Feel as though you're reeling from the barrage of change designed to undo the public sector bloat created by the last government? The change in ideology is marked - while Labour saw bureaucracy as the means of managing and controlling the public sector, the Tory-dominated coalition clearly see markets as the most efficient and preferred allocator of society's resources.
This has been particularly marked in the NHS. The commissioning of health care will be pushed down from primary care trusts to consortia of GPs as strategic health authorities, whose role is to oversee the provision of health care locally, will go. Let's hope the GPs are capable of rising to this challenge as they will now be in control of £80billion of spending. What happens if the GPs say "no thank you"?
While this amount of money is nowhere near enough to bail out a medium sized bank, it is still quite considerable and we, as tax payers, have a right to know that it is being effectively spent. More important, GPs will now be responsible for commissioning or procuring in a newly emerging health care market. The jury is out on how good commissioning/procuring is in the public sector but I have real concerns.
When I worked in local government, I was once told which "way was up" by an ICT vendor who said something to me that I have never forgotten - he said "I've been trained for 20 years to sell this stuff and you've never been trained to buy it". This is what we academics would call an "asymmetry" but it doesn't matter what you call it, all that matters is that the cards are stacked against the novice and novices get taken to the cleaners.
The ideological switch from bureaucracy to market as the prevailing means of controlling the public sector will no doubt ripple through the whole public sector and your own ideology will determine whether you think this is a good thing or a bad thing. The dividing line between bureaucratic paralysis and the potential for markets to fail in delivering services to the most vulnerable members of society is remarkably thin and it is to our huge discredit that we have not been able to construct a way of managing the public sector that can exploit the benefits of both approaches and minimise their downsides.
As we switch from Labour to Conservative we swing from one approach to another – unfortunately the costs of doing this are far from trivial and the potential for disruption to service delivery is huge either from industrial action arising from the forecast redundancies, slashed pensions and worse terms and conditions or from the change process itself as, for example, GPs have to learn how to commission and have to adapt to their new role.
We are all aware of the problems of bureaucratic over-management and the alienating effects of the targets regimes that have proliferated under the former labour government. My wife, a teacher, was once being observed by an Ofsted observer who, at the same time, was being observed by an observer of Ofsted observers.
However, has anyone in the sector been trained to cope with this market-dominated world? Will we really be delivering better value for money instantly or is the whole thing teetering on the edge of disaster? Yes, the tax payer has the right to expect that their taxes are being effectively spent and that the public sector is as efficient as it can be but this is not likely to happen in a battle of ideologies both of which are equally flawed.
Les Worrall is professor of strategic analysis at Coventry University
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