Speech on Open Public Services
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Prime Minister David Cameron has delivered a speech setting out the principles underpinning the reform and modernisation of public services.
Today is an important day for the coalition and for our country.
The contents of this white paper will be felt in every state school, hospital and prison, by every doctor, teacher, parent, patient and citizen.
I know there are those who thought we might be pulling back or losing heart for the task ahead.
So let me assure you of this: we are as committed to modernising our public services as we have ever been.
I’m not going to make the mistakes of my predecessors…
…blocking reform, wasting opportunities and wasting time.
This is a job that urgently needs to be done, and we are determined to see it through.
Because this is not just about improving our schools and hospitals…
…it’s also a vital part of building a bigger, stronger society that is so central to my vision for our country.
So today I’m going to set out three things: why we need change in our public services…
…what our changes look like…
…and - most importantly - what all this is going to mean for you.
Why we need change
First, why we need change.
I won’t stand here and say our public services are a disaster.
I can’t say that - because I’ve seen how good they can be.
I think of the incredible care my eldest son received through the NHS.
The fantastic school where my elder daughter and son goes, the teachers who inspire them so that every day they come out full of new ideas.
I know how committed our public servants are and how hard they work.
I know what our public services can do and how they are the backbone of this country.
But I know too that the way they have been run for decades…
…old-fashioned, top-down, take-what-you’re-given…
…is just not working for a lot of people.
Public services were centralised with all the right intentions…
…to drive progress through from on high, to keep tabs on how that progress was going with targets and rules and inspections.
But the impact of this has been incredibly damaging.
I meet countless parents frustrated that they can’t find the right state school for their child.
I went out on the beat with a policeman who had to arrest people for the pettiest reasons - even when he thought it was the wrong thing to do - because he had to hit his targets.
I campaigned against the arbitrary closure of special schools, which flew in the face of what so many parents wanted and caused so much pain.
And as a parent I remember the difficulties of trying to get the right wheelchair for my eldest son…
…and still hear too many stories of the right wheelchair arriving after the child has almost outgrown it.
This is the experience of millions of people:
You’re told the meals on wheels lunch won’t be there til 4pm because that’s just how the rota works.
You’re given a hospital appointment half an hour away even though there’s a great clinic just down the road.
Too often it’s felt like us versus an impersonal, bureaucratic machine.
All these frustrations might - just might - have been worth it if they had led to dramatic improvements…
…if they had made our country a fairer place, or given us real value for money.
But the evidence shows that in all these things, the top-down system is failing.
We’re not getting good enough results.
One of the keys to Britain’s success in the future will not just be the performance of our economy, it will be the performance of our public services.
But compare us to other countries, and the evidence is clear: we’re not doing as well as we should be.
In less than ten years we fell almost twenty places in the world rankings on maths and literacy.
In Shanghai the average child is two years ahead of a child here.
And it’s a similar story in healthcare.
If our cancer survival rates were at the European average, you want to know how many lives we’d save each year?
We’re failing on fairness too.
We should be open and honest about how our public services have created a fairer, more equal country since the Second World War.
But at the same time, we’ve got to acknowledge where public services are failing on fairness.
It is an appalling fact that in England today, people living in the poorest neighbourhoods will, on average, die seven years earlier than those living in the richest.
The poorest children - those who qualify for free school meals - are half as likely to get five good GCSEs as their better-off peers.
The last time they counted, just 40 people who had had free school meals were going to Oxbridge - out of 80,000.
We’ve got a welfare state that doesn’t deliver welfare, that doesn’t get people back into work but traps them in poverty instead.
And we’re not getting value for money either.
Total public spending increased by 57 per cent in real terms from 1997 to 2010.
But on no measure can we claim that things have improved by more than fifty per cent.
Even if we weren’t deeply in debt, we would have a responsibility to do something about this.
But today, as we work to clean up the mess we inherited, the need to get more for less is not just urgent but critical.
So this is the case for change.
If we want to compete in the world, if we want our country to be a fairer place, if we want to get real value for money…
…and above all if we want the decent, reliable public services that make life better for people - then we need to modernise.
There will be no progress if we just stick with the status quo.
What our change is
So let me tell you what our change looks like.
It’s about ending the old big government, top-down way of running public services…
…and bringing in a Big Society approach…
…releasing the grip of state control and putting power in people’s hands.
The old dogma that said Whitehall knows best - it’s gone.
There will be more freedom, more choice and more local control.
Ours is a vision of open public services - and we will make it happen by advancing five key principles.
First, the principle of choice.
Wherever possible we are increasing choice by giving people direct control over the services they use.
Why? First because it’s a good in itself.
You wouldn’t pay for a gym membership and then get told you’re only allowed to use the running machine or only allowed to come in on a Tuesday…
…and neither should you pay your taxes then get told you’ve got to take what you’re given.
I know what some people say: ‘I don’t care about choice - I just want a decent school at the end of my road.’
I understand. And if I could write a government cheque to guarantee that, I would.
But here’s the thing - government can’t just make good schools appear.
You can’t just pass an edict for standards to improve.
You need the right structures in place.
And this is where choice is so vital.
When you have the power to choose where your child goes to school…
…and that choice is backed up by state money…
…schools will start bending over backwards to give you what you want: better discipline, more sports, after-school clubs.
That’s how standards rise in public services - when you get the structures right.
And this isn’t some theory - the evidence is already there.
A study published by the London School of Economics found hospitals in areas with more choice had lower death rates.
So right across our public services we’re extending choice.
Giving patients the freedom to choose the healthcare they want, where they want.
Giving social housing tenants more choice about where they live.
Giving parents of children with disabilities their own personal budgets…
…so it’s them who decides how that money gets spent, not someone who’s never met them and doesn’t know their lives.
Now I know what you might be thinking:
‘We’ve heard politicians talk about choice before and nothing ever changes.’
But something very big and different is happening with this white paper.
For the first time ever we are looking at how we can enshrine a general right to choose in law.
No ifs, no buts, no more get-what-you’re-given…
…this is get what you choose.
A clear, legal right to make the best choice for you.
And if anyone tells you that there are no other options on the table…
…you’re going to have powerful people you can go to to take up your case and fight your corner.
We’re taking the Ombudsmen services and giving them a new role.
We’re asking what powers and profile they need to act as an enforcer of choice in public services, getting what’s best for you.
On top of that I can announce today that Which? - who for years have been advocates for consumers in the private sector…
…will now become your advocates in the public sector too.
In other words, we’re putting you in control like never before.
Of course sometimes, it’s not possible to put that choice directly in people’s hands.
That’s why the second principle is decentralisation.
We’re going to make sure power over public services is held as locally as possible.
Already we’re giving councils a whole load of new powers, and communities new rights to buy assets like village shops and pubs.
We’re going to have powerful mayors in our biggest cities, and Police and Crime Commissioners in every force area.
And today, with this white paper, we go even further.
In its pages you’ll find plans to give neighbourhood or parish councils new powers to run services and really take control of their area.
We want to see democracy on a properly hyper-local scale…
…you and the people you know - the people you wave to on your way to work in the morning - having genuine control over the things that matter to you…
…improvements to your streets, your roads, your local parks.
Most importantly, we’re looking at giving more local councils their own funding streams too.
Already we’ve rolled out community budgets to sixteen areas, putting money into the hands of local people.
And this is just the start - we want to move forward quickly to roll out these community budgets to around 50 more local authorities this year alone.
We haven’t seen power this local for generations.
Other governments pay lip-service to localism - we’re doing it.
Now devolving power doesn’t just apply to those who use public services - it’s about those who work in them too.
That’s why the third principle of modernisation is diversity…
…opening up public services to new providers and new ideas.
This is absolutely critical to what we’re doing.
Just think if the rest of our lives were as un-diverse and restricted as our public services.
Imagine you’re buying a mobile phone.
You go to the shop - only one shop - and there they’re selling one model of phone.
You can guarantee the service wouldn’t be what you’d expect, the quality wouldn’t be great…
…and yet we apply the same tired, old monopolistic thinking across so much of our public services.
These plans put an end to all that.
This white paper says loud and clear that it shouldn’t matter if providers are from the state, private, or voluntary sector - as long as they offer a great service.
Now to those who say the only place good services can come from is the state…
…I say try telling that to the people whose lives have been saved by the RNLI…
…or the people who feel ill late at night and go to an NHS walk-in clinic run by Assura.
Neither of those organisations is run by the central state.
Both of them run an excellent service.
Diversity isn’t a threat - it’s a promise of better public services for everyone.
Just look at what’s happened to education in New Orleans.
After Katrina, they had to start again with their schools system - and they invited a whole load of new providers in to run charter schools.
Now more than half the students in the city go to charter schools - and standards are rising.
And we feel so strongly about this that with this white paper we’re taking a big step.
From now on, diversity is the default in our public services.
What does that mean?
It means that instead of having to justify why it makes sense to introduce competition…
…as we are now doing with schools and in the NHS…
…the state will have to justify why it makes sense to run a monopoly.
So in national security - yes, there’s a case for the state taking care of things on its own.
In frontline policing and the judiciary - yes, a monopoly makes sense.
Pretty much everywhere else - we want to see diversity.
Now making this change won’t be easy.
Sometimes, a charity or social enterprise trying to come into public services will find strong forces trying to keep them out…
…vested interests, people who want to stick to the status quo.
We need a level playing field so that anyone with a good idea can get involved.
So with this white paper we’re making sure that across public services - in health, social care, education, housing…
…there are organisations whose job it is to make sure new providers can come in.
Let me be clear: if you’re a company who has some innovative ideas on getting offenders off drugs, we want to know what those ideas are.
If you’re a charity providing home help to adults in social care, we want more people to benefit from that.
And if you find that people are holding you back and blocking your way, you’ll be able to go to these organisations to fight your case.
The old narrow, closed, state monopoly is dead.
The fourth principle of open public services is fairness.
It’s no good having services that are excellent for a few and unattainable for the many.
It’s no achievement raising standards if you still leave the poorest behind.
That’s why across the board we’re bringing in new help for those who need it.
A pupil premium to get disadvantaged children into the best schools not the worst.
A National Scholarship Programme to help talented young people into university.
A Health Premium to reward progress for improving health in the poorest areas.
Community organisers to go into the most deprived neighbourhoods, raise people’s aspirations and make a difference.
The people who have been most let down by top-down public services are going to be lifted up.
And let me make one other point on fairness here.
It astonishes me that it’s those who call themselves progressive, who say they’re on the side of the poorest, who are the most anti-opening up public services.
It’s the current system that is incredibly unfair.
People with money can get friendly with their local GP at a dinner party, maybe see them out of hours if there’s an emergency.
They can move to a different part of town if the schools are better there.
In this world of restricted choice and freedom it’s the poorest who lose out.
Well, these plans are about creating those opportunities for everyone.
On this I am determined: as we push forward with modernising public services, no one will be left behind.
The fifth and final principle is accountability.
All services need to be accountable to the people who use them and the taxpayers who pay for them.
Sounds obvious doesn’t it?
But with the old top-down model it seemed as if no one had to answer for anything.
Ministers could spend your money like water behind closed doors.
Useless providers were given big cheques just for laying on a service, regardless of whether that service was good or not.
It was a bit like giving a child an A grade just for sitting through an exam - even if they’ve never written anything down.
It doesn’t make sense.
In every other part of life, reward follows effort and achievement.
People are held accountable for their decisions.
And so it should be in our public services.
One of the biggest levers of accountability we’re bringing in is payment by results.
If providers have good ideas to get people off alcohol or drugs, or get them back into work for the long-term, we’ll say great, come on in…
…but you’re paid according to the outcomes you achieve.
Show us the results and we’ll show you the money.
Another really powerful tool we’re using is transparency.
We’re putting stacks of information about public services online…
…from the MRSA infection rates in your local hospital to the science exam results in your local school to crime maps of your streets.
This is going to have a profound impact.
Arming you with the information to make the right choices.
Helping us save money.
And most importantly, driving up standards.
Five years ago, it was made far easier for the public to access, understand and use data on survival rates following heart surgery.
And guess what happened?
Survival rose dramatically.
This shouldn’t surprise us.
Our doctors, teachers and police officers are passionate about driving up performance and being the best.
If they see things being done better and differently elsewhere, they’re going to race to improve themselves.
So this is how accountability, like choice, diversity and decentralising power, is going to make our public services better.
This isn’t about ideology. It’s about the best way to get things done.
What this will mean for you
So that, broadly, is what our changes look like.
But I know that people might be thinking - never mind the productivity graphs and the different sorts of provision, what does this all actually mean for me and my life?
Let me tell you.
Open public services are going to mean you in control.
No more take what you’re given.
No more like-it-or-lump-it.
Say you’ve got a bad back.
In the old way of doing things, you’d go along to doctor who might send you to a hospital to have a scan and operation.
Now, you can look online and check the hospital out.
If you’re not happy with the performance there, you can choose a different hospital…
…an NHS one or one run independently - anywhere that’s registered as safe and charges the NHS going rate.
Right across public services we’re putting you in charge like never before.
And because we’re doing that, open public services are going to mean, quite simply, more of what you want.
More rigour and crunchy subjects in schools.
More really friendly customer service in hospitals and clinics.
More on-the-ground policing from your local force.
And it’s going to mean less of what you don’t want.
Less bureaucracy. Less officialdom.
Less hanging on hold for hours waiting for someone else to make a decision about your life.
And most profoundly, open public services are going to mean an end to an old divide in our country.
It won’t just be the rich who get the best services.
Access to excellent hospitals and schools not the privilege of a few…
…but the entitlement of everyone.
In other words, the plans in this white paper are the start of a better, fairer country.
I want to end today by saying this.
Britain has a proud record of pioneering public services.
We led the way on universal education.
We broke new ground on universal healthcare.
We made provisions for the poorest in our society.
We showed the world that in a civilised country, you create opportunities for those who aren’t born with them.
You make safety nets for those who need them.
We have led the way - and we can lead the way again.
In modernising public services…
…in up-dating them.
…in making them the envy of the world.
Creating universal public services was one of the great achievements of the 20th century.
Renewing those services is one of our great challenges in the 21st - and this government is determined to meet it.