Free-at-the-point-of-use public services

British voters want healthcare and education to be freely available to every citizen – regardless of income. State-funded public services do not have to be state-supplied, however.

Most Britons believe that everyone is entitled to a good education and decent healthcare. They hate the idea that a sick person should miss out on treatment for lack of money, or that a child should be denied a good education because of their parents’ financial circumstances. There is strong public support, therefore, for the British state’s ‘open access’ schools and hospitals.

Modern Tories do not question this entitlement to free-at-the-point-of-use public services – although some appeared to do so in the 1980s and 90s. Tories are increasingly keen for more diversity in the supply of these ‘free’ services, however. Tories believe that private and voluntary sector organisations can often deliver superior services for better value-for-money. The London-based think tank Reform has done most to expose the weaknesses of Britain’s public services and how they might be modernised.

The Tories need to achieve at least two things before they embark on radical reform:

1. They need ‘permission’ from voters for reform; and
2. They need to anticipate the significant challenge of managing private provision of public services.

Permission to reform public services

Voters are suspicious of the Tories embarking on public sector reform. Most voters suspect (accurately) that most Conservative MPs do not send their children to state schools. Margaret Thatcher’s infamous remarks about wanting to go into a private hospital on the day she wanted, at the time she wanted, still reverberate in the ears of people who respect the ‘good intentions liberalism’ of the NHS (despite its manifest failings).

Radical reform – led by Tories - will only get the voters’ permission if Tory politicians have first shown them that really want those services to succeed. Personal use of public services by Conservative politicians might be a first big step towards winning that trust.

Managing public service reform

Once given permission for reform Conservatives should consider the advice given by Professor Stephen Goldsmith and William D Eggers of New York’s Manhattan Institute. Reflecting on the repeated problem of cost-overruns when private contractors undertake government work, Goldsmith and Eggers wrote:

“Not enough attention has been devoted to one of the central policy and management issues of our time: what kinds of systems, organisational structures and skills are needed to operate a government that increasingly orchestrates (rather than owns) resources and purchases (rather than directly provides) services?”

“Managers skilled in negotiation, contract management and risk analysis,” must be recruited to manage this new world of privately-provided public services. The Manhattan Institute fellows concluded their New York Times piece with these words:

”Holding providers accountable and measuring and tracking their performance has to become a core government responsibility that is as important, if not more so, than managing public employees.”

Britain with much experience of costly Private Finance Initiatives (for schools, hospitals and London’s tube) certainly could do with a few more skilled contract managers and a few less welfare-dependent bureaucrats.