The New Shape of Public Services

Public services must be changed, not just funded. This report outlines the new vision for the NHS and state education which would make them more innovative and consumer focussed. The key is to make the public services producers "free–standing, self–owned and independent". They would manage their own budgets and set their own policy and priorities. Parents choosing a school would direct the government funding for their child to the institution they selected. Doctors and patients by choosing a particular hospital for a course of treatment would direct state funds to that institution. State schools, universities and hospitals would be driven by the demands of their customers. The public services would have to improve quality and efficiency.

 

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The Wrong Package

The latest book in the series from the Adam Smith Institute and MORI looks at the delivery of public services. The findings of the report highlight the differences between the consumer agenda and the producer agenda. The new survey looks at three services: police, schools and local government and the conclusion from all three is that what they deliver is not what the public want. The public want the police to tackle criminal gangs and organized crime, muggings and street crimes, prevent burglary and recover stolen property. A huge majority of people say that teaching the basics - reading, writing & comprehension - should be a top priority. Local government should concentrate on CCTV, keep council estates in good repair and tackle litter, graffiti and dog dirt. The disparity between what is delivered and what is wanted is clear to see.

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A Class Act

While both Labour and Conservative parties talk about the value of parental choice in education, other countries are actively encouraging it. "All state schools could become independent." says the reports author, former Fabian society research chief Stephen Pollard. Examples are given where the public funding private provision model is successfully being used. In America charter schools, which have been set up by local parents receive tax funding, are non selective and are exempt from much of the regulation imposed on state schools. New Zealand has copied the charter school model, replacing the old district bureaucracies with new boards of trustees for each school and has abolished zoning. 82% of New Zealanders now claim to be satisfied with their children's education, and 97% of low income families being satisfied. Equality and educational standards would both rise if the government stopped running schools and paid others to do it instead.

 

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Paying for Medicines

A new ASI report suggests that Britain should follow Sweden, Norway, Holland and Belgium in asking people to pay the first £60 of their annual prescriptions bills. This would bring an extra £2 billion into the NHS, cut the waste of 'free' medicines that are never taken, and would allow patients to weigh up whether expensive new medicines – unavailable on the NHS today – were really worth paying for. Is £60 too much? It's only a sixth of what the poorest families already spend on booze, betting and baccy, says author Ian Senior.

 

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Funding UK Healthcare

Britain's tax funded health system is no longer the world's envy, but a quaint oddity. It will remain in financial crisis until we bring far more private spending on healthcare. Health costs cannot be met by taxation alone. The Institute highlights three areas where funding could be changed. The first is competing funds where 'NHS tax' contributions are paid into a number of 'social insurance funds' of their own choice. The second is charges where there should be co-payments for some minor services, as already happens in Europe. The third is cost, taking the responsibility for healthcare funding out of central government and handing it to private or non profit social insurance funds, will increase what we spend on healthcare.

 

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The NHS Plan: A view from 30,000 feet

Professor Alain Enthoven is one of the world's leading health policy analysts. In this paper for ASI, he reflects gloomily on the prospects for real improvements in NHS delivery unless there are more radical reforms than those politicians are contemplating.

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Facing the Future

The British appear to face he newly unfolding century with mixed feelings. They think Britain will survive, but may be less influential. It will be closer to the Unites States. They are skeptical about many of the predictions made for scientific advantage, but confident about general advances achieved in living standards and life's opportunities. Broadly speaking they expect better times, unmarred by world wars. They expect the welfare state and most public services to wither and die, replaced for most people by private alternatives. About 3 in 5 of them expect this to happen to the NHS and state welfare, and 2 in 3 expect it of state pensions.

Where the young differ from their elders, they tend to be more optimistic. The notable exception to this is that more of them think a world war is likely. They do not, however, think that the British will regard themselves as Europeans first or expect Britain to lose independence or influence.

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Unitary Medical Regulation

The regulation of clinical practice must focus on the clinical service standards that are delivered to patients, and not on protecting professional self-interest. It must be accepted and trusted as such by the public. We envisage therefore a single regulatory authority that is independent of the healthcare professions. It should be dominated by lay representatives, and perhaps chaired by a lawyer rather than a clinician.

 

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Respectable Trade

'Respectable Trade' is a critique of what the author calls the 'dangerous delusions of corporate social responsibility and business ethics'. Should we ask more of our business people than that they conduct their affairs as openly and honestly as anyone else?

 

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The Big Turn Off

'The Big Turn Off' analyses the attitudes of young people to government, citizenship and community. It shows that only a small proportion of young people share the government view that citizenship means volunteering to do things, challenging the law if they think it wrong, or being active in the community. They have little time for government, be it local, national or European, thinking it largely irrelevant to their lives.

 

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