The problem with public service "choice"

Choice without the capability to exercise drives a pernicious wedge between some users and others.

"Brick by brick, edifice by edifice, we are slowly dismantling the big-state" says Prime Minister David Cameron. In its place will be, if not the much-maligned "big society", then, well what exactly? If Tony Blair’s mantra going into the 1997 General Election was "education, education, education," Cameron’s fixation can be summed up as  "choice, choice, choice."

In criticising Cameron’s choice of strategy to raise standards in schools, hospitals and other public services, I don’t intend to defend the status quo. Of course there’s significant room for improvement, there always is. Nor do I seek to deny that in some cases non-state providers may be able to augment state provision where the latter is clearly failing. But in striving to raise standards we must ask whether the reforms being brought in are the right reforms, whether they’re likely to deliver said higher standards, and if so for whom.

In launching the next phase of the government’s Open Public Services programme, the PM asserts that in giving service users a choice between providers will give them control over how they experience the service and give the providers competitive pressure to up their game. The trouble is, this assertion is just that; there is very little evidence that choice and competition in themselves lead to higher standards in public services, and what little evidence that exists is of remarkably poor quality.

For every unpublished, non-peer-reviewed study that claims to show how choice and competition raise standards, you can find many rebuttals that expose methodological and empirical flaws. Take the now infamous studies claiming that competition for elective surgery (indexed not by a measure of choice itself but by geographic density of hospitals, a poor proxy at best) improves outcomes in mortality from heart attacks (through an unspecified mechanism); the papers show weak statistical correlations at best, not a causal relationship, and yet they’re unquestioningly cited as evidence that “hospitals in more competitive areas perform better on quality and efficiency than those in less competitive ones.”

The standard practice for resolving such a lack of clarity as to whether X (in this case the existence of patient choice in where they’re treated) causes Y (higher standards of care) would be to conduct a trial: give some patients choice, measure (and this is crucial) whether they actually exercise said choice, and see whether their medical outcomes are better than a group of patients from whom choice is withheld. I’m not the first to call for well-controlled trials of social policy (doctor and health writer Ben Goldacre is amongst those who have), but in the absence of reliable evidence to date, surely there ought to be trials to show just how effective choice can be in driving up standards?

Cameron makes more than an empirical error in promoting choice, however; his “instinctive belief” (sic) that consumers – or citizens as we used to be called – exercising choice in an open market will drive up performance and productivity results from a confused view of what constitutes a public service in the first place. The confusion is laid bare in Benedict Brogan’s defence of the Tory perspective on public service reform; Brogan reveals more than he perhaps intended when he says that under the proposed system of choice in services, the consumer "will be given the same kind of protections in his dealings with the public sector that he enjoys when he buys a television set or books a holiday."

With great power comes great responsibility, Peter Parker was told; well, under the Open Public Services regime, with Great Choice comes Great Voice – the corollary to choice of provider is voice to complain, transparency of data and help in finding out how to raise your voice, so to speak. All good things in themselves and fine if you’re buying a TV or booking a holiday, a robust complaints procedure might make TV makers or airlines up their game – but outcomes from public services are often only apparent several years down the line (think schools and healthcare for chronic conditions), at which point it’s too late for a complaint to the market regulator to make a difference. If the government is indeed to become more a commissioner in a market than a provider, as is Cameron’s intention, then if voice alone is the consumer’s redress then we must accept a widening in outcomes for those able to exercise both choice and voice, and those who are less capable.

And that’s the key. It’s a crass philosophical mistake to conflate public services – that deliver public good by pooling peoples’ risk, purchasing power and the benefits they get in ways that enrich society as a whole – with transactional goods that we consume largely for our own individual benefit. Cameron remains convinced that choice is the way to promote better services – but choice without the capability to exercise it is just a pernicious wedge driven between those comfortable enough to travel large distances and research their options and those who need good public services local to them. Choice, choice, choice says the PM – excellence, equity, evidence, say I.

Prateek Buch is head of policy and research for the Social Liberal Forum

David Cameron launches The Big Society Capital fund at The London Stock Exchange on April 4, 2012. Photograph: Getty Images.

Prateek Buch is director of the Social Liberal Forum and serves on the Liberal Democrat Federal Policy Committee.

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Forget the flat caps - this is what Labour voters really look like

Young, educated women are more typical than older, working-class men. 

In announcing the snap election, Theresa May set out her desire to create a “more united” country in the aftermath of last year’s referendum. But as the campaign begins, new YouGov analysis of over 12,000 people shows the demographic dividing lines of British voters.

Although every voter is an individual, this data shows how demographics relate to electoral behaviour. These divides will shape the next few weeks – from the seats the parties target to the key messages they use. Over the course of the campaign we will not just be monitoring the “headline” voting intention numbers, but also the many different types of voters that make up the electorate. 

Class: No longer a good predictor of voting behaviour

“Class” used to be central to understanding British politics. The Conservatives, to all intents and purposes, were the party of the middle class and Labour that of the workers. The dividing lines were so notable that you could predict, with a reasonable degree of accuracy, how someone would vote just by knowing their social grade. For example at the 1992 election the Conservatives led Labour amongst ABC1 (middle class) voters by around 30 percentage points, whilst Labour was leading amongst C2DE (working class) voters by around 10 points.

But today, class would tell you little more about a person’s voting intention that looking at their horoscope or reading their palms. As this campaign starts, the Conservatives hold a 22 per cent lead amongst middle class voters and a 17 per cent lead amongst working class ones.

Age: The new dividing line in British politics

In electoral terms, age is the new class. The starkest way to show this is to note that Labour is 19 per cent ahead when it comes to 18-24 year-olds, and the Conservatives are ahead by 49 per cent among the over 65s. Our analysis suggest that the current tipping point – which is to say the age where voters are more likely to favour the Conservatives over Labour – is 34.

In fact, for every 10 years older a voter is, their chance of voting Tory increases by around 8 per cent and the chance of them voting Labour decreases by 6 per cent. This age divide could create further problems for Labour on 8 June. Age is also a big driver of turnout, with older people being far more likely to vote than young people. It’s currently too early to tell the exact impact this could have on the final result.

Gender: The Conservative’s non-existent “women problem”

Before the last election David Cameron was sometimes described as having a “woman problem”. Our research at the time showed this narrative wasn’t quite accurate. While it was true that the Conservativexs were doing slightly better amongst young men than young women, they were also doing slightly better among older women than older men.

However, these two things cancelled each other out meaning that ultimately the Conservatives polled about the same amongst both men and women. Going into the 2017 election women are, if anything, slightly more (three percentage points) likely overall to vote Tory.

Labour has a large gender gap among younger voters. The party receives 42 per cent of the under-40 women’s vote compared to just 32 per cent amongst men of the same age – a gap of nine points. However among older voters this almost disappears completely. When you just look at the over-40s, the gap is just two points – with 21 per cent of women and 19 per cent of men of that age saying they will vote Labour.

With both of the two main now parties performing better amongst women overall, it’s the other parties who are balancing this out by polling better amongst men. Ukip have the support of 2 per cent more men than women, whilst the gender gap is 3 per cent for the Lib Dems. 

Education: The higher the qualification, the higher Labour’s vote share

Alongside age, education has become one of the key electoral demographic dividing lines. We saw it was a huge factor in the EU referendum campaign and, after the last general election, we made sure we accounted for qualifications in our methodology. This election will be no different. While the Conservatives lead amongst all educational groupings, their vote share decrease for every extra qualification a voter has, whilst the Labour and Lib Dem vote share increases.

Amongst those with no formal qualifications, the Conservative lead by 35 per cent. But when it comes to those with a degree, the Tory lead falls to 8 per cent. Education also shapes other parties’ vote shares. Ukip also struggles amongst highly educated voters, polling four times higher amongst those with no formal qualifications compared to those with a degree.

Income: Labour’s tax increase won’t affect many Labour voters

John McDonnell, Labour’s Shadow Chancellor, has already made income part of this campaign by labelling those who earn above £70,000 a year as “rich” and hinting they may face tax rises. One of the reasons for the policy might be that the party has very few votes to lose amongst those in this tax bracket.

Amongst those earning over £70,000 a year, Labour is in third place with just 11 per cent support. The Conservatives pick up 60 per cent of this group’s support and the Lib Dems also perform well, getting almost a fifth (19 per cent) of their votes.

But while the Conservatives are still the party of the rich, Labour is no longer the party of the poor. They are 13 per cent behind amongst those with a personal income of under £20,000 a year, although it is worth noting that this group will also include many retired people who will be poor in terms of income but rich in terms of assets.

Chris Curtis is a politics researcher at YouGov. 

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