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