User Choice in Public Services - Essay Example

Registration Number: Degree Programme and Year of Study: of Coordinator: of Assignment: Discuss the extent to which user choice in public services increases efficiency, enhances service quality, and improves equity. Illustrate your answer with examples drawn from one public service. User Choice in Public Services: Impact on Efficiency, Quality and Equity Introduction Public services users have been enduring the most for insufficient quality of public service, inadequate infrastructure, and lack of redressal forums. This has led to longer waiting periods for critical treatments, lack of adequate knowledge about alternatives available, and overall reduced customer satisfaction in most public services. While better options are still available for higher and middle class consumers, the lower class has had to do with substandard quality of life and lesser options with each passing year. Former UK Prime Minister Tony Blair also sought to improve this particular area through implementation of choice in public services, which served purpose in a limited sense. However, choice has not been necessarily preferred by the customers more than quality of service. In a limited sense, it has improved services sector, and also brought about some competition for existing players, but equity aspect can still be debated. For the purpose of this discussion, we shall also specifically consider health sector and discuss various aspects related to availability of user choice therein. Background When Tony Blair's government assumed power, it was noticed that public services were slowly crumbling with tremendous dissatisfaction to customers. The fact was true across the spectrum, whether health services, education or any other field. Lack of competition, lesser choice to customers and pathetic outlook of service providers towards users led to hapless customers waiting for long periods for the service, and then returned home dissatisfied. Queues were getting longer, wait for elective surgeries went up to 12 months and there was evidently tremendous wastage of resources. The system was unresponsive to patient's genuine requirements; giving a feeling of being organised more to favour those who worked within it rather than those who used it. Lack of equity was evident with most services favouring well off people and mostly at the cost of services to poor. (Le Grand, 2006). In fact, in a survey by MORI on words that described state of public services in Britain today, the adjectives in descending number were bureaucratic, infuriating, faceless, hardworking (the only positive note), unresponsive and unaccountable while friendly, efficient, honest and open were among the lowest ranked. (Le Grand, 2006) This led to an action by the government in the form of offering choices to a customer regarding service provider, rewards directly linked to quality and quantity of service provided, improving management effectiveness, and other such customer friendly measures. The efficacy of the system as it developed in the form of choice to customers shall be discussed in subsequent paragraphs. There was a feeling of legacy that the government takes more, controls more, but does not deliver more. To overcome these obstacles, reform programs needed to be guided by plurality of provision, decentralisation, and user choice. (Philip, 2006) The Case for User Choice. User choice is believed to promote better quality, faster response, increased efficiency and equity in public services across the spectrum. It has been described to be more effective than alternatives such as voice mechanism, i.e. speaking up against unfair treatment of customer. While it may not be always the appropriate one, it is an important public service reform. Certain aspects favouring user choice in public services are based on the fact that the user wants more choice today, choice improves quality, responsiveness, competence, promotes equity and facilitates personalisation of services. However, there are certain inevitable conditions that are required to be met for assured effectiveness of choice option: (Courtesy: http://archive.cabinetoffice.gov.uk) a. Information. Customer needs to have correct information to make the right choice and thereby achieve better satisfaction. b. Consequences. Due to its potent feedback option, choice is an incentive for changing and improving the system. Direct linkage with money would allow loss of revenue to the services not chosen. c. Alternatives. No choice would be effective if alternates are unavailable and not credible. d. Entrance and Exit. These aspects require firm dealing with failing providers and encouraging the newer entrants for overall effectiveness of choice option. Audit Commission findings on choice brought out following aspects crucial for service providers and policy makers: (Sykes,2005) a. People want more choice especially in areas of personal social care. b. There exists a considerable difference of perceptions in people's expectations and provision by service providers. c. Choice availability differed from area to area and people to people. Some regions offered better choice to consumers than others. This led to a disparity between quality of services offered despite promises of equitable distribution. d. Citizens expected longer contact periods and better access to facilities. e. People preferred simple, demonstrative, easily understood service information to follow. Pros and Cons: User Choice. With these conditions satisfied, it can be expected that the choice option available to a customer would be productive and leads to desired results. But contrary to promoters of choice theory, choice has also variously been described as an expensive option, offers poor value for money, leads to greater inequity due to its exercise mainly by financially weaker sections and thus its divisive nature. It is important to evaluate its real cost and whether we want to pay for it. Its relation with fairness would be another challenge to be overcome. While diversity would be a by-product of greater choice, its high standard of responsiveness cannot be guaranteed in any way. (Public Sector National Report, 2004) Ultimately, it is not choice alone but responsiveness that needs to be improved. Choice Decisions. There are many kinds of choice decisions that are required to be made by individuals: (Public Sector National Report, 2004) a. Strategic Decisions. Lifestyle choices, like moving into newer locations for children's education or proximity to health facilities in old age. b. Tactical Decisions. Provider choices, for example which school to choose from or which hospital to be admitted in. c. Operational user choice. Personal preferences like what timings of the Gym or swimming pool to choose. Generally, the polls have indicated that people from lower social classes consider choice as an essential ingredient while upper classes do not bother much about choices. It is the middle class which is non-committal and favours choice in certain aspects while does not mind otherwise in others. Further, since the lower class gets a poorer deal with or without choice in most cases, they do not affect commercially oriented public services providers' decisions much. However, middle class always becomes the dominating factor for most service providers due to their commercial intent as they can tilt the balance sheet either way through their decisions. Gender wise, women tend to be more interested in choice than men are. However, most individuals are unwilling to pay for additional choices, which goes against the option of choice. Equity aspects are, however, a bit more confusing. While better-off people have access to better facilities, more choice would further expand their horizons and further improve their access to better services, but they do not seem to be much concerned about this aspect since they already have enough. The corollary is true for lower sections of the society. Thus improvement in equity due to better choice is a debatable issue and cannot be firmly pinpointed at this juncture. Moreover, MORI poll for BBC also brought out that choice will improve service but not inequity. People already make choices like moving to suitable areas for children's education or better health facilities. However, polls reveal that people who perceive maximum importance of choice are also least likely to benefit from it. Thus, idea is not to introduce more and more choices, but to see how it can prevent accompanying inequity too. The challenge is to ensure that public inequity is reduced because of more choices being made available and not increased. (Public Sector National Report, 2004). Despite these exceptions, it is an established fact that extending user choice amounts to better quality, efficiency and equity. Thus the policies have to be appropriately designed with features like offering support to individuals unable to make correct choices, and a mechanism needs to be incorporated to offset cream-skimming which greatly restricts that benefit of choices to all categories of people. (http://www.publications.parliament.uk) Challenges in Providing Services. There are reasons to believe that choice alone may not improve quality of service as such. Some additional packages may need to be included for actual benefit to the customer. Further, providing choice may incur considerable expenses, which should be considered worthwhile both by provider and user and sharing them with customers may be necessary. Concern about choice leading to competition and associated deterioration of standards should also be addressed. Choice can also lead to cream-skim customers so that better-off customers, who can boost ratings of service providers, get access to all the services while lesser ones have to make do with even lower quality of service access. (http://www.cflg.manchester.ac.uk) Limitations of Choice and Voice There were certain limitations of both choice and voice. Since it is different across social spectrums, choice could complicate social inequalities. Further, without proper information, sound advice, and advocacy, choice can lead to disillusionment for vulnerable customers. Further, choice can only work in situations of clarity of outcomes. On the other hand, voice option does not offer as much empowerment as choice for the lower rung. Further, adequate representation cannot be achieved for evolving far-reaching policies. This option works only where adequate redressal mechanism is in place. Consequently, both choice and voice options have limitations in providing an effective mechanism for improving productivity and efficiency. Health Services: A Case Study. For the purpose of this paper, we shall discuss aspects directly dealing with health services. The public health sector has a relatively poorer track record, partly due to actual limitations and partly due to public sensitivity of the issue. Health services quality in public and private sectors is poles apart. While much has been blamed on government's monopoly till a few decades back, aspects relating to governance, accountability, service quality, waiting periods, maintenance and overall customer satisfaction in a public service still leave much to be desired for general category of people. This monopoly can be tackled in various ways, making management accountable with associated penalties, providing voice to people to speak up against poor quality and provide alternate choice to people. All three have been tried in some way or the other and have served limited purpose, with choice aspect producing most desirable outcomes, albeit with certain shortcomings which can be tackled effectively through incorporation of appropriate corrective measures within the system. (Le Grand, 2006) One variation in public health sector is that this is a welfare sector, and privatisation choice will be an expensive one for consumers. It is for public sector to provide service, and private sector will always have a sole motive of profits. Hence, improving public sector than making available a choice would be a more desirable option for most sections of the society. There also seems disparity in people availing medical services and those actually needing medical services. Survey has brought out that unemployed and low income group people use lesser health services than actually needed as compared to economically or educationally better-off sections. On the contrary, this is the group which actually needs more and better health care system. The better off will still get away with a good choice, while economically and educationally weaker sections would still have to make do with poorer option. An expensive choice would of course amount to a no choice situation for these sections and their sufferings will then further increase. (Le Grand, 2006) People's Needs A MORI survey in 2003 showed that 77% of people would prefer to make their own choice of hospital. Another British Social Attitudes Survey (22nd report) revealed that 65% of people should have great deal of choice of treatment outpatient and in-patient, 63% of hospital choice and 53% of appointment time. The study further revealed that more women than men, financially weaker than better off, and more uneducated than educated individuals wanted choice in their services. (Le Grand, 2006) Thus, while all groups wanted choice, it was evident that disadvantaged people wanted choice more than the rest. However, it was not clear whether this class actually benefited more or not from choice option. It seemed that middle class got their due through exercising the 'voice' option, while higher class didn't bother much either way. Further, it has been evident that the poor cannot exploit choice opportunity and even if they do it, they will not do it as well as the better off people. Moreover, even if they did so, the hospitals would still cream-skim the better off ones due to their effect on ratings thus leaving the poor ones out of the loop again. Equity aspect was always the compromised one. The Positive Side for Privatisation. While the private hospitals have been accused of ruthlessly working for profits, there are some very positive aspects worthy of emulation for public sector. It was evident that private hospitals were carrying on with operations at a rate three to four times faster than public ones. Estimates for cataract operations were eight times faster. Patient satisfaction rate was as high as 97% in private hospitals. (MORI, 2005 as mentioned by Le Grand, 2006). Other international surveys too discovered that those treated in private clinics had better experiences to share. The standard of treatment was definitely better. The only other side was apparently their motive of profits. Conclusion The government expenditure in public services has been tremendous and many patients felt that they were more accessible and responsive when things went wrong. However, what has been lacking in most such situations is the management aspect. With monopoly lifted and choice option available to the consumers, this limitation can be looked after sooner than later. A kind of social reform is definitely necessary to improve the situation. It could either be better monitoring of performance or forceful reinforcement of the voice option. However, ex-PM Tony Blair's reforms of user choice and better competition ultimately seems to be more practical and viable solution. While it could be debated, the final outcome of offering user choice can be expected to be better quality, a more responsive and equitable state of affairs. (Le Grand, 2006) Choice is definitely a good thing in retrospect. No frustration can be as great as being stuck in a deal with no way out. Nevertheless, choice systems may not always work fruitfully in stereotyped format in most cases. (Smith, 2006) In most cases, the problem lies not in choice but the quality and responsiveness. Choice is an option only when the system does not work the way it is supposed to do so. Further, choice functions well only when exercised with due caution, adequate information and in correct situations. Sometimes, even no choice is a choice. On other occasions, the satisfaction is in the fact that we have a choice, and that we have the power to change the situation. Bibliography 1. The Case for User Choice in Public Services. Retrieved on 27 Apr 08 from http://archive.cabinetoffice.gov.uk/opsr/documents/pdf/the_case_for_choice_exec_sum.pdf. 2. Choice in public services. September 2004. Retrieved on 28 Apr 08 from http://www.audit-commission.gov.uk/products/national-report/b7162be7-a71a-4237-ad67-dc4deb9effac/choiceinpublicsector.pdf. 3. Le Grand, Julian. 22 Jun 2006 Equality and choice in public services.(V. Fairness and Social Justice) Retrieved on 29 Apr 08 from http://goliath.ecnext.com/coms2/gi_0199-5698909/Equality-and-choice-in-public.html. 4. Choice in public services: A summary review of the evidence. Retrieved on 27 Apr 08 from http://www.cflg.manchester.ac.uk/downloads/choice_in_ public_services.pdf. 5. Philip, Chris 26/03/2006 Fairer taxes, better public services and real choice for all: this is how to beat Labour. Retrieved on 27 Apr 08 from http://www.telegraph.co.uk/opinion/ main.jhtmlxml =/opinion/2006/03/26/do2607.xml. 6. Le Grand, Julian, 21 Feb 2006. The Blair Legacy Choice and Competition in Public Services (Transcript of Public Lecture). Retrieved on 26 Apr 08 from www.lse.ac.uk/collections/LSEHealthAndSocialCare/documents/ByProfessorJulianLeGrand.pdf 7. Sykes Roger, 2005. Extending Choice in Local Government services. 8. Choosing Well: Analysing the cost and benefits of choice in local public services. 2006. Audit Commission Report 9. Choice, Voice and Public Services. 2005. House of Commons Public Administration Select Committee Fourth Report of Session 2004-05 Retrieved on 28 Apr 08 from http://www.publications.parliament.uk/pa/ cm200405/cmselect/cmpubadm/49/49i.pdf. 10. Local Government Association - Annual conference 2004. Retrieved on 27 Apr 08 from http://www.ncc.org.uk/nccpdf/speeches/NCC014_Choice_in_ public_services.pdf 11. Coleman, Helen. 2006. Choice in Public Services - Not Like Shopping. Retrieved on 28 Apr 08 from http://www.esrc.ac.uk/ESRCInfoCentre/ about/CI/CP/the_edge/issue23 /shopping2.aspxComponentId=17146&SourcePageId=17167. 12. Smith David. 2006. No Choice But To have More choice. 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Retrieved on 29 Apr 08 from http://www2.chass.ncsu.edu/garson/pa765/publicchoice.htm. 18. Handy Peter. 2003. User Choice: Fact or Fiction. Retrieved on 29 Apr 08 from http://www.acci.asn.au/text_files/speeches_transcripts/PH_UserChoice_290803.pdf 19. Choice, Voice And Public Services. 2005. Retrieved on 29 Apr 08 from http://www.parliament .uk/documents/upload/4Choice%20iandqpaper.doc 20. Boyd Alan. 2008. Choice in Public Services. Read More