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Unpredictable reform

January 17th, 2011 Posted in health, Public Sector Reform by

It is unlikely the Prime Minister’s cliché-ridden speech today will go down in any anthology of great political rhetoric. It was at any rate reported mainly in the context of a story about groups representing powerful vested interests expressing concern their power would be diluted, prior to the release of a Health White Paper, later this week, that will suggest diluting their power.

The speech was wider that, it attempted to paint a picture of what the Coalition government will be doing to ‘modernise’ public services across the board. Broadly more opportunities for user choice, professional innovation, competition between providers, transparency, and devolution of control. Things we welcome, and that will largely only be opposed by those for whom any retreat from public sector purity runs the risk of actually improving services.

One criticism hurled at the proposals for example from the British Medical Association, a trade union for doctors, is that the outcome of reform is unpredictable, much like receiving treatment from their members. And this as opposed to the entirely predictable decline of British health provision relative to the rest of the OECD where such ‘modernisation’ has been common practice for decades.

Where possible competition and choice in any service are important drivers of innovation and productivity. Planning services by diktat or committee may hold an appeal for some members of the BMA, who perhaps suffer the medic’s delusion of perfect foresight. However there is no reason to believe that this works any better for health and education than it did in the old Soviet tractor factories.

Innovation and service improvement relies on people behaving unpredictably, entrepreneurially, thinking and acting differently. It relies on organisations have the flexibility and responsiveness to identify change that works and implement it in their own way, sensitive to the needs of their own users. It doesn’t generally happen through political consensus building by strategic authorities and national pay bargaining.

It would be good if the government would consider going further, perhaps re-examining systems that incentivise people to put more of the own money into their services. Whilst the left scream queue-jumping and fairness. The consequence of creating large walls between what is free and what can be bought, is that less money goes into services, whilst that which does is inefficiently allocated.

What I do think will be fascinating is how the BBC handle these changes in their flagship Casualty and Holby City franchises. Whatever happens in the political debate, public perceptions will in no small part be driven by popular media. Perceptions of crime levels for example are quite close to those painted by soap operas, rather than reality. Cameron might, in that regard, be wise to speed up plans to privatise parts of the Beeb before getting too radical with the rest.

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