The Conservative Party does not necessarily dislike public services. Its current policy in England – and in those parts of the United Kingdom where the responsiblity for particular public services is not devolved – is to ensure that as far as possible those delivering public services are not on the public payroll. The supine sidekicks of the Tories – the Liberal Democrats – are going along with this scheme, which if unchecked could mean that by 2015 not a single person in England delivering publicly funded services would be on the public payroll.
The emphasis so far has been in health and social care. but other moves are afoot, for example to allow people working for Jobcentre Plus to own and control their organisation, or part of it. The “externalisation” of adult social care and community health services by Swindon borough Council and Swindon Primary Care Trust (PCT) from April 1 provides a case study.
Under an initiative started by the previous Labour Government – the ‘Right to Request’ – groups of public service workers were encouraged in a limited number of areas and activities to bid to form mutuals or co-operatives to take control of the running of the services previously provided by the local National Health Service (NHS) or local government. There had been several examples of that in both health and social care.
Now rebranded as ‘Right to Provide’ by the UK Coalition Government, there is now a definite push to get public sector employees to consider taking control of their activities. This raises several moral and political issues, including:
The Swindon PCT and Council example showed that there was little public consultation as to what should be done to move the service out of the PCT. To be sure, under the previously agreed Labour scheme, no PCT is allowed to directly run such services since the start of April 2011. Yet the unaccountable ‘managers’ in the PCT and the Council officers and councillors involved repeatedly refused to consider or even talk to those with an alternative suggestion as to how things could be taken forward. It would have been possible to produce an organisation with a wider public governance. It would have been possible to pass on the service to another public body, even to another NHS body. Wiltshire Council has very recently done exactly that, by transferring community services to the Swindon-headquartered Great Western Hospitals NHS Foundation Trust! It is what we in the co-operative movement would call a transfer of engagements.
For example, there are proven ways of building in public accountability that shares control among different groups of people. This is called multistakeholder governance. It is used by NHS foundation trusts to elect public and staff governors, for example. It is used by many co-operatives in several countries. Yet the Coalition is fixated on employee control alone or even on the more insidious employee ownership, even of very large public service providers. One reason that the Labour Government pursued some of its public services reforms was to try to tackle what is called ‘producer capture’. That is when groups of public sector workers act in ways that give little emphasis to the needs of services users. or to use different language, do not have sufficient ‘customer focus’. An employee owned or employee led body providing public services is open to the same criticism.
The Coalition trots out the example of the John Lewis Partnership, no doubt beloved by many of the well-heeled and by the chattering classes. As was said by Peter Hunt, chief executive of Mutuo, at a conference on social enterprise, mutuals and co-operatives in health and social care that I co-organised in London at the end of March (www.socialenterpriseinhealth.org.uk) the John Lewis Partnership is not a model for public accountability in any shape or form. Whatever its undoubted merits at involving employees in the running of its department stores and supermarkets. That is a far cry from caring for patients. The John Lewis Partnership model has many benefits from the point of view of involving its staff. but where does that leave the public? The users of services? Or other organisations involved in health and social care, such as local voluntary and service user groups?
Another key local political point is that the so-called managers in the PCT and Council, and their political bosses, failed to adequately consult – and indeed rebuffed – suggestions about their plans, and failed to consult those who are knowledgeable on co-operative, mutual and social enterprise development pertaining to health and social care.
The local Council and PCT have effectively placed a large public service in the hands of its employees, removing at a stroke public accountability. In two or three years it will have to retender up against well-prepared for-profit enterprises if the segment that is all about competition, in the Health and Social Care bill now proceeding throught the UK Parliament, survives. In fact the competition element is the biggest single change being proposed in that bill a fact that seems to have taken many politicians and their advisers too long to twig.
I hope that I may be wrong, but I am not holding my breath as to whether those elements of the bill will get changed.
Geraint Day, Labour and Co-operative candidate for Wroughton and Chiseldon, 2011 Swindon borough Council elections.
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