More Choice for the Citizen – Published in Magill Magazine July 2008

2nd July, 2008

Click below to read Paschal’s article as Published in Magill Magazine July 2008

This year marks the 100th anniversary of a revolution in how government provides for their citizens. A similar revolution is now needed in how public services are delivered to ensure they can keep pace in our rapidly changing and globalised society. Coincidentally, the Organisation for Economic Co-operation and Development (OECD) recently published a landmark report on the state and future of our public services. It recommendations are good and worthy, suggesting greater mobility for public servants, more managerial delegation and greater accountability for performance and spending. The point is that we need more radical thinking on the structures that deliver public services, not just the standards. The government must be courageous; we must give the power to those using our schools, hospitals and services and allow patients, parents and families make the decisions that set the pace for reform. Brian Cowen should be brave and give power back to the people.

Conditions were very different one hundred years ago. David Lloyd George, Chancellor of the Exchequer of a reforming Liberal government, introduced the first ever non contributory old age pension at 5 shillings per week for individuals over seventy ‘of good character’. The Children Act of 1908 sought to stop the imprisonment of children and to protect children at risk. These measures laid the foundations for the Trade Boards Act of 1909 which applied minimum wages. Moreover, the famous People’s Budget of the same year introduced explicitly redistributive welfare and tax policies. This remarkable period of legislation and policy change established the basis for the creation of the modern Irish welfare state.

The 1908 public service model was one where patients, pupils or the aged were regarded as passive supplicants who should be grateful for whatever they received. The social conditions at the turn of the twentieth century warranted such thinking. These assumptions are no longer valid and must be challenged to reflect the impact that technology, longer living and higher educational attainment has had on our citizens.

In the century that has passed, profound changes have occurred both in the nature of policy challenges now facing us and the society within which they arise. Globalisation and European economic integration have reduced the tax and spend options open to government. Rising expectations due to greater education warrants that those using public services are better able to appraise the quality of what they receive and compare to other experiences in their lives.

In 2008, Ireland swims in a sea of irony. Private and professional empowerment has never been as high, yet the level of helplessness for many in dealing with public services has never been higher. Our imperative must be to give more power to users of public services. We can do this by simply giving individuals and families greater ability to choose public services and more information to influence the quality of service they are receiving. These objectives have been described as ‘choice and voice’. Decisions about the best place to go to school is or where to give birth are vital life choices so why not allow those making these decisions the information and choice they need to make these choices well ?

Delivering ‘choice and voice’ will create innovation and competition in how tax payer’s money is spent. This need will get more acute. The globalisation of our economy happened during a time of exceptional worldwide economic growth. A return to normal economic conditions should create greater focus on how government spends our money. Stark focus is needed on a model that has seen public sector spending increase from €21 billion in 1997 to €53 billion in 2007 without a comparable change in the quality of service we receive. An agenda of reducing red tape, administration and quangos is needed but of itself will not radically change the model that turns our taxes into services. We must make the users of our services the genuine leaders in their reform, not vainly looking to make this happen through dictats from central government.

The new OECD report correctly identifies the scale of the challenge we face. It notes “ A more integrated approach at national and local level will better allow Ireland to more effectively meet the challenges of achieving wider societal goals and the delivery to the citizen of more coherent and integrated services”. As you would expect the burning passion that a teacher, pupil or patient will have for improving their services is entirely missing from an economic consultant report. What is also missing from this report is the recognition that the users of our schools, pension systems and hospitals should be allowed to play a role in setting the pace for reform. It’s recommendations focus on the use of e-government, budget frameworks and ‘networked approaches to working’. Entirely absent from these important strategies are those who fund and use public services in the first place.

To implement this new agenda within our schools, we should be supporting movements like Gaelscoilanna and Educate Together, where parents and teachers come together to provide different models of schooling. These movements create choice in how education is delivered in Ireland. This is good for pupils who chose to go to these schools and for other schools who must appraise how they educate. Parents should have more of a voice in how their schools work by the provision of timely and regular information to allow them to compare their school against other schools in their districts. This is the case in Stockholm where the local authority publishes a prospectus comparing the performance of each local school.

Choice in health demands the introduction of universal health insurance so that all patients, regardless of their income, can choose between a co-located and public hospital. Voice means that patients must be able to access the evaluation of their hospital for cleanliness, success rates in operations and variety of care methods. For example, on the British National Health Service web site : “Your Health, Your Choice” the performance of each hospital is publicly available. This equates to nothing less than a transparent world of choice for pupils and patients.

As a parent I should know how the performance of my child’s school quantifiably compares to other schools in my district. The state should also be providing me with a reasonable choice of schools, from an Educate Together school to a traditional church sponsored option. As a patient I should know how my consultant has looked after other patients in the past and the track record of my hospital in treating my sickness. Co-located hospitals should be providing choice for everyone, not just those who can afford it. As a tax payer I should know what local performance is delivered by the €20 billion that is annually spent on my behalf.

The government, led by the then Minister for Finance has tinkered around the edges of reforming public services. This has taken the guise of Value for Money Reviews assessing how money is spent in various government departments. By the end of 2007 40 of the 66 reviews had not been published with no apparent action to make our money do more. Reform, led by the centre, will not deliver the step-change we need.

Choice and voice will inevitably create competition, this is welcome. The need for our society and economy to deal with globalisation and it’s competitive pressures is one of the key challenges we face. If individuals have to respond to this, then so should the institutions upon which they rely. In many cases incentives to do better are already at work, with schools, hospitals and other public services searching for ways to improve their services. This could be because of competition for pupils or patients or the vital public service desire to do better. Accurate and regular information must be in place to allow users to know whether the forces for better performance are working, or to create them where they are missing. Crucially, funding for publicly funded institutions (whether they be schools or hospitals) must be in place to allow their professionals to do as good a job as their private counterparts. The implementation of a choice agenda must be done in a socially just manner, which merits the need for competition on a level playing field.

This is, therefore not a Trojan Horse argument for a conservative view of the state requiring a retreat from our lives or reducing publicly funded services. I explicitly support an increase in funding for our schools and hospitals depending on taxation to ensure the right class sizes or the right number of public hospital beds. However this must be done in a world where the users of these class rooms or hospital wards can themselves regularly understand the quality of the service and have the choice to go to a different school or hospital. This choice from either the private or voluntary sector must be created to ensure additional public money is well spent. Public service reform would therefore be bottom up and be led by those using these services.

A small extremely open society and economy in a turbulent world must have absolute excellence in the services their taxes provide. ‘Choice and voice’ means those using the services will play a crucial role in making this happen. I believe this will develop a genuinely reforming agenda to deliver social justice and economic competitiveness in a globalised world.