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Last updated: 08 November 2008
7 February 2008
Thank you to David Walker not just for that introduction but for all the work you do to illuminate public policy debates, as well as your role on Guardian Public magazine.
This is the fifth Guardian public services summit, and it has established itself as a space for people to step back and think about the future of public services and a place to celebrate the achievements of people who work in the public services.
And I want to start by saying that it is thanks to the achievements of many of the people in this room, and the differences you have made to people's lives, that we are starting the conversation from a position of confidence in our public services and the role they play in our society.
Having addressed many of the problems we inherited in 1997-whether it is 18 month waiting times in the NHS or crumbling school buildings – through targets, choice and contestability and other mechanisms, we can now be more ambitious.
For me the starting point is the kind of society we want to see and how we think about equality. For the founders of the welfare state, equality was about securing a basic minimum of services – a basic minimum of healthcare, a basic minimum of housing, a basic minimum of income.
But modern equality comes not just from the basic goods but from the ability to choose the life you want to lead. This is based not only on the equal moral worth of every citizen but our equal right to express our choices and exercise our capabilities.
This demands an interest in both what public services provide but also how they are provided, and whether they are genuinely liberating or not.
So my argument today is this: if public services are going to liberate people to choose the life they want to lead, they must be more responsive.
That means, first, more personal – responsive to rising expectations and complex needs.
Second, more collaborative – responsive to the contributions individual users can make.
Third, more flexible – responsive to the skills and insights of the workforce.
Fourth, more accountable – responsive to community preferences.
And fifth, more forward-looking – responsive to the demands for different services, as we look ahead to calls for new public goods, new inequalities that need to be tackled and new risks that can only be met together.
These are the themes of a document the Strategy Unit in the Cabinet Office is publishing today on the challenges we face in public services in the coming years and I'm going to say a bit about why each of these is important, and how we're going to bring this about.
First, then, more personal services: better catering to the individual's needs and better tailoring services to their particular circumstances.
But how do we actually make public services more personal?
Partly it's about having the resources to allow services to be more intensive. So in education it's because the basics are better, with 35,000 more teachers, that one-to-one tuition will now be possible for 300,000 children in English and in Maths by the end of the decade. It's because the basics are better in health that we can now move towards more out-of-hours services provided by GPs.
But we can only use these resources to best effect if we know the citizen's needs and understand how the service feels to them: I am very influenced by Alexis Cleveland who reformed the pensions service and discovered the old stereotype that pensioners wanted to go to the benefit office was wrong: they would far rather do it in 20 minutes over the phone.
That's why all government departments have committed to transforming their public service by putting the user at the centre.
And to drive a more personal service will sometimes require an expansion of choice. I recently met a young woman called Hedi. She has physical and mental disabilities, and needs a lot of help with everyday tasks. At first, she was given a standard contracted-out service, with no choice over who looked after her or when. But in fact, because she is young she really wants a young carer she can get on with.
She wants help in the evenings so she can see friends. She wants her support to be tailored not just for the nature of her condition but her lifestyle, what she wants to do in life and her personality – and she herself is the best person to make those choices.
What allowed her to achieve this was her direct payment. If we believe in personalised services, if we believe equality means the equal right to choose the life we want to live, then we must explore how this idea can be taken further – and we must support this.
Ivan Lewis announced just before Christmas that all adult social care will be moving in this direction. We need to look at other areas to see where this might be taken further.
So responsive public services start by being personal to individual needs and individual lifestyles.
But as I said at the start, responsive public services look not just at needs but also at strengths and abilities. Public services must respond to and mobilise the expertise, ideas, time, and willpower of people using them.
What I call the “letterbox model
” – where the service was just
delivered to the user – doesn't see us as participants who can shape
our own lives. It doesn’t meet the standard of modern equality that I
mentioned at the start.
If you ever could ignore this insight, you certainly can't do so today.
For children to succeed in school, it is as much, if not more, about the capacities of parents to help them, as about what teachers deliver to them. For the 15 million people with chronic diseases, and for the eight out of ten hospital inpatients who have a long-term condition, their welfare is as much about their learning how to care for themselves as about their doctor.
In fact, Derek Wanless calculated that the difference between success and failure in preventative health could cost two per cent of national GDP through the NHS alone.
There are brilliant examples we can build on. Last Friday I met parents and
teachers at St Dominic's School, Knowsley. The council worked with the
parents on how they play more of a role in public services and hit upon the
idea of volunteer “parent pals
” to bring parents together and help
them engage, and I'm sure schools across the country will be able to
talk of their own ideas to reach out to parents.
As someone at St Dominic's said: ten years ago people used to say it was down to the parents and therefore what can we do? Now they say it's down to the parents and we involve them in their kids' education.
That spirit has run through our long-term decisions of the last few months. You can see it in the Children's Plan, which will expand the role of parent support advisers, and it was in the Prime Minister's speech on a preventative NHS, which said all 15 million patients with a chronic or long-term condition will be offered new access to active patient and self-care programmes.
Now – so far, I have been talking about how responsive public services feel for the user, responding better to individual needs and individual strengths.
But if what matters is the relationship at the frontline, then we must unleash the talent and knowledge of the person who is closest to the user: the frontline professional. That is the third element of responsive public services.
To be responsive to users' individual needs and strengths, modern professionals must be not just providers but also expert advisers, not just instructing users but guiding them. Hedi's use of direct payments, for example, was informed by more than an hour talking through her options with a professional.
And to do that, a professional needs more autonomy than they have now.
I recently met Jo Pritchard, the driving force behind a nurse-owned social enterprise called Central Surrey Health. She talked to me about how becoming a social enterprise has allowed them to cut waiting times for physiotherapy from 6 months to 3 weeks. How? By freeing them up to respond to the needs they see by changing how they work.
New providers, whether social enterprises or the private sector, can often do this, and their role is important in bringing new ideas into play. We need to continue with the move towards diversity of provision where it can make a difference to the quality of public services.
But I also believe a professional shouldn't have to leave the public sector to change how it works. To give all professionals, not just some, the flexibility they need, we are reducing the number of overall targets, and we are focusing them on final outcomes not processes.
But there is more we need to do: the question we will be examining over the coming months is how we can find better ways to bring greater freedom and flexibility to the frontline. And the Cabinet Office and Treasury are working together to learn from the best of public, private and third sector organisations about how we can empower professionals and ensure that policy making is better informed by the practical knowledge and expertise of frontline staff.
If there is less top-down control, and I believe there should be, then it requires different forms of accountability: that strengthens relationships and brings services closer the community.
In part, this is about what you might call hard accountability ––– through institutions, including local government. It's why I'm pleased that we are legislating to give local authorities greater control over some key issues, including for example bus services.
How we ensure local accountability of key services through the right sort of institutions is also part of what Jacqui Smith is considering following the publication of the Flanagan report on policing today.
And it is central to what Alan Johnson is doing in health, developing proposals for a new relationship between the public and the NHS through the Darzi Review and an NHS constitution.
Hard accountability is absolutely necessary, but in truth the kind of accountability that many members of the public might be more interested in is what you might call soft accountability – through information and informal mechanisms of participation.
This is about residents' ability to meet the police on issues that concern them, take part in very local decisions about budgets and neighbourhood management and a range of other democratic experiments which Hazel Blears is pioneering at DCLG.
So public services must be responsive to the individual in the ways that I have described but they also must respond to the world as it changes.
At its best, the welfare state alleviates the risks the individual faces, tackles inequality and provides public goods that the market cannot provide.
As society changes, we will face new risks. The great strides forward in longevity produces insecurities around care, independence and isolation – and we must respond with new forms of healthcare.
We face new threats to equity. Technological change and competition from abroad bring the risk that those without skills will get left behind – and we must respond with education to 18, to give all young people the skills they need. And we know now that the roots of inequality start to grow long before children reach school – and we must respond with better education for under-fives.
And finally, there are new sources of demand for public goods. Just as we realised in the 19th century that no individual could protect themselves from inadequate sanitation, so too we know that no individual can truly protect themselves from climate change.
Of course, there is always a balance to be struck when meeting these new needs between the role of the individual, the community and the state. The state can meet none of these new needs on its own but all of them need a role for the responsive state.
What will never enable us to meet these new needs – and we need to be blunt and honest about it – is the rollback state – the idea that we can face these significant problems and also have a much smaller state.
The third sector can play an enhanced role in delivery but ask anyone in the third sector whether they can pick up the pieces for inadequately funded services, and they will tell you they can't. So let's have a responsive state, let's have a plural state but let's not be taken in by the idea that rolling back the state will be good for social justice.
Let me end with this thought.
I set the ideal earlier of equality as the life we choose to lead – equality as freedom and the freely-chosen life.
When I look at the public services in our country, I am filled with confidence.
When I talk to Hedi, now free to live the life she chooses with care personalised to her, I am filled with confidence.
At St Dominic's school, seeing them not give up on parents but find new ways to involve them, I am filled with confidence.
Hearing how Jo Pritchard with her nursing social enterprise and other professionals across the public sector can reshape public services, if they're given flexibility, and as we make the police, the NHS and other public services more accountable to the local community, I am filled with confidence.
Ten years ago, the question was whether public services and the welfare state could survive as universal services.
It is a testimony to the work of people in this room that that is no longer the issue.
The public appetite today is not for us to abandon public services, to ignore new needs and roll back services.
Instead it is for public services that truly liberate the potential of everyone.
Over the next few years, I believe that we can create responsive public services and the kind of society we want to see.
Any questions, please call Polly Billington, Special Adviser to Ed Miliband, on 020 7276 0271.