Mutuals: Government must deliver on radical public services agenda, says Institute for Government

By David Bicknell

Responding to the Government’s Open Public Services White Paper launched by David Cameron this week, the Institute for Government says the agenda is a radical one, but failure to deliver will come at a cost.

Commenting on the launch, the Institute’s Programme Director, Tom Gash said:

“There’s not much that is new in this white paper but it is still a radical agenda for change. Other governments have tried and failed to remodel public services. The difference this time is that the stakes are higher. With massive cuts to public spending, if these measures don’t work, the state will not be in a position to shore up services.

“A white paper by itself doesn’t change anything. To make this vision a reality, a lot of work lies ahead. Failure to take these next steps in any of the policy areas covered by the paper will lead to the risk of future u-turns, uncertainty and failure”.

The Institute argues that several key issues need to be addressed going forward. These include:

  • Mechanisms for accountability in service delivery must be thought through. Voting in a local election is very different from choosing your GP but in future there are likely to be different combinations of accountability mechanisms for different services.
  • Whilst removing top-down targets  and giving greater autonomy to frontline professionals, government must still be clear on the lowest level of service permissible before this autonomy is withdrawn or restricted.
  • Transparency – data will need to be accurate, timely and accessible if people are going to be able to use it to exercise their choices.
  • Ministers will have to be willing to relinquish power. They’ll still be held responsible for local decisions even though they no longer have control over them.
  • As public services are opened up to new providers, ministers must be absolutely clear about who is responsible for what.
  • Mutuals will need to have the scope to blend state and private investment and not be soley dependent on a single source of funding.
  • Commissioning for outcomes must focus on those outcomes that are measurable. But measuring outcomes is often harder than measuring outputs. For example, it is easy to measure whether a hip operation took place. It is less easy to measure whether or not the operation has improved the patient’s quality of life.

The Institute argues that policies in the white paper are at different stages of their development.  Ministers, central and local government and practitioners will all have work to do if they are to ensure that they are implemented in a way that genuinely improves public services and the lives of citizens. Drawing on its publication Making Policy Better, the Institute recommends that departments will need to:

  • Carry out a “reality check” on policies, involving implementers and/or users of services in testing or piloting them.
  • Consult those affected by changes and address the issues that arise as a result of these consultations.
  • Ensure that policies have been properly costed and that they are resilient to external risks.
  • Make sure the role of central government is properly thought through and that it is clear who is accountable for delivering particular services and the criteria on which they will be judged to have succeeded or failed.
  • Have plans in place for collecting feedback on how policies are being delivered in practice and the mechanisms are in place to act on this feedback.
  • Make sure that policies are implemented in a way that allows government to assess whether they have worked or not and how they can be adapted and strengthened.

 Gash added:

“In order to avoid repeating the experience of the beleaguered NHS reforms, the coalition will need to invest a good deal of time and resources in delivering its radical programme for reforming public services. To publish a white paper and then walk away will not be enough but today’s announcement, with its emphasis on consultation and analysis seems to show that government has learnt from its mistakes and is ready to take the time to deliver something which could change forever the way citizens choose and receive their services”.

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