracts from local stores; or to incentivise school improvement, such as the Florida A+ programme, which provides vouchers to students whose schools are assessed as performing poorly over time.
Of course, choice implies a diversity of service options, so that this concept carries with it the need for much greater variety in service provision than we have witnessed over the past half century.
2) Seamless government
Government is always half finished. Whether we are talking about the regulation of industry or the delivery of social care, government usually organises its public offerings so that they reflect the logic of the various departments and agencies, and not so they make sense to service users.
In the US, the answer to stove-piped service delivery is referred to as ‘seamless government’. In the UK, it is ‘joined up government’. In both cases, the term which seems to suggest a solution is, in fact, a restatement of the problem – how do we join up public services so that, instead of being organised in a way that is convenient to producers, they make sense to service users?
There have been a variety of ‘solutions’ over the years – super-ministries, pooled budgets, one-stop-shops, case managers – and none of them has delivered a truly effective solution. There is general agreement that information technology is one of the keys: the electronic interface can deliver the appearance of a joined up information service, and we are making some progress in this way. In the UK, Business Link provides a remarkable online service to business proprietors.Yet when it comes to human services, ‘joining up’ remains a challenge. One of the most promising solutions lies in the ‘no wrong door’ approach first explored in the United States more than a decade ago. The underlying concept is that different people enter the social care system in different ways – some may perceive their problem as unemployment, others may see it as homelessness, someone else may first enter the system through an encounter with the law.
There is no point in telling these people that they have entered the social care system through the wrong door. The objective must be to provide them with the integrated care that they require, no matter how they initially perceive their problem: no wrong door. The answers seem to lie in joined up information systems and highly effective case management, but to date, these have proved difficult and costly to implement.
If we have reason to believe in the potential of joined-up government, it is because the public are becoming increasingly frustrated at the siloed nature of modern government, and because politicians and public officials continue to experiment in their search for a solution.
