Choice in public health service: one area examined by PASC

The Commons public administration select committee has called on the government to be more realistic about the role of choice in public services.

The MPs published a report on Thursday examining "choice and voice" in the particular areas of health, secondary education and social housing.

They said the government’s pledge to reform services by ensuring people have both more choices and more say in the services they use is welcomed.

But the committee said there is a long way to go in delivering specific promises to the public. The MPs argue that the language used is also creating confusion.

"The tendency to apply the labels of choice to schemes and services such as school preferences, where the first choice option may be unattainable for many, only creates disappointment and disillusionment," the report said.

And the committee says that, while there has been much political debate about "choice of provider" — giving people a choice of hospital for their operations for example — people often appear more interested in more practical sorts of choice such as a choice of food in hospital.

The report makes a number of recommendations aimed at improving the responsiveness of  public services to their users.

It calls for a series of public service guarantees giving users a right to choose an alternative provider if services are inadequate, and consideration of school vouchers to encourage schools to admit low-income students by providing extra money for them.

Development of a measurable "public satisfaction index" so users’ views about services can be tracked better and improvements made faster is suggested, as is the use of lotteries by schools to allocate places when demand exceeds supply.

Also proposed is better access to a range of services via a new public services direct system and a major extension of two government schemes which have helped users make the best of health services - the expert patients programme and patient care advisers as part of hospital choice.

The report concludes: "The government is right to want to give the user more control over public services, whether through choice mechanisms of different kinds or through new forms of voice.

"However, it is important that... the design features of both are consistent with key public service principles.

"There is much scope for innovation and learning in relation to both choice and voice, just as there is ample scope for rhetoric and confusion.

"In this report we have tried to encourage the former and avoid the latter, as the route to genuine public service reform."