Barriers to Choice
In 2012, the Cabinet Office and Treasury asked me to lead a review into the barriers people encounter when they try and exercise the choices they have been given in public services. The review was published in January 2013. Three important findings emerged.
First, that the bureaucratic barriers to choice are pretty powerful if you are less confident or articulate, and if you want something slightly out of the mainstream. I have looked at ways in which we can increase people’s authority in the system, so that they feel more able to ask for what they want.
Second, the need that people have, especially disadvantaged people – not just for information, though that can be problematic too, but for face to face advice. They get around eight minutes from the doctor, some support from the social worker doing their social care assessment, but otherwise very little.
I don’t believe there is any appetite, or budget, to insert a new layer of professionals into an already complex system. So what I proposed was to pilot an extension to existing schemes providing peer support from volunteers, so that they’re trained up to provide navigation support – to help people make decisions, find their way around the system, maybe just help them with the internet.
Finally, what you find when you talk to people about choice in detail is that the kind of choices they think they are getting are often not what they are being offered. They want the choice of a consultant who won’t mind them asking lots of questions. Or to study Spanish at A level when all that prevents them is their school’s timetabling system. Or to go to bed later than 5 o’clock when their carer comes round. Basic flexibilities in the system which articulate people can get by being pushy, but which others can’t.
This is a broader agenda for choice than just competition – to give people more authority in the system at least to ask if their specific needs can be accommodated. That’s what my recommendations are designed to achieve.
The report, appendix and poll findings are published on the Cabinet Office website.
You can see the official reaction by ministers here.
This is what I said at the launch.
The interview with me about the review in the official organ of the Civil Service.
The Guardian leader wrote a perceptive comment about the findings.
The influential NHS blogger Roy Lilley lent his support to the basic ideas.
This is where I tried too explain in more detail what I was trying to achieve.