PASC 04-05 10

Session 2004-05

Press Notice 10


PASC-the House of Commons Public Administration Select Committee-today calls on the Government to be more realistic about the role of choice in public services.

In a Report, Choice, Voice and Public Services, (HC 49-I), the Committee welcomes the Government’s pledge to reform services by ensuring that people have both more choices when they use services and more say-a stronger ‘voice’-in how they are provided.

But the Report, which concentrates particularly on health, secondary education and social housing, also says that the Government has a long way to go in making ‘choice’ and ‘voice’ mechanisms deliver on their promises.

The language of choice, the Committee says, can also create confusion: “the tendency to apply the labels of choice to schemes and services such as school preferences, where the first choice option may be unattainable for many, only creates disappointment and disillusionment”.  It says that Ministers’ attention should focus more on developing practical programmes which promote choice alongside equity.

The Committee says that, while there has been much political debate about “choice of provider”-giving people a choice of hospital for their operations or a choice of secondary school for their children-people often appear more interested in more practical sorts of choice-for example a choice of subjects in school or of food in hospital.

The Committee concludes that:

• specific, limited and targeted schemes for provider choice, such as the London Patient Choice Project and the Coronary Heart Disease Choice scheme, make effective use of NHS capacity. They demonstrate that well-designed schemes can help the NHS put choice of provider to good use for the benefit of patients;

• however, recent ministerial comments about the potential for hospital closures in the era of patient choice raise serious concerns about the future of local service provision, and indeed about the future overall capacity of the NHS;

• the private sector offers potentially beneficial competition to the public sector, and can provide extra capacity. However, the guarantees of minimum levels of business given by the NHS to private healthcare providers may lead to inefficient use of resources. The Committee suggests that it may be necessary to change the design of the patient choice system, perhaps with less emphasis on guarantees for private providers;

• while choice is regarded by the public as an important feature of good public services, it is not necessarily their highest priority;

• some of the problems with choice would be eased if there was more acknowledgement of its limitations. The rhetoric on choice does not match the reality. Too often the ‘choice’ label is applied to schemes in which the most the consumer can hope for is second, third or even fourth choice;

• wider choice in public services can be consistent with equity, but only if schemes are well-designed and motivated by a desire to reduce unfairness;

• certain types of selection by provider in a public service can be incompatible both with equity and with the principle of choice for the user. The Government should, in particular, consider the effects on its wider social objectives of selection by schools;

• there is the potential for conflict between two central goals of Government policy: the drive to produce efficiency savings and the desire to expand choice for the users of public services. The Committee also finds it disturbing that there are continuing doubts about the effectiveness and efficiency of the financial and computer systems on which the NHS is basing the new schemes for patient choice.

The Report discusses how representative bodies, complaints mechanisms and user surveys can be employed to provide a stronger ‘voice’ for the user of public services. The Committee identifies  a series of shortcomings with the Government’s record in all three areas. In particular, it says that there are significant uncertainties in the Government’s approach to Sure Start and the boards of foundation hospitals. It also criticises the Government’s response to  calls for reform of the Parliamentary Ombudsman system and NHS complaints.

The Report makes a number of recommendations aimed at improving the responsiveness of  public services to their users:

• a series of Public Service Guarantees which would give users a right to choose an alternative provider or other redress if service standards are inadequate;

• consideration of progressive school vouchers, for use within the state system, to encourage schools to admit low-income students by ensuring that extra money is provided for them;

• the development of a measurable and comprehensible Public Satisfaction Index so that users’ views about services can be tracked better and improvements made faster;

• the use of lotteries by schools to allocate places when demand exceeds supply;

• better access to a wide range of services via a new Public Services Direct system, based on the success of NHS Direct;

• a major extension of two effective Government schemes which have helped users make the best of health services-the Expert Patients Programme and Patient Care Advisers as part of hospital choice.

The Report’s final conclusion is that: 

“The Government is right to want to give the user more control over public services, whether through choice mechanisms of different kinds or through new forms of voice. However, it is important that … the design features of both are consistent with key public service principles. There is much scope for innovation and learning in relation to both choice and voice, just as there is ample scope for rhetoric and confusion. In this report we have tried to encourage the former and avoid the latter, as the route to genuine public service reform.”

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For further information please telephone Philip Aylett, Clerk of the Committee on 020 7219 3498

Tony Wright may be contacted for press inquiries on 020 7219 5583

Publications and evidence, including uncorrected evidence, is also available on the Internet at:

For information regarding forthcoming meetings including venues and times please call the

House of Commons Committee Information Line on 020 7219 2033 (updated daily).

NOTE FOR EDITORS: The Committee was nominated on 16 July 2001.  Its terms of reference are to examine the reports of the Parliamentary and Health Service Ombudsmen, and to consider matters relating to the quality and standards of administration provided by Civil Service departments, and other matters relating to the Civil Service.  The members are:

Tony Wright (Chairman) (Lab) (Cannock Chase)
Annette Brooke (Lim Dem) (Mid Dorset and Poole North)
Mr Ian Liddell-Grainger (Con) (Bridgewater)
Mrs Anne Campbell (Lab) (Cambridge)
Mr Gordon Prentice (Lab) (Pendle)
Sir Sydney Chapman (Con) (Chipping Barnet)
Hon Michael Trend (Con) (Windsor)
Mr David Heyes (Lab) (Ashton under Lyne)
Brian White (Lab) (Milton Keynes North East)
Mr Kelvin Hopkins (Lab) (Luton North)
Iain Wright (Lab) (Hartlepool)