Select Committee on Public Administration Minutes of Evidence

Letter from Michael Jacobs, General Secretary, Fabian Society (PSR 37)

  1.  In his evidence David Lipsey claims that I was arguing for much higher public expenditure and corresponding taxes at French levels, which would make a government unelectable. My argument was only that if you want choice in the system this requires spare capacity, and this is expensive. The French system has choice because there is spare capacity, and it is expensive. I was not arguing that we should go down their route, only that we must recognise the implications of a simple slogan such as "greater patient choice".

  2.  My remarks on the "postcode lottery" were incomplete. There are two kinds of so-called "postcode lottery". One is caused by performance standards. In some areas NHS performance is much worse than others: the service provided is less effective or efficient. This kind of postcode different (on any significant scale) is unacceptable and should be addressed by raising performance standards in lower-performing areas. The second kind is caused by different choices being made about how resources should be used. In principle I am in favour of greater decentralisation of decisions about spending priorities, so long as these are democratically accountable. I see no reason why health providers in area X should not decide that, on the basis of local needs, they will give a higher priority to particular treatments than their counterparts do in area Y. This is what democratic decentralisation is all about. It was unnecessary of me to refer to the democratic boundary between the UK and France. It applies between England, Scotland and Wales. As a result of devolution, health spending priorities are now decided in each of the constituent nations of the United Kingdom—and rightly so. There is nothing in principle to say that the relevant boundary for the NHS should be regional rather than national. But it happens that I do believe it should be regional—though I am in favour of basic national standards which act as a floor. (These could then be exceeded regionally or locally), I want to see greater innovation and pluralism in public services, and for this reason I am in favour of (democratic) regional government. That is where in my view most public service decisions should be made, including health ones.

  3.  On the substantive question we were asked about, I would like to see the idea of the "public service ethos" translated into a kind of "Hippocratic Oath" taken by people who work in public services. This would probably not be an actual oath, but a Code of Conduct or similar which set out exactly what the community expects of public services, and how public servants should behave. This would thereby enshrine and make explicit the idea of the public service ethos.

  4.  The interesting question then would be whether such a Code could be added to contracts the public sector made with private (and voluntary) sector organisations. One of the objections sometimes made to private contractors is that they don't go "beyond the contract". Could such a set of guidelines help ensure that private contractors could be held not just to the letter of the contract but to its spirit?

December 2001

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