In the summer we asked Whose NHS IS It Anyway? and answered that in the NHS Allliance’s eponymous manifesto. The way the Coalition Government’s policy is developing, we should now be extending the ownership question to all public services. The main reason is this: the flip side of the “Big Society” is a smaller (possibly much smaller) state provided sector. That focuses the ownership issue: who controls the more reduced and more targeted services the state provides is a question that won’t and shouldn’t go away. If there are tighter needs criteria to access services, then users must co-create the approach or the Coalition’s appeal to “fairness” will ring pretty hollow.
Future gazing at shifting horizons
There are some positive statements about the benefits of citizen engagement in the recent 2020 Public Services Trust report ( chaired by Andrew Foster) that could be used to support specific arguments in Whose NHS Is It Anyway? and other public services. The “2020” work and other signposts to the “small(er) state” new order such as Magna Carta for Localism from London Council leaders in Wandsworth, Westminster and Hammersmith&Fulham are strongly influencing the Coalition’s direction for public services reform across the board.
You can see this in Deputy PM Nick Clegg’s recent speech to the Institute of Government on “horizon shift” by which he meant a radical redistribution of power away from the centre.
A shift to localism must bring local ownership with it – and that does not mean local bureaucrats in control it means local communities in control. To prepare for this, we need to be thinking more widely than just health as all public services are interconnected and users would like to interact and influence them without barriers.
Engagement in the smaller state and bigger society
Questions to address include:
What could engagement be like in a much smaller state funded sector?
Would engagement be different in “Big Society” initiatives, if so how and why?
What competencies do lay people need to make an effective contribution?
What new levers are easiest to pull nationally and locally that make a difference?
What kind of lay representatives will be fit for purpose in this new environment (implications recruitment and selection)?
What will be their training and support requirements and who will supply this?
What does everyday participation mean when the centre is no longer in control of many things? Must everyone become a professional lay person to have a voice that is heard?
All of us are Owners
Earl Howe, coalition health minister in the Lords, speaking about GP commissioning at the Kings Fund on 13 September reiterated a tenet of the new government:
“Our proposals for GP commissioning will push decision making much closer to patients and local communities and ensure that commissioners are accountable to them. … This government believes that power is something to be given away, not hoarded. Local services should be accountable to local people.”
Lots to consider here. Whose NHS Is It Anyway? is just part of the answer to a much bigger ownership question. Moral ownership and a right to have a say in how they are organised and delivered and that makes all of us “owners” of public services and that is true irrespective of our contributions as taxpayers. Our friend Caroline Oliver was eloquent on this recently.
We believe government should be taken at its word about wanting to give away power. It is time for the owners to start raising their voices in the conversation about the future of public services. That way we will find the synergy between active citizens in all the sectors from health, care, environment, transport, education and beyond.