Taking control of public services

3 August 2016

Those who believe Brexit was primarily a vote against immigration, ignore the evidence. Almost 50 per cent of leave voters opted for it to “take back control” of UK political institutions.

The implications of controlling political institutions changes with the circumstances that envelop them. But from Thomas Hobbes’ need to cede power to an absolute sovereign to bring order to deadly anarchy to the Founding Fathers’ vision of a democratic republic, modern definitions hold the principle that political institutions can only be designed by the people they serve.

Today’s complex welfare states take the principle of control of institutions one step further. People rightly expect services they pay for and use to mirror their needs. The vote for greater control of UK institutions on June 23 should be seen as a call to design public services in a way that works for everyone.

The first task is to pay attention to outcomes that matter to service. In healthcare, metrics of service delivery are oft-criticised for not meaning anything to patients — focusing on inputs and outputs, not outcomes. Patient involvement can change this. In Cornwall, a range of organisations designed services around the healthcare goals patients deemed most important. This saw self-reported wellbeing improve by 23 per cent and non-elective emergency admissions for those with long-term conditions fall by 40 per cent between 2013 and 2014.

Constructing an outcomes-based system means designing services around the needs of the user, not the system. Integration of services is key. In healthcare, GPs should offer a range of approaches in their general practice, such as urgent care, diagnostics services and social prescribing — instead of sending patients to hospital. This can only be done through overhauling the current commissioning framework to ensure that GPs are incentivised to provide the most effective care in a patient’s pathway. Similarly, criminal-justice services, such as prisons, probation and mental-health services could be integrated to work more effectively for those in the penal system. Giving police and crime commissioners the power to do this could go some way to reduce the stubbornly high reoffending rate.

The complexity of twenty-first century welfare states brings a new meaning to controlling public institutions. People-powered services not only embody the principle of control so clearly sought on June 23 — they enable the delivery of better services. Debates over the terms of our relationship with the EU should not distract the Government from designing these services.

Alexander Hitchcock, Researcher, Reform

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