Top down – or bottom up? Simon Courage

Language Policy levers. Or instruments

What’s available - examples Taxation – Raise money VAT – Reward and penalise certain behaviours Zero-rated VAT on food

What’s available - examples Regulation – To permit Civil partnerships – In favour of Vitamins in bread – Against Theft

What’s available - examples Performance management – Targets Hospital A&E admission times – Inspection Ofsted in schools

What’s available - examples Ensure provision of services – Direct Police – Procured Bulk waste disposal

What’s available - examples Exhortation – Leadership Local authority convening of partnerships – Evidence base Research, evaluation, data warehouses

What happens S-curve

What happens Perverse effects

What happens Professional resistance

4 Cs Competition Providers compete for contracts Price and quality, plus other desired effects Open up to private and third sectors – Work Programme for unemployed people Contestability Introduce threat of competition Reduce barriers to entry Open up, say, 15% to private or third sector Keep public sector on toes – NHS elective surgery

4 Cs Choice Parent, patient – client, user – chooses Expresses preference from range – School admissions – NHS Choose & Book – Choice-based lettings Civil society State rolled back to make way for civil society – Farmers’ markets Civil society organisations deliver services on behalf of state – Recycling Civil society creates new services – Pocket parks - dowry

To make this work Requires good information for users – League tables Schools – Which XX? lists Universities – Inspection reports Hospitals Good advice – Especially for disadvantaged GP as gateway to hospitals Understand the limits of markets – We don’t really understand health, can’t prepare Pathways

Where next? How far could you take this? – Choice of police inspector? Where shouldn’t you use this? – Judiciary Q&A