Date post: | 13-Jan-2016 |
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Top down – or bottom up?
Simon Courage
Language
Policy levers. Or instruments
What’s available - examples
• Taxation– Raise money• VAT
– Reward and penalise certain behaviours• Zero-rated VAT on food
What’s available - examples
• Regulation– To permit• Civil partnerships
– In favour of• Vitamins in bread
– Against• Theft
What’s available - examples
• Performance management– Targets• Hospital A&E admission times
– Inspection• Ofsted in schools
What’s available - examples
• Ensure provision of services– Direct• Police
– Procured• Bulk waste disposal
What’s available - examples
• Exhortation– Leadership• Local authority convening of partnerships
– Evidence base• Research, evaluation, data warehouses
What happens
S-curve
What happensPerverse effects
What happensProfessional resistance
4 Cs
Competition• Providers compete for
contracts• Price and quality, plus other
desired effects• Open up to private and
third sectors– Work Programme for
unemployed people
Contestability• Introduce threat of
competition• Reduce barriers to entry• Open up, say, 15% to private
or third sector• Keep public sector on toes
– NHS elective surgery
4 Cs
Choice• Parent, patient – client, user
– chooses• Expresses preference from
range– School admissions– NHS Choose & Book– Choice-based lettings
Civil society• State rolled back to make
way for civil society– Farmers’ markets
• Civil society organisations deliver services on behalf of state– Recycling
• Civil society creates new services– Pocket parks - dowry
To make this work
• Requires good information for users– League tables
• Schools
– Which XX? lists• Universities
– Inspection reports• Hospitals
• Good advice– Especially for disadvantaged
• GP as gateway to hospitals
• Understand the limits of markets– We don’t really understand health, can’t prepare
• Pathways
Where next?
• How far could you take this?– Choice of police inspector?
• Where shouldn’t you use this?– Judiciary
• Q&A