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The choices that matterBy Martin McIvor Those tasked with preparing Labour’s election manifesto seem determined to make “choice” in public services the central issue of their campaign. “A modern progressive approach calls for choice to be redistributed, not ignored”, Alan Milburn has argued. “Expanding choice is about enhancing equity and opportunity, not undermining it”. At an abstract philosophical level, this cannot be argued with. The right has traditionally alleged that social and economic equality only advances at the cost of individual liberty. But the left has always countered that its objective is the equalisation of freedom, so that all can make choices that have historically been reserved for the privileged few. But as soon as we attempt to apply such principles to reality, the argument becomes more complex. As US academic Barry Schwartz argues in his book The Paradox of Choice, expanding our range of choices in one domain can restrict them in another. To take a notorious recent example, we now have an exasperating range of telephone directory inquiry services to choose from. But the effort it takes to find out which is the most reliable, or best value, and memorise the number, is effort many of us would rather expend on more interesting and rewarding pursuits. Indeed, Schwartz presents research to show that many of the choices offered by advanced consumer capitalism actually leave us anxious, dissatisfied, even depressed. The market forces us to navigate an ever-changing and ever-proliferating range of goods and services, when we might be using our free time to enlarge and enrich our lives in more meaningful ways. And so we have to ask, in public services as in all other areas of life, which choices matter? As a recent report from the New Local Government Network helpfully points out, “choice” in public services can mean different things. It may mean choosing what, where, when and how services are available. Or it can mean choosing who provides them. Once we get beyond the rhetoric and examine the actual policy prescriptions of New Labour’s most enthusiastic proponents of choice, it becomes clear that the choice they are most keen to entrench is the latter – a choice between different providers of services such as health and education. By the end of 2005, health secretary John Reid promises, NHS patients will be able to choose from four or five hospitals for non-emergency treatments, one of which should be private. Meanwhile new education secretary Ruth Kelly is proceeding with polices to increase “parental choice” by introducing more specialist schools and privately sponsored City Academies. The trouble is that there is little evidence that voters really want to have to make these choices. Last year the House of Commons education select committee reported that “the school admissions process, founded on parental preference, can prove a frustrating and time-consuming cause of much distress in the lives of many families”. And the fact, often cited by ministers, that most patients will opt for a hospital with a shorter waiting list if offered does not demonstrate that they want to be able to choose their hospital – only that, unsurprisingly, they want their operation as soon as possible. In fact, all the opinion poll and focus group evidence indicates that most people would much rather be able to rely upon their nearest and most accessible services, than have to pore over league tables and “shop around” for the best deal. This would mean that, among other things, their local school would be able to support a wide range of curricular choices, or their local hospital would run an efficient appointments system. It means high standards across the board, and flexible and responsive modes of provision. And the way to achieve this is through sustained public investment, collaboration and networking across services, and the empowerment of public service users through increased democratisation and accountability. It will not come about by breaking services up into separate “business units” and forcing them to compete for “customers”. This is why some in the Labour Party and the unions fear that all the talk of “choice” is really a clever way of packaging a set of policies designed to open public services to increasing private sector involvement, and offer the middle classes a way of gaining an edge on those less articulate and assertive. The paradox is that by forcing people to choose between providers in health and education “quasi-markets” may have the effect of limiting choices that for many are more important - choices about what kind of services are provided, and where and when they can access them. Moreover, by creating unequal hierarchies or “tiers” of service, and undermining public sector capacity, such policies could set back the ability of many to make the bigger choices about the direction of their lives that universal health and education services should be there to support. Those children who are not accepted by the most popular secondary schools will have their educational opportunities and their wider career options narrowed as a result. And last month it was revealed that already some NHS hospitals are closing down wards and services as public money is diverted to private sector providers, prompting the BMA to warn that the scheme could “destabilise the NHS”. This does not mean that those concerned with developing universal and egalitarian public services should set themselves against “choice” as such. Instead we need to focus the debate on the choices that matter. Either we can break up the universality and integrity of the welfare state in the name of an often empty “choice” between providers that will leave many with restricted options and diminished opportunities. Or we can commit to developing the public sector as an innovative and dynamic provider of a diverse range of services, equally available to all, on the basis of which every member of society will be enabled to lead fulfilling, self-directed lives. That is the choice that matters most, and is the choice that voters should be given at the next election. Martin McIvor is Director of the left thinktank Catalyst – www.catalystforum.org.uk. Published in Tribune, February 2005 |
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