School league tables: past performance is not necessarily a guide to future performance

Many of the opponents against choice in public services rely on weak arguments. “The middle class will benefit” – yet they already win by having the resources to choose through moving into catchment areas (or buying in the private sector); ”the poor don’t want choice” – yet surveys demonstrate otherwise; “what people want is a good local school/hospital/whatever” – yet choice (with competing providers) is a means to that end.

I was therefore interested to read an article in the latest bulletin of Bristol University’s Centre of Market and Public Organisation, Research in Public Policy. The authors of Are league tables any use for choosing schools?

George Leckie and Harvey Goldstein studied the statistical significance of value added scores and concluded:

... when taking account of this uncertainty, the comparison of schools becomes so imprecise that, at best, only a handful of schools can be separated from the average school or from one another with an acceptable degree of precision. This implies that publishing league tables to inform parental choice of school is a meaningless exercise, as parents are using a tool which is not fit for that purpose.

In particular, they noted the lag of over five years between the parents looking at league tables when choosing a school and the children sit their exams. Five years a long time in the life of a school.

Does this information problem blow a hole in the argument for empowering parents and other customers of public services? I would suggest not – there are other measures of performance other than exam league tables. (There may, of course, still be value in value added league tables if failing or coasting schools raise their game through being either “named and shamed” or spurred by fear of falling school rolls.) Nevertheless the research does pose more of a challenge than the arguments usually wheeled out against choice.

Light touch or better regulation in social housing and beyond

This week in Inside Housing the new Chief Executive of the Tenant Services Authority tells us that he does not talk about “light touch regulation”.

It’s an excellent sound bite but I was wondering what the opposite of that is: heavy handed regulation? (To be fair, the TSA does not appear to plan to bring a big, clunking fist to social housing.)

It’s a pity that the term “better regulation” has gone out of fashion.

I had a certain fondness for the five principles of better regulation:

1) Proportionality
2) Accountability
3) Consistency
4) Transparency
5) Targeting

There is a real risk that the lack of regulation in the financial sector (or perhaps more accurately problems with what regulation there was) will lead to the rehabilitation of red tape.

Craig Dearden-Phillips wrote in the Guardian recently of his big worry that:

the main message of the credit crunch - that "markets don't work, we need more regulation" - is read across into other arenas like health, welfare reform, education. All areas where, pre-crunch, we were witnessing a rapid shift from 1970s statism to a more nuanced approach in which markets, competition and a diversity of providers are used to drive up standards

On the continent some thinkers used to talk about the “social market” as: the market where possible, the state where necessary. It would be good if in social housing (and public services generally) the regulators used the slogan: competition where possible, regulation where necessary.

I know it’s not snappy. But it is what is needed.

Putting people into public services: better regulation and inspection

The National Consumer Council has launched a new, short report on Putting people into public services: better regulation and inspection (pdf available).

The report should be required reading for the new Oftenant in social housing. Indeed all regulators and inspectors should be asked to think about the issues raised.

The report warns of the danger that services are modelled on what satisfies regulators rather than the public.

The report’s vision is of a regulatory system that:

1) is organised for the benefit of the people who use services, not for the convenience of regulators and the regulated;

2) inextricably links efficiency, value for money and satisfactory outcomes for the people –specially as new and different providers enter the market;

3) builds on continuous conversation with service users and the public – starting from where people really are, rather than from assumptions of how they might think and behave;

4) makes the most of service users as the experts on what it feels like to receive a service; and

5) builds popular support for difficult regulatory decisions.

I would also add that wherever possible choice and competition should be used to drive improvement – rather than relying exclusively on regulation and inspection regimes. While the regulator and the inspector may ensure recognition of social benefits and costs, promote good practice and protect the vulnerable and poorly-informed, they are not so good at generating innovation, encouraging value-for-money and tailoring services around individual needs.

Are colleges open for business?

I have spent much of today trying to speak to colleges about them providing construction training for a client. While some FE colleges are enthusiastic and accessible, others offer unreturned emails, labyrinthine websites and ringing-out phones. I am lucky to escape the loop of one college’s telephone system.

It will be a challenge when they are assessed on their responsiveness to customers under the LSC’s Framework for Excellence.

Maybe choice and competition will sharpen up their act.

NHS at 60 – faltering progress on reform

The Economist has made content from its crystal ball gazing The World in 2008 available on the internet. It’s worth a look.

There is a fairly depressing prognosis for the NHS as it reaches the age of 60. The article notes that Gordon Brown lacks the enthusiasm for introducing the market forces of competition among health care providers. The article concludes:

It is hard for the public to feel confident about how Labour is handling the NHS when its staff are so dissatisfied. And one of their biggest gripes has been the threat of private health-care groups moving in on their territory. But there will be a long-term price to pay. For it is exactly that threat which has the potential to unleash real change in the NHS, as Mr Blair belatedly realised. His vision of turning the NHS into a publicly funded health-care market may have run into difficulties, but that reflected the resistance of the vested interests of its staff as well as ministerial incompetence. Under Mr Brown and his health secretary, Alan Johnson, genuine progress in transforming the NHS looks set to falter in 2008.

Vision, Brown and the market for think tanks

Last month Prospect magazine gave the “left-leaning” Institute of Public Policy Research the accolade of Think Tank of the Year. I see this as significant given IPPR’s closeness to New Labour and power – plus a government in search of the “vision thing”.

It is note-worthy that the IPPR has been thinking and promoting reform ideas quite distinct form the Blairite agenda of choice and competition. Public Finance has carried an article by Carey Oppenheim and Lisa Harker setting out a Brownite “narrative” of collaboration between users and producers.

The two IPPR staffers identify behind “personalisation” and “co-production”, two guiding principles:

The first is that people should have more opportunity to shape their own public services and should be better involved and informed. The notion is that ‘how’ public services are delivered is as important as ‘what’ they deliver. The second principle is that a transformation of outcomes will only come about if users of services are jointly involved with professionals in achieving changes in behaviour. This might sound pretty unradical but it is likely to change fundamentally the experience of using public services as a patient or parent.

That all makes sense.

But I would suggest that public services still require incentives to change, innovate, improve quality and reduce costs – in other words, there is a need for the disciplines of markets. Think tanks like Reform and the Social Market Foundation continue to develop ideas around choice and competition.

Txt helping to cr8 better public services?

In media coverage of the billion texts now being sent every month there has been little mention of the emerging impact on public services.

Schools and colleges are starting to communicate by text on issues such as attendance. Social landlords are reminding tenants of visits by maintenance staff and gas checking staff. Prospective tenants are even bidding for flats and housing in choice based letting. Once tenants increasingly they can use their voice and contribute their views via text in resident involvement activities.

Personalising public services sounds like jargon. But text technology is connecting public services with customers. Its a good news story thats lacking the coverage that it deserves.

The NHS: gifts and markets - the need for both economies

Life has been busy so I have only just got round to reading last week's Society section of the Guardian. It carried an interesting article, Gift rap, by Paul Hodgkin about the role of gift economies in the health service.

I agreed with the main thrust of the article that altruistic and collaborative enterprises (such as support groups) have a vital role in NHS. Hodgkin is chief executive of Patient Opinion which is itself a good example of such gift enterprises. “Co-production” is likely to be a growing part of NHS activity in the future too.

What I disagreed with Hodgkin about was his casual rejection of "markets" in the NHS. He commented:

there are a number of reasons why the search for fully functioning markets in healthcare has little likelihood of success.

He went on:

First, markets within the public sector are zero sum - more hip replacements here means less chiropody there. Or put another way, the foundation trust's surplus tends to mirror my PCT's deficit.

But there will always be a choice between hip replacements and chiropody - unless resources are unlimited. Love it or loathe it, but the National Institute for Clinical Excellence is a way of making those decisions by setting entitlements. The market (or call it choice for patients and competition among providers) is a tool for resolving whether those treatments are at hospital A or hospital B or polyclinic C.

Hodgkin continued:

Second, the "goods" the market is trying to allocate are usually not desirable - unlike a holiday in the Maldives. No one aspires to go to hospital for a mastectomy. As consumers, patients can call some shots in a market. But their fears and anxieties are easy to exploit by suppliers (read doctors) inducing demand for ever "better" care.

I think that medical treatment is very desirable when you need it - even major surgery. The point about professionals over-treating is valid although incentive structures can be developed that address that risk. So doctors and/or hospitals are rewarded for healthy outcomes rather than simple throughput of treatments.

One of the biggest obstacles for markets is the imperfect information that patients have about alternative doctors, hospitals, etc. But Patient Opinion and similar initiatives are tackling that.

I believe that Hodgkin's article reflects are cultural weariness of "markets". We hear the word and imagine Del Boy selling three legged tights or City traders yelling "Sell, sell, sell" into their mobile phones. Perhaps there would be less prejudice against "markets" (and associated hostility to reform) if we spoke about decentralised decision making by patients (or parents or service users or whoever) rather centralised decision-making by planners and politicians.

Gordon Brown and public sector reform

The Brown government’s views on public sector reform are somewhat hard to discern although the pace of change in the NHS may soon be slower. However, there is an interesting debate on reform going on.

The Society section of the Guardian website is carrying both an article by a former Downing Street adviser and a selection of views on the role of choice in changing public services.

Although I see choice and competition in public services as a driver for improvement and efficiency, the cartoon above does amuse me.

NHS independence day - coming soon?

Today’s Financial Times carries an interesting article about plans being prepared for greater independence for the NHS.

I am a sceptic about proposals for an NHS constitution and “independence” unless such moves enshrine and promote choice and voice for patients and communities.

The idea of less central interference from politicians and Whitehall is welcome. But can politicians sit on their hands when they get the blame – rightly or wrongly – for everything that goes wrong anywhere in a £90 billion business?

Regulation in the news: the NHS and social housing

Red tape is in the news this week.

According to the NHS Confederation, bureaucracy in the NHS is increasing with 56 bodies having a role in inspecting, assessing or monitoring the NHS. Is this necessary? (Report pdf available.)

With greater patient choice and more diversity of providers there should surely competition should replace regulation to some extent at least. Regulation should focus more promoting competition among providers (like OFCOM and other regulators) and disseminating information for “consumers”.

There is the on-going debate about regulation in social housing with the Cave review. This week Inside Housing has an interesting overview of the arguments from the various interested parties. (Sadly the article is not on the IH website.)

I strongly favour proposals for contestability and “choice based management” with the tenants able to exercise choice when their landlords fail them. This mechanism has been suggested by the Audit Commission in their submission to the Cave Review.

Further education colleges and choice

This week’s debate about Brighton & Hove City Council’s approach to over-subscribed schools (“lottery” to the media; “equal preference” to the Council; “random selection” to the experts) was interesting.

The issue has arisen from the need to manage fairly the challenges of schools choice. (I’d recommend the podcast on schools choice from Bristol University’s Centre for Market and Public Organisation for background on these kinds of issues.)

For a long time I've been waiting for the simple idea of choice arriving on the agenda of the further education sector. There is now lots of talk of “personalisation” and “contestability” (for the uninitiated - reducing barriers to entry for new providers). Recently “learner choice” has been spotted in the pipeline.

Yet since the creation of the Learning & Skills Council (and to some extent before) there has been pressure for mergers. While some mergers have made sense – particularly where well-managed colleges have effectively rescued weaker ones – others seem to have been driven by a belief in rationalisation and reducing to the sector to 150 or so colleges. There is a real risk that the scope for learner choice as well as the impetus for innovation and the possibility of meaningful benchmarking could be merged away.

More NHS patient choice - but voice too please

It was good to read last week’s announcement by the Department of Health that there would be a major extension of patient choice. (An analysis is available on the website of the think tank Reform.)

NHS patients needing “elective” treatment like a hip replacement can currently choose from four local hospitals, 34 foundation trusts and 15 independent sector providers. The Department of Health’s roll-out of choice means that by the summer there will be over 200 hospitals and treatment centres on offer to patients. Then by the end of 2008, patients will be able to choose from any hospital which meets NHS standards and costs.

The Department of Health is also creating a new website that will bring together information on all hospitals and treatment centres to empower patients to make more informed choices than ever before on their healthcare. This is vital to make choice informed and meaningful.

Linked with Payment By Results, these changes mean that the best providers will be encouraged to expand and shorten waiting lists. It’s a shame that these changes have come in so late and after so much money was injected in the NHS.

Having said that, as I have argued before, there is still a need for patient choice to be supplemented by voice – particularly in the areas where there are fewer hospitals. This can be seen from a map below from the Centre of Market and Public Organisation’s study of Choice: Will more choice improve outcomes in Education and Health Care (pdf available).

Consumerism in the NHS and other public services

Consumerism and choice in public services have been in the media this week.

On Wednesday David Walker in Guardian Society attacked "the Tesco model" in public services. Essentially his argument was that:

The very basis of social policy is assessment of need, followed by distributive decisions that give relatively more to one group than another.

And, therefore, unlike shopping. (Isn't social policy about more than need assessment and distributive decisions - shouldn't it be about empowerment?)

Then on Thursday BBC4's Analysis programme explored how ideas and expectations of choice are affecting everything from personal relationships to public services. It was a more balanced survey than David Walker's polemic. (The second half of the programme on Listen Again focuses on education and health.)

One of the academics suggested that market forces of choice and competition in public services eventually dissolves the state.

I would ask - is this a problem? As long as the state facilitates, funds and regulates provision - does it matter if its not the provider?

What is important is that the state develops the role of society with social enterprises and mutual organisations like co-ops - so that we are more than individualistic consumers.