The Other Invisible Hand: Delivering Public Services through Choice and Competition

The Other Invisible Hand: Delivering Public Services through Choice and Competition

The Other Invisible Hand: Delivering Public Services through Choice and Competition

The Other Invisible Hand: Delivering Public Services through Choice and Competition

Synopsis

How can we ensure high-quality public services such as health care and education? Governments spend huge amounts of public money on public services such as health, education, and social care, and yet the services that are actually delivered are often low quality, inefficiently run, unresponsive to their users, and inequitable in their distribution. In this book, Julian Le Grand argues that the best solution is to offer choice to users and to encourage competition among providers. Le Grand has just completed a period as policy advisor working within the British government at the highest levels, and from this he has gained evidence to support his earlier theoretical work and has experienced the political reality of putting public policy theory into practice. He examines four ways of delivering public services: trust; targets and performance management; "voice"; and choice and competition. He argues that, although all of these have their merits, in most situations policies that rely on extending choice and competition among providers have the most potential for delivering high-quality, efficient, responsive, and equitable services. But it is important that the relevant policies be appropriately designed, and this book provides a detailed discussion of the principal features that these policies should have in the context of health care and education. It concludes with a discussion of the politics of choice.

Excerpt

Ask people what they want from the public money that is spent on health care and education, and the answer will be simple: a good service. Sometimes they will add that they would like this service to be on their doorstep: a good, local service. A high-quality local school; a caring, responsive, family doctor; a top-class district hospital.

This short book is about how these aims can best be achieved. It examines four means of doing so: trust, where professionals, managers and others working in public services are trusted to deliver a high-quality service; targets and performance management, a version of what is often termed command-and-control, where those workers are instructed or in other ways directed to deliver a good service by a higher authority; voice, where users of public services communicate their views directly to service providers; and the 'invisible hand' of choice and competition, where users choose the service they want from those offered by competing providers.

The book does not argue for one of these means being used to deliver public services to the complete exclusion of the others. On the contrary, it contends that each has its merits, and that, in consequence, all have their place in the delivery of public services. But it does also point to the disadvantages of each system. And it pulls together evidence and theory to argue that, in most situations, services whose delivery systems incorporate substantial elements . . .

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