Comparing choice and voice as ways of improving public services
In my job working at Participation Cymru I used to respond to policy consultations around participation in Wales.
The Beecham Report: Delivering Beyond Boundaries was the basis for a lot of our work. It quoted Rhodri Morgan's clear red water speech, which talked about how Wales' approach to delivering public services would differ to England's. Voice would be the driver of improvement on Wales' side of the border, compared to the choices that would be available in England.
Did citizen's voices inform citizen-centred services?
Whilst philosophically I was absolutely on board with this vision for Wales, I saw little of it in reality. The traditional consultation mechanisms continued as you would expect, but I didn't really see any services radically centre people's wishes at the heart of their work, and I certainly didn't see much co-production. It's not that I think that voice can't be an effective driver of improvement, I just didn't really see any radical mechanisms in place.
How is choice working out in England?
When I moved to England I was fortunate enough to get a job with Research in Practice, where I've been working ever since. One of my first duties was to familiarise myself with the new policy context that I found myself in. I was surprised by the similarities between the Care and Social Services Act in Wales and the Care Act, although the latter's focus on commissioning was a clear difference. This is where choice comes in – it's all about choice for the commissioning body, not the citizen. I can't think of any meaningful choice that I've been given since living this side of the border.
There has been an illusion of choice when asking for our preferences. My step-daughter's school place wasn't informed by her or our preferred option, but by the catchment area that we live in.
When I've accessed non-emergency health care, the only choice I've been given has been around whether I want to pay more to access services privately. Austerity has moved delivery costs for many services into the bank accounts of citizens.
So what do I draw from this?
So effectively I've just detailed the inability of two different systems to improve public services. How depressing.
What I really wish is that politics wasn't so toxic. Given that we have different parliaments across the constituent parts of the UK, it's a real shame that governments aren't able to learn from each other. For example it feels like health and social care integration is something that's talked about incessantly. There has been a lot of focus in England around the work that's taking place in Greater Manchester, without looking at the evidence around how it's been working in Northern Ireland for years.
I might be biased, but this Research in Practice podcast is excellent on comparing the rates of children coming in to the care system in different parts of the UK. Whilst Northern Ireland is a comparatively poor country, it takes less children into care than other parts of the UK. There is so much rich learning here, I just wish that we could be a bit more open to learning from each other.