David Cameron made a truly radical speech yesterday on modern public services, a subject close to his heart. Cameron was clear in his ambition to make our schools and hospitals among the best in the world. This will be achieved by giving “more choice to those who use our public services and more freedom to the professionals who deliver them.”
Choice is a key philosophical dividing line between the Coalition’s desire to improve the services people receive and Ed Miliband’s union backed protection of the status quo.
One of the criticisms that will emerge over the next few weeks is that Cameron’s approach will foster a ‘Postcode Lottery’. Yesteday on Channel Four News, Jon Snow forcefully asked a health minister if, under the new proposals, a person will get the same treatment in Cornwall as they would in Cumbria. I celebrate the fact that this is not guaranteed. The concept that our Government’s priority should be that, from John O’Groats to Land’s End, there exists a homogeneous system controlled by Whitehall is socialist, statist, and most importantly counter-intuitive to peoples’ needs. All areas should be encouraged to provide services that are better than those in the neighbouring borough. It is through competition that we all improve.
Those who criticise this approach as being lassiez-faire are wilfully misinterpreting the point. The state has a hugely important role in ensuring basic standards are met and that those who succeed pass on their lessons to others. Instead of holding people back, the Coalition’s approach is to let the fastest run as quick as they can, while helping others to catch-up and maybe overtake.
Of course, I am not really talking about a ‘Postcode Lottery’ as this implies luck as being more important than endeavour. Instead of: “You’ve got to be in it to win it”, Cameron’s approach is: “You’ve got to be a part of it to improve it.” We are in control and we have responsibility.
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RT @betapolitics: “@PlatformTen Encouraging the Postcode Lottery http://bit.ly/hTMfvb" A blog from me on encouraging advancement, not homogenisation
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Another good post Nick, the term ‘postcode lottery’ is certainly a damaging shorthand to indicate concern about service standard variations. Richard Reeves, former head of Demos and current Clegg advisor, argues we need to think about Postcode Democracy instead (I think Clegg has started using the term as well).
I suppose that there is a second element beyond variations in standards that people object to, the idea that the content of those variations can be objectionably arbitrary – for example in some councils you can’t recycle cardboard, in others you can’t recycle plastic, others don’t seem to collect recycling at all. The boundaries between which these variations happen can also seem arbitrary (which was one of the reasons behind scrapping LEPs). I think many people fear a situation where you move two blocks east and you no longer qualify for surgery (or, as now, you need to move to get your children into a particular school).
That’s terrible! That attitude will just entrench inequality, not fix it! Govt’s goal must be to lift national standards in NHS – allowing increasing regional inequality is against essence of NHS. Those in poorest areas are least able to ‘improve’ their hospitals, and have most work to do… sounds unfair to me.
I think it’s important to distinguish between negative regional variation (e.g. higher rates of misdiagnosis in one area) and tailored regional variation (e.g. increased infant health services in an area with a young population).
The latter should be encouraged, but the former must be minimised.
Adam – Thanks for pointing me in the direction of Richard Reeves. “Post-code Democracy” is a good way of describing what is happening. You make a very interesting point about the arbitrary nature of having varying services. One of the important roles for Government – at all levels – is to allow comparisons to happen and to facilitate change. The point about people not wanting to move is a very good one and needs further consideration.
Rupert – Your attitude is a bit defeatist. I don’t see why the ‘poorest’ areas should not come up with good ways of improving the services they receive. The Government is there to ensure that certain basic standards are always met and to help those who fall behind catch-up. Everyone can only improve if we allow the successful to innovate.
Bryonny – I agree but it is worth remembering that negative regional variations already happen, even though the last Government tried to have a homogenous system. What is important is that where areas slip behind they can learn of good performing areas to improve.
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