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FEATURES - CONSUMER CHOICE

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Customers should be in control of choosing what public services they want, says Charles Leadbeater ...
Customers should be in control of choosing what public services they want, says Charles Leadbeater

IIf it wasn't for local government reorganisation, Anne Rhodes would probably still be doing tapestry every day.

Ms Rhodes was born with cerebral palsy and went to a specialist school for children with learning disabilities. When most people her age were leaving school for jobs or college, Ms Rhodes was directed to an employment resource centre on the edge of Blackburn. On her first day staff asked her what she would like to do: make curtains or tapestry. Unsure that either much interested her, she opted for tapestry.

Ms Rhodes followed that routine every day for 17 years until 1998 when Blackburn with Darwen BC took over the centre from Lancashire CC. The council offered Ms Rhodes an opportunity to personalise the service she received by giving her the opportunity to participate in its design and delivery. It was the first time in 17 years she had been asked what she wanted.

That limited opportunity to exercise choice unlocked her voice. She told the staff she had always wanted to get a job but had never realised she might be able to do so. After going on a training course at Manchester Open College, she went to work part-time at a children's nursery. She said she felt 'normal for the first time in her life'.

We need to understand what is distinctive about Blackburn's approach, because this simple model could be a part of every aspect of public service provision. Personalisation through participation offers a more promising avenue for public service reform than any other currently available.

Ms Rhodes' position sums up the asymmetry at the heart of public services: professionals and providers have the budgets, power and information, and users do not. How would the various proposals on offer for improving public services help Ms Rhodes?

One argument is that public services just need more money and staff, to improve services and bring them up to date. A second is that Ms Rhodes shou ld be set free as a consumer, with the funds to buy services to suit her needs. A third argument is that she should be seen as a citizen.

In fact, her life was transformed through a combination of all three. Staff took the time to help her articulate the intricacy of her needs; gave her enough choice to voice her aspirations; organised relationships with training providers and other partners to create a solution which the centre could itself deliver. Crucially, she was an active participant in this process.

Public service reform should be user centred, but it must also deliver better outcomes for society as a whole.

We need a new framework to show how personal needs can be taken into account within universal, equitable public service. A good example of how public services can be updated is Liverpool Direct, the joint venture between the city council and BT. Users can call the Liverpool Direct call centre 24 hours a day, seven days a week, all year.

The centre is getting over 50,000 calls a month and offers a very tangible example of how users have been given more say in their services. Ventures like Liverpool Direct provide a basic level of personalisation by modernising the customer interface. But, to generate more satisfaction, public services need other approaches too.

Some people argue that consumer choice creates the pressure for change. And why shouldn't elderly patients have a choice about where they get a hip operation done, or parents be given more choice about the curriculum of the school their children go to?

In some services it makes sense to put consumers directly in charge of commissioning, such as enabling disabled people to buy their own home care packages. Offering choice in other services would require far reaching changes, not least to financial flows. Capacity would need to shift in response to demand and consumer choice would challenge the power of providers to allocate resources. But there are limits as to how far public service reform can be driven by consumer choice.

C onsumerism assumes competition that allows choice between providers, but in some public services - policing, for example - it does not make sense to have competing providers. Market consumerism could also threaten the equity on which public services are based.

Many people are attracted to the idea that services should respond to the views of citizens. Citizenship speaks to the ideals of equity and collective provision embedded in public services and people generally want good public services for everyone. But citizenship cannot tell us how public services should be organised day by day. Instead, we need an approach which gives people a direct voice through the way in which everyday services are actually delivered.

Personalisation through participation, such as that which Ms Rhodes eventually received, is devised through a combination of factors. These included: professionals working with clients to help unlock their needs and aspirations; expanding choice and voice for all users; partnership working, with institutions acting as gateways to services; professionals acting as advocates for users, and users being more involved in shaping services. And, finally, funding must follow user choice.

Participative approaches to public services change the relationship between the individual and the

collective, the public and private. Public policy is most effective when it harnesses private activity rather than supplanting it. The state's job will be to enable that process.

Charles Leadbeater

Author of Personalisation through participation, published by Demos

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