Dillow lacks loyalty
Chris Dillow is right to say that public service reform can be more than just about keeping costs down:
[There is] a possibility – that competition and choice in public services, regardless of its impact on overall standards, might be egalitarian. Introducing “exit” might redress the inequality caused by “voice” alone….
…Debate about public service reform has crystallized along boring left-right lines……This has led to neglect of a more interesting idea – that perhaps public services might be reformed in genuinely egalitarian directions.
But if we’re going to use the Exit, Voice Loyalty heuristic as a basis for knowing how public service reforms in the interests of the poor best fit with how people act, then we need to use all its bits, and apply it to all the bits that make up a public service.
That means focusing on those who provide the service as much as on those who receive it. After all, on a day to day basis, that’s where the real power lies. Whatever, the policy makers say, it’s how well your GP actually listens, diagnoses and and treats that matters most, and that happens best when the GP is interested and motivated.
As Lipsky has shown, loyalty to work the ‘profession’ tend to run deeper than any other, and are prioritised over other demands for loyalty, including those of the service user, when these are at odds with those of the profession. Therein lies alienation and poor service delivery of the type that makes user ‘exit’ sensible, for those who can afford or demand it. In its most extreme and twisted form, therein lies Wintebourne, in which those with no possibility of exit, and no voice, suffer most.
So as Chris notes, the Left should be working out how best to design public services which meet the needs of the poor most. Whether they are provided by the state should become something of an irrelevance - a matter reserved for those interested in defining what a state is.
The more important challenge is the development of ‘professional pride’ – a term which in everday use is not limited to the current ‘professions’ – in a system of public service provision that genuinely respects both sides of the provider/user whole. Tawney had it about right:
If industry is to be organized as a profession, two changes are requisite, one negative and one positive. The first, is that it should cease to be conducted by the agents of property-owners for the advantage of property-owners, and should be carried on, instead, for the service of the public.
The second, is that, subject to rigorous public supervision, the responsibility for the maintenance of the service should rest upon the shoulders of those, from organizer and scientist to labourer, by whom, in effect, the work is conducted.
Unionisation, democratic oversight and incentives based on professional pride, not profit. Very old-fashioned, but maybe very modern.