/ Health, Parenting

Is the government right to open up public services?

Would you like more choice about your healthcare and schools? The government wants to open up our public services – but we must make sure that these choices are meaningful ones.

While so much airtime last week taken up with tales of ambient pasties and the fear of a potential fuel crisis, you could be forgiven for missing the government’s update on its plans to open up public services.

This is planned to ensure that public services, like schools and hospitals, work better for everyone.

What is an open public service?

We all engage with a range of public services in our daily lives – from refuse collection to hospitals, street-lighting to secondary schools.

The Open Public Services agenda is described by the government as a move towards treating people more ‘like grown-ups’ – giving us more choice and control over the services we use and better information to help us choose between them.

The communities we live in should also have a much stronger voice – rather than being limited too much by central or local government.

Rather than just getting what we’re given, it’s an opportunity for users of public services (i.e. all of us!) to ask for what we want. For example, in social care some people already receive direct payments to buy the care services that suit them best, rather than having them arranged by the local council. It’s an idea that has caught on in health too – with personal health budgets being piloted this year.

Demanding more from public services

The argument is that services will provide a better standard of service and be more productive if they focus on what users need. Competition for our custom between a wide range of providers will ensure that we get more choice and that services react better to meet those needs.

In practice, the government is working on a number of ideas to make this a reality. For example, pilots will be taking place this year on allowing people more choice over their GP, rather than being tied to one near where they live.

The government has also pledged to look at tools that might give us more power to demand the services we want. For example, they are looking at a possible new ‘right to choose’ and a campaign to let us all know what our rights are around choice.

At Which?, we want to see high quality public services available for all – so we welcome realistic steps to make services more responsive to people’s needs by putting more choice and control in their hands. But that choice must be real and meaningful and information made available a way that works for people.

What happens when things go wrong?

The government imagines that eventually it will become more of a guarantor of services than a provider – making sure that people have fair access and that basic quality standards are met. They are also looking at how to make sure that people get redress when their choice isn’t met or services don’t meet those standards. We want to see effective mechanisms to deal with people’s problems and complaints when things go wrong.

As I work on health – an area where we’ve been promised more choice for some years – I’m keen to know what your experience is of using rights like this. Have you been supported to make choices about where you receive your treatment, for example? If you didn’t get what you wanted, what would have helped you? And is choice something you even consider when you’re thinking about your health?

Ken Grahame says:
7 April 2012

It’s perfectly simple – the Tories intend to do everything the can to achieve the standard Tory line – ie, break up as many public services as they can. Their promises to keep the NHS “safe” are now seen for the total lies they always were, and by the time they finish, they will have wrecked our Education system as well.
These SERVICES should NOT be farmed out to private enterprise -they are far too important to us all to be used as a source of profit.

Gerald says:
19 January 2013

Which world are you living in, since when does the people who can afford to pay choose the Public Sector schools to educate their children, do you really think they would pay for an inferior system.
People come from all over the World to buy these services surely that should make one realise just how good our Private Sector is..
The state would still be in charge and any safeguards can be built into the purchasing system and if the system is run by properly and efficiently and with non politically motivate Public servants we would have a good chance of getting a good service at a reasonable price which is NOT the case today. STOP being politically motivated and go for the best at a realistic price.

Totally and completely agree. The Tory agenda is to privatise everything and allow the rich Tory Chummies to profit from the move. Just as it was in the 1930s The poor and vulnerable truly suffer – not the middle class or rich.

The only bright spot is the present “government” is so truly inept that it may not survive until 2015 – because the Lib-dem support will desert in hoards if their ratings plummet as many hope..

Sophie Gilbert says:
8 April 2012

I have to add my voice to Ken’s and Richard’s. NO to privatisation of public services, by stealth or otherwise!!!

This break up and privatisation of the NHS started back in the 1980’s with the advent of Trust hospitals. The old medical school tie network were loosing money under the old system of payment for patients because the population of London had moved out to the suburbs and home counties. This meant that the District General Hospitals were getting more money. So to stop this Trust hospitals were invented with the London Hospital Whitechapel being the first.

The London Hospital Whitechapel secured the biggest PFI despite the resignation of Sir Nigel Crisp on the Monday and the £1.4 billion PFI being announced on the Tuesday. Why invest in a hospitals in the centre of London when the demographics show that the busiest hospitals are in the suburbs? Unfortunately it is rumoured that the doctors who made this decision at the London are members of the conservative party. Its strange how under Darzi all the the Trauma Hospitals are old Medical schools in London, poorly accessable and have to have helicopters to meet there own guidelines.

Now we have Foundation Trusts and re-organisation with cut backs. The most vunerable people in our society like the Elderly and the mentally ill have been given the biggest cutbacks.

Involving the Private sector in any delivery of Public Service will end up costing us all more money. The Private sector only gets involved if it can make a profit for itself and its share holders that increases year on year. None of the de-nationalised have inproved the service that we recieve, it just costs us more for them.

Instead of privatising why not look at improving the management of the organisations and involve the workforce, not just a select number of doctors who look after there own interests.

PJ says:
9 April 2012

It seems the Tories and Liberals are out to destroy the NHS, the NHS is the “jewel” of the British way of life, we the public pay for it via our taxes. Understand it needs more control, and don’t let the services offered by NHS be abused by non EU patients. Take example of what privatisation has done to the Energy market, Railways, etc, all these industries are ripping off the British public. Let’s hope the Which group campaign for better energy prices takes off!

PeterW says:
9 April 2012

“Choice” – even if it is not a disguised approach to destroying the public sector – is not necessarily a good thing. Too much choice can be both wasteful of resources and a source of stress for consumers. For example are we really better off having to choose between umpteen gas and electricity providers, each with a myriad of (deliberately) confusing tariff options? I much preferred the old system of simply getting electricity from the electricity board and gas from the gas board, with no decisions to take. Even if the old system did not provide the cheapest possible prices, it arguably gave us an overall quality of life benefit by freeing up time spent on “choice”.

It is horrifying that we may now have to spend more and more time doing research (which the average person is unqualified to do) in order to try and pick the best provider of important services like health care.

Choice does not guarantee a high standard of service. For example, much care provision for the elderly has long been in the private sector, with individuals and their families being free to choose which care home to use. All well and good? No, just look at the scandals regarding abuse and other failings that have made the news.

In an ideal world choice for basic services would not be necessary, if a decent quality of service was guaranteed by one’s single local provider (backed by appropriate quality checks made by the government and with an appropriate avenue for any complaints via an ombudsman).

It’s basic economics that the more suppliers of a product or service independent of each other they realise customers can up sticks and take their money elsewhere if they’re not happy. With monopolies or oligoplies it’s like it or lump it.

“Too much choice is wasteful of resources” you feel… I’m not with you – whose resources?

As to the confusing tarriffs, just go to MoneySavingExpert.com or look at the Which? Switch campaign!

I review my utilities at least once a year and switch if I can find a better deal.

“Choice does not guarantee a high standard of service.”

It sharpens a company bosses mind when customers choose to exodus from their rubbish service. The result is poor firms fail and better ones do well.

It’s your right as a consumer to tell a firm where to get off by not giving them your money.

Bureaucrats only know how to spend YOUR money, and because it’s someone else’s cash and not thier own, they don’t give a whit about the price – they’re not concerned with getting a good deal – why should they? It’s not their money!

Gerald says:
31 January 2014

Dear Peter,
If we lived in the ideal world I would agree with you, we obviously do not, you quote the case of bad Care Homes ,you do not quote that the represent a very small minority, you also dot not mention the recent revelation of really bad Hospitals and all the cover ups perpertrated by fellow public Officials for years, this is something CQC would deifinately not have condoned for the private sector.
For a true comparison check out real facts based on real costs to the tax payee with real quality surveys, then you might arrive at a true situation which the British Public have done for years now, thats the real reason that the private sector exists at all, isn’t it?

It’s high time the public should choose between govt insurer or independent insurers. The NHS has an effective monopoly.

Gerald says:
10 December 2012

The problem is that a large proportion of the Public haven’t a clue what to do with “Choice” just look at the voting system and the pathetic turn out. How much more important can it get for Joe Blogs to respond?? Why do Dictatorships evolve around the World if the masses really wanted choice !
This is what society gets when it allows so called “Public Servants” to rule their lives, Freedom of Choice has been hard earned is this Country use it wisely don’t let it disappear.

Can the NHS really get any worse than it is now? I like the idea of having more choice available for some services.

Surely the acronym NHS means a National Health Service, what is wrong with that being a monopoly?

Surely the point should be that if the NHS isn’t providing a proper service then the people in charge should be forced by the government to improve it? Selling it off to the highest tory donor is NOT an efficiency saving, it actually costs us more.

Also think of the water companies, this was privatised yet monopolies created. They broke up the railways monopoly and now taxpayers are actually paying more whilst private companies take dividends. Yet monopolies still exist on almost all routes.

Stop kidding yourselves that you have a choice, you don’t, you are just being led to believe that you have and that choice creates a better service, when clearly it doesn’t, using the examples of rising rail fares, hosepipe bans and NHS trusts to back up that claim.

angela says:
29 June 2012

We took direct payments when they first came out , we are now thinking of putting it back to Social Services to provide services .The paper work was easy to start with now they want carers to fill in paper work like a qualified audit officer . We bought a service from a private provider but when things went wrong the first thing we got asked was how did we pay , when we said direct payments we found no one wanted to know . We are now in the process of taking legal action , it was the only option open to us . It seems to be that the government is going down the road of doing away with social care because instead of a social worker you will get a support planner , what good it that to anyone needing care , and try and find out how a RAS gives the exact points you get is like something from the secret services even people doing the courses to fill them in do not get told how you score the points , all you get is I do not know the tick boxes get fed into a computer and it works it out . what a great way to cut everyone’s services , just blame the computer it worked your points out .

Gerald says:
19 January 2013


surely all the problems you are experiencing are with the Social Services officials , they are the ones who have set up the system its obvious they do not like you having a choice and that is why they are making it difficult for you Please don’t give up stick up for your freedom of choice.

Gerald says:
19 January 2013

Dear Dean,

I agree no monopoly is good, and has to be avoided like the plague. The NHS is the second biggest employer after the Chinese Army it costs this Country Billions of Pounds surely introducing competition can only be to our benefit? Bye the way did you know that even the NHS is already outsourcing services to places like India (Private firms) This initiative should be applauded if it produces a better overall system. I do not think that anyone is suggesting closing down the NHS the object is to make it more efficient, just out of interest I wonder what proportion of the supplies and services are already let out to the Private Sector ?

Gerald says:
22 January 2013

No brainer ,

Cost to the tax payer for 1 week in a Hospital Ward for the Elderly £2500
.. .. .. … .. .. 1 .. .. .Nursing Home .. .. .. £700

The above prices are for the more or less the same standards of Care ,board and lodgings.etc Think in terms of Hundreds of thousands of people the saving to the Economy is Mega

Any questions ???

Gerald says:
9 February 2013


Just out of interest why have you censored the NHS figures out they were necessary for a comparison !

It’s a good economics point but perhaps it could be construed as an ad for the said company. If you mentioned ‘Independent health firm’ instead of naming it, and invited others to contact you via facebook for the name of it that might be a better arrangement, I don’t know.

Gerald says:
9 February 2013

Has anyone been following the Mid Staffs Hospital fiasco …. need I say anymore ?????

It’s basic Economics that the more suppliers of a product or service independent of each other… they realise customers can up sticks and take their money elsewhere if they’re not happy. With monopolies or oligoplies (a few suppliers/providers) it’s like it or lump it.

If any service…. ANY service or product, including healthcare is supplied by one and ONLY one provider, it’s a MONOPOLY and you can give any shoddy level of care at the highest prices and fees you like, because you CAN’T go to anyone else. Econ 101.

Politics is the art of disregarding basic Economics.

If there is only ONE best service or best value, then it’s no longer the best service or best value, is it?… because there’s nothing to compare it to!

Recently there was a ‘one low tariff’ idea for energy firms… If there’s only one lowest price tariff, then it’s no longer the lowest, is it?

If everything is five feet tall how do you know what tall or short is? Humans only know the meaning of things through its opposite thing: You only know what ‘hot’ is because there’s ‘cold’, or ‘not as hot’.

Gerald says:
10 February 2013

Hi Jonty

The figures Which have been omitted were the comparative figures to the private sector which applied to Hospital trusts such as the Mids Staffs Hospital which amounted to £2500 per week as compared with £700 per week for the Care Home. When one looks at the recent scandal emerging from this and other Hospitals, I leave the comparisons of quality and value to others, perhaps you could comment on this point

Gerald says:
10 February 2013

Dear Jonty
Your point makes total sense to me as long as everyone applies fair
and logical comparisons to the equation.and ,as you say , do not get to involved with politics.

We need to remember that ‘fair’, ‘fairness’, ‘opportunity’ and ‘society’ are abstract nouns that are essentially meaningless – what is ‘fair’ to one may not be ‘fair’ to another. There are many other political abstract nouns/cliches that are the lexicon of logical mind bypassing placard politics that go straight to the emotive survival brain of jealousy and tribalism, words that sound impressive but mean nothing, together with doublespeak that bend a debate politically without even the public realising. e.g.

First there was “Pro Life”. Who wants to be “anti Life”?
Then, “Pro Choice” Who wants “anti choice”?
“Public Sector” really means, “Govt Sector”
“Private Sector really means “non Govt. run, independent Sector”, also the use of ‘Private’ makes it sound secretive, closed, elitist, as opposed to ‘public’, a euphemism for sectors employed by the Govt, or rather the taxpayer (inc. Govt. themselves), because Governments don’t HAVE any money, it’s YOUR money.

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I am indifferent to whether the tests should be carried out by government-employed assessors or by private companies; both methods have their advantages and disadvantages. The important thing is for the tests to be carried out competently, conveniently, and in a manner that imposes no stress on the benefit recipient or applicant. Ideally the tests should be completely standardised so specialised facilities are probably the best places in which to hold them but home tests can be just as reliable and should be offered where there is a necessity. It is also important that the composition and methodology of the tests are under government control and supervision to minimise variances in application of the benefit criteria.

It is arguable that there is more room for favourable discretion under a private assessment than under a government one where rigid adherence to doctrinaire procedures for performance measurement purposes might militate against a fair assessment. On the other hand, if it is really is the case that private companies are under pressure to reduce the pass rate [and I’d like to see the evidence before accepting that at face value] by severe or incomplete testing then that is a genuine cause for concern. On both sides it comes back to the thoroughness of the inspection and monitoring of the assessment process whether internally or externally provided – a notorious public service weakness.

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We should set appropriate benchmarks for eligibility for disability payments, whether done by a private or a public organisation. We should not set any pass rate as a target, not pay any bonus (other than perhaps for processing a specific number of applicants) as both these distort the way assessor organisations will behave.

I agree, Malcolm. The process must be seen to be as fair as possible but I have an open mind on whether we can rely on civil servants to do it properly or whether a well-supervised external service provider would be better.

All attempts to improve the benefits system and make it more equitable seem to have flaws, give rise to heart-rending stories, and provoke emotional opinion pieces in The Guardian. I am not saying the article is wrong or untruthful but to my mind it lacked factual objectivity in terms of cause and effect.

I should be interested to know the name of the company that carries out the assessments and their professional experience and competence in the role. It would also be interesting to know about the contract specification and the bonus regime. Is it really the case that any performance incentive in such a sensitive scheme as this is as crude as being a bonus for every claimant professionally assessed [i.e. not “deemed”] as being fit for some form of work? That cannot be right.

I forgot to mention above that I couldn’t get the link to work that was posted by Duncan to an article in The Independent.

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Thank you Duncan. That is a much more informative article and very thought-provoking.

Although the fear of being assessed as fit for work might be the trigger for suicidal thoughts, and gives rise to the anxiety and stress around the date of the assessment, it is likely that the very thought of having benefits reduced or withdrawn is the condition that primes the pump, as it were. Some will say this is the consequence of over-reliance on benefits which in abstract terms might be true but that ignores the effect on individuals and requires sensitive adjustment.

I have no knowledge of how people are treated after an assessment that says they are capable of doing some work. Are the full implications explained, from the worst to the best scenario and outcome? Is counselling provided? How nuanced is the assessment? Does it indicate what type of work might be suitable, whether or not it can be done at home, how many hours a day and week are possible, whether at-work support is available? We don’t get to hear this side of the story.

At the end of the article in The Independent there is this quote from a DWP spokesperson – A decision on whether someone is able to work is taken following a thorough independent assessment, and after consideration of all the information provided, including supporting evidence from a GP or medical specialist. We continually review the WCA (Work Capability Assessments), and have already introduced a number of changes to strengthen the service.” [The phrase “strengthen the service” is open to alternative interpretations and might best have been avoided in this context. Also note that the evidence has to be “supporting” – what happens to evidence that does not support the assessment, or am I being too pedantic?].

What the DWP does not say is whether the GP or medical specialist is consulted after the assessment to consider the results and the implications for their patient, or plays any part in the consideration of suitable forms of employment, or can appeal against the assessment on the basis of his or her knowledge of the patient, their domestic situation and their family circumstances.

The article refers almost exclusively to suicide attempts and talks in terms of percentage changes in the numbers without stating the base from which the change is measured. To that extent the article is tendentious. The actual number of attributable suicides each year is not given, but that could be because there are no solid statistics and the outcomes of Coroners’ inquests might not always be conclusive. Any increase in the propensity for suicidal behaviour is worrying but further exploration of that and the psychosomatic influences might not be appropriate here.

I just hope the professionals at the DWP [and hopefully in consultation with the Department of Health and Social Care] have given full consideration to the psychiatric implications of the assessment process.

The government appears to be satisfied that the assessment regime and its implementation are achieving its main goal which is to enable more people to go into employment with the concomitant reduction in the cost of benefits, but a major aim should also be rehabilitation and integration into society. On its own, access to work is a good thing financially, for social adaptation, and for self-esteem and confidence. But the assessment process has the hallmarks [or has been given the label] of being Treasury-driven, which is unfortunate. The focus should be on the enablement of ill and disabled people and a bespoke match with an opportunity profile that encompasses full-time work, part-time work, working at home, working in an office, shop or factory, indoor or outdoor work, and a spread of working environments found in liaison with the client’s GP and assistance to secure a suitable placement plus aftercare. I wonder how close that is to reality.

Private Eye were vocal in their criticism of ATOS and their dealings with PIP claimants. (ATOS is French owned). https://beastrabban.wordpress.com/2015/10/17/private-eye-on-atos-incompetence-running-pip/

It was 3 years ago and I don’t know the current situation.

Nor have I read this: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/725533/pip-assessment-guide-part-2-assessment-criteria.pdf
“DWP PIP Assessment
Part Two – The Assessment
A DWP guidance document for providers carrying out assessments
for Personal Independence Payment
Updated on 16 July 2018”

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BBC News 5 June:
Atos and Capita must improve the delivery of Personal Independence Payments (Pip) or face losing their contracts, MP Frank Field has said.

The government says it is looking at extending the firms’ contracts by two years to “better allow for a stable transition to any new provision”.

And it was developing IT systems to move some of the work in-house.

Work and pensions committee chairman Mr Field said the ministerial statement was a clear warning to the companies.

All Pip disability claims to be reviewed
“The government is making the important first steps to enable it to get out of a hole of its own making,” said the Labour MP.

“Having the capacity to bring assessments back in-house will put it in a far stronger position to turn the screws on its hitherto failing contractors, in the interests of claimants and all taxpayers.

“This should serve as notice for Atos and Capita to start delivering, or else.”

I don’t think profits from EDF’s UK operations would directly subsidise the retail price of French electricity. That said, I can see that the revenue from the sale of French electricity to the UK would increase the overall sales volume of EDF’s French nuclear stations, so that retail sales in France wouldn’t need to recover all of the operating costs of those stations. Hence, the retail prices in France can be lower, because of the sales to the UK.

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Just relaying the latest figures from Ofgem, duncan. The median electricity price in the EU July-Dec 2017 was 14.44p. Both France and the UK were above.

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I cannot understand why this matters and what the practical alternative is.