Little has really changed in our ability to shape services directly around our own circumstances, despite the impact they have on our lives. As Ed Miliband has said, “I get as many people coming to me frustrated by the unresponsive state as the untamed market”. Too often, p atient choice is confined to options made by professionals. Limited access to personal care budgets and a lack of shared decision-making more generally means only a few get the flexibility and freedom to shape their own care.
One of the central themes of Labour’s Policy Review is how best to invest to prevent social problems in order to avoid the costs of failure. We know that reforming public services, and so improving interactions between service users and providers, is crucial to this ambition. As Ali McGovern, Liz Kendall, Steve Reed and Dan Jarvis have all argued, empowering citizens isn’t about disempowering public sector providers. Good decision-making thrives on early and continual feedback. Yet Which? report that many people don’t complain about poor public services because of fear of reprisal by providers. We can’t allow a situation where vulnerable social care users suffer in silence. Many providers already address this; from Unison’s work with personal care users and their members, or Worcester University, where patients interview applicants to be student nurses or healthcare assistants, and help deliver the training course itself.
Recently the government quietly included the public sector in its Consumer Rights Bill. This gives individuals the right to services performed with reasonable care and skill, at a reasonable price and within a reasonable time. So far the government admit this covers tuition fees, and use of childcare vouchers and personal care budgets. If a service doesn’t meet the required standard, students, parents and patients will be able to request a repeat performance, a price reduction or even a refund. Those with the loudest voices or largest wallets will make good use of these powers; those without will be further excluded and their voices diminished.Without an alternative inclusive approach, sharp elbows will increasingly be the decisive factor at the sharp end of decisions about provision – with increasing inequality as a result.
Yet that doesn’t mean we should discount individual viewpoints. Instead we need to find ways to expand participation so both personal and collective interests can be heard together. Labour’s focus is on being on the side of every service user, seeking ways to empower all with the resources and confidence they need to act both independently and together if they so choose. To that end, we recognise that knowledge is power. Whether it is patient records, university syllabuses or school performance, we understand the benefits of unlocking access to data. More open flows of information to the public have the capacity to help create better-informed consumers who can then themselves make better-informed choices first time.
But access to data alone is not enough. Too often, those with complex needs or a lack of confidence struggle to sift through the information and make effective decisions. Users who ask for help need someone to answer the call – advocates who aren’t beholden to service providers. These advocates could assist in exercising rights and options for redress when things go wrong. In a study in Nottingham, 40 per cent of cases dealt with by advice agencies involved “preventable” failure caused by poor decision making in the public sector. Using advocates to provide advice and so improve how residents accessed services cut the average time taken to resolve cases from 100 days to 23 and then finally to just five. This saved time, money and tempers for all concerned.
This shows how the response users get is as important as their rights to information. We need to work with service providers to welcome user participation, and help create a culture where their expertise doesn’t rest on making decisions for people, but working alongside them. This government will leave citizens to navigate services alone, leaving those without resources – either money or other skills – to struggle alone.
Labour’s Policy Review is looking at how we reform the public sector by devolving power to people, investing in prevention and incorporating cooperation and collaboration in the co-commissioning and design of services. Our mission is to stand shoulder to shoulder with every consumer – not blunting the efforts of those who already fight for the best services, but instead putting more power at the elbows of the rest for the collective benefit of all.
Stella Creasy is shadow minister for competition and consumer affairs, and MP for Walthamstow
Jon Cruddas is Labour policy review co-ordinator, and MP for Dagenham and Rainham