Partners not victims

Policy Officer Morven Masterton sums up our event at the Conservative Party Fringe 

This session focused on how to improve public services, in particular, through reconnecting and engaging the public with the services they receive. With the Secretary of State for Health, the Rt Hon Andrew Lansley on the panel, alongside Dr Jennifer Dixon, Director of the Nuffield Trust, the session was intended to have a health slant but many of the issues raised applied to public services across the board.

Ben Page, pollster extraordinaire, gave an insightful snapshot of the data, opinions, trends and concerns of the public at large. He illustrated that at different times and on different issues the public believes the state should sometimes be enabling, sometimes be nudging, and sometimes be nanny-like. Though there seems to be general consensus that ‘the people in charge don’t know best’, there is not always a consistent view of what the alternative is. As public services are opened up to ‘any willing provider’ the question is who can provide most effectively? Ben’s MORI surveys showed that while people think the private sector is more efficient in service delivery, not-for-profits are believed to provide more caring and compassionate services. There’s a common perception among the public that you cannot make a profit and have a conscience at the same time.

The debate centred  on what reforms should look like and how to ensure they could garner the support needed to carry them through. For Ben and others, the key challenge for government is to think about the people working in these services. Ben argued that for health reforms to be fully realised, they must be backed by doctors and nurses and at present, many of these highly trusted personnel are critical of the NHS. The lack of support for the reforms from frontline deliverers raises a huge communication problem for the Government.

Jennifer Dixon stressed that engagement had to be at the right level. She argued that it is vital to involve the public in the things that particularly affect them and that efforts should be devoted to local level engagement. Her feeling is that at the moment, the public does not get the rationale for reform. It needs to be translated using terms that people can understand and connect with.

The Health Minister admitted that lessons had been learned from the health and social care bill. The NHS Future Forum demonstrated that the original consultation on reforms should have been carried out with organisations and individuals.  There needed to be a better discussion about what individuals expect the state to provide and what are they prepared to do themselves.

Mr Lansley went on to stress that choice and competition are not ends in themselves; they are a means to good services. For Government, it is about affecting a change in the culture of service provision.Mr Lansley was pleased to cite the 25,000 public sector health workers who had transferred into the social enterprise sector since the election, principally through  ‘right to request’. These moves were important progress in reaching the 10% of health and social care provision that will soon be delivered by social enterprises. When asked by Jonathan Jenkins, our new CEO, whether the Minister was pleased by progress in achieving his ambition to create the world’s largest social enterprise sector, he conceded that he would have preferred to be further along the road, but was positive about the future.

Matthew Taylor, head of the RSA and former strategist to Tony Blair, said that the new government was continuing and accelerating the public service reform agenda that Blair had started developinga decade ago. Matthew sees the problem now as being that public service productivity is flat. He explained that there is a huge aspiration gap between what we as citizens want and what we do. Citizens need to be more engaged, resourceful and pro-social. Matthew called for “socially productive public service interventions”, activities that encourage social interaction. He mentioned a few great examples - including the NHS Expert Patients Programme, where patients are involved in their own treatment and also help support others with similar problems - but said that these initiativesare few and far between.

Jesse Norman MP opened with the contention that ultimately we all want to have our cake and eat it. He gave the example of volunteering; people get involved when they think they are making a difference, when they can see the benefits and, when they can link up with others. He believes that the mere fact of ability to link is of enormous importance to human beings and these mechanisms of linkage are enriching to our lives. He gave the example of street parties which he said are famous for reducing disorder, primarily because “it's hard to mug someone you know”.

The session highlighted the complexity of the reforms and their wider impact on society. There seemed to be widespread recognition of the need for public sector reforms, acknowledgement that engagement, at the right level, is fundamental to seeing the reforms through, and that interventions and activities must be pro-social, fostering more linkage between both citizens directly and between the state and individuals.