22 June 2006
The Prime Minister delivered a speech about how the third sector, otherwise known as the voluntary sector, could work with government to deliver more customer-based public services.
He then took part in a Q and A session with delegates to the Future Services Network conference.
Parts of this transcript may have been edited
Read the speech in full:
Thank you all very much and it is a pleasure to be with you this morning and to say a few words to you and then I think to take part in a panel discussion and do some question and answer and so on.
First of all I think it is remarkable that this conference is taking place in the way that it is, with the National Consumer Council and ACEVO and obviously the CBI all coming together and seeing what we can do together, and the role of government in all of this is obviously fantastically important.
I just wanted to say a few things by way of opening. The first is that there are many, many good examples of cooperation between government and the voluntary sector going on up and down the country as we speak. To give you a couple of examples, for example Changemakers, which is an organisation that is running Why Speak? up in north Tyneside, which is about talking to disabled young people about what say they can have, how they can interact with policy makers, how they can have some say over their own education. Addaction in Liverpool is working with Accident and Emergency Departments in the NHS to deal with people who have got chronic alcohol problems. And as you know the Working Links organisation, which is trying to get people off benefit and into work and actually brings together the public, the private and the voluntary sector, is a remarkable example, 65,000 people who have been long term unemployed and workless have been helped back to work. And as I think you know, Ivan Lewis either has or is about to make an announcement about the review of the community equipment and wheelchair services and taking what is a market of around about £200 million and saying let us open this up now to the voluntary sector and see how that can play a major role in ensuring that people get better access to the equipment they actually want in the way they actually want it.
So I think there is a lot that is going on, but here is what I wanted to say by way of introduction really. For us as a government, public service change and reform matters for a very, very simple reason, and part of the trouble when I talk, and I do this myself when we talk about public service reform it can become so technocratic that people forget either the purposes of why you are doing it or what is the reason why we feel so passionately about public services. The truth is that public services are the necessary part of equity in our society. Unless services are provided on the basis of access and availability, on the basis of need, not wealth, then it is impossible for a fairer society to develop. So public services are integral to everything we stand for as a government and what we want to see achieved, and as you know we have put a massive amount of investment into them.
However, the issue is this. As society changes then people’s expectations change as to what they can get from public services, as more money goes into public services so people say: ‘Well that is great, you have put this money in, but I want to see the benefits of that.’ And then something else is happening at the same time, which is that in every other walk of life barriers are coming down, practices are changing, the way that business or indeed your own organisations are being run is constantly having to adapt and adjust, and it would be very odd frankly, bizarre even, if the same process of change didn’t also affect the public services.
And so what we are trying to do right across the piece is to break down barriers, they may be barriers at the work place, for example what nurses can do today in the National Health Service is infinitely greater than what they would have done a few years ago, if you talk to schools nowadays maybe they would want to hire an extra teacher, but maybe they would want to hire an IT specialist, maybe they would think that a mix of classroom assistants and teachers is a better way of doing it.
If you look at who provides the service, the fact is in every other walk of life monolithic and monopoly services are being broken down. It would be very odd if that wasn’t going to happen in the public services as well. So this is about a process of change, but the purpose of the change is to make sure that the values and the ethos of public service is maintained. If any organisation, be it a public service or anything else, does not adapt to a changing world, the result of that is that the ethos and the purpose gets diminished.
So that is why one of the things that is very important when we are talking about the changes we want to see is to emphasise that the purpose of change is in order to make the basic principles and values of the service work better for the modern world. And if you believe in public services then you have to believe in their change and adaptation as the world changes around them.
Now that then comes to a very simple point about the delivery of public services. The truth of the matter is, whether it is central government or local government, government as a whole is necessary in terms of funding, it is necessary in terms of setting clear objectives, it is not always necessary in terms of delivering the actual service. And if we want to increase the amount of creativity and innovation then we should be using the creativity and innovation there is in whatever part of society. And the truth is some of those organisations that are doing the most ground-breaking work, most innovative work are to be found in the voluntary sector today. And whether it is delivering people off benefit and into work, or whether it is for example dealing with some of the chronic problems that serial offenders will have who have maybe spent some time in the criminal justice system or have a propensity to commit criminal offences, perhaps because they have got an addiction problem or a mental health problem, the truth is there is enormous and brilliant work going on in the voluntary sector and we should break down whatever barriers are necessary in order to try and liberate some of that energy, talent and potential in order to achieve the objectives that we all want to see.
Let me give you another example. I think it is a very open question as to what is the best way to deal with youngsters who are disaffected in school and who may be playing truant or causing difficulties in the classroom and so on and therefore inhibiting the chances of other people to learn. Now we have tended to do this in a very, very prescriptive way through local education authorities. Again if government, whether local or central, moves to an enabling role, there are many voluntary organisations that are experts in this area that work with such young people day in, day out, perhaps actually they would provide a better way of dealing with this than the traditional forms of government.
So what this is all about is breaking down the barriers that allow us to deliver the best for people. And the ideology of public services is about the belief in public services and their ability to develop people’s potential, to give them access to services, not on the basis of their wealth, but on the basis of their citizenship. The practice of public services is a practical issue to be decided on the basis of what is the best thing that delivers the best service. And if it is true, as I think it is, that in every other walk of life barriers are coming down, it would be strange, not to say reactionary, if it wasn’t also happening within public service delivery. And that is why, whether it is the independent sector or the voluntary sector, the purpose of breaking down these barriers is to get the best for the people that we want to represent and to serve.
Now the very reason for putting Ed Miliband in his new position in the Cabinet Office specifically as the Minister for the voluntary sector is not just because of his evident genius, which is true of all Milibands - having just ruined your brother’s reputation by saying he was the Wayne Rooney of the Cabinet. I don’t quite know what we can say about you Ed, but perhaps better not say anything. But it is not just because of his ability, it is in order to get change across government. And I recognise and I say this self-critically, that although we have made certain changes that are important, and although the relationship I think is a lot different from what it was, it is not as good as it should be and needs to be.
So what we want to do very simply is to work with you to sort out what are the remaining issues that we need to get right, things like you know the long term funding and so on, what are the things that we need to do as I say in a sense to harness the energy, and potential, and creativity of the sector, and what are the things you need to do with us in order to deliver the best for the people that we all of us in different ways want to serve. That is the purpose of it.
And the reason why I wanted to come along today was to say this is for us a priority. The reason we have a Minister with the very specific and special responsibility is because we consider it a priority, and we want to in a sense up our game across the whole of this area and do it in a very decisive way over the time to come.
So thanks very much for listening to these words, I will be delighted now to take part in the question and answer session, and thank you Polly for chairing it.
Chairwoman:
Thank you very much indeed, and first of all we are going to get questions from our three speakers up here: Stephen Bubb of ACEVO, John Cridland of the CBI and Ed Mayo of the National Consumer Council. So Steven, would you like to kick off?
Stephen Bubb (ACEVO):
Thank you. And first of all Prime Minister, thank you for both reaffirming that you will continue to drive public service reform and that you see the third sector playing a big role in that. I am here in a way as a representative of people who have been delivering public services for at least 600 years longer than the public sector. I have a member who runs an organisation.
Tony Blair:
He wasn’t there in the beginning, no.
Mr Bubb:
It started in 1137 with returning Crusaders and now looks after the homeless in Newcastle. We think the first contract for service delivery was the Corum family in 1760, and it was a contract with the Treasury and it was so mean that it finally fell through.
I think it is very interesting actually when you look at the history of public service delivery, the changing barriers and boundaries, and I found something from Beveridge’s original blueprint in 1942 and he said that one of the guiding principles must be cooperation between the state and the individual and he warned that anything the state does must not stifle incentive, opportunity or responsibility. And I think our proposition is that if you are really serious about more choice and a bigger voice for users, for consumers, then you have to have a bigger role for the third sector. And I think 21st century service delivery will be through more service delivery in the third sector, different forms of delivery working with the private sector.
There are four areas where we think we can play such a big role: first of all in health; secondly in education in terms of trust schools and academies, which you have pushed yourself; in the prison and probation area; and in employment services. And I think you and I probably just remember ‘Cathy Come Home’. It is actually the 40th anniversary of that film in December and as you look at what has happened in homelessness, charities formed to campaign around homelessness, and actually now you wouldn’t develop policy in government without involving those charities closely, and in fact those charities themselves are about delivering services to homeless people in a very joined-up way. So it is not just about finding a home, it is about jobs, it is about healthcare, it is about advice and support, being joined up in a way that state sometimes can’t do, and that is a huge advance.
And I think one of the reasons we bang on about the barriers, about contracts, is that that gets in the way of us delivering better, and actually it wastes money. It isn’t about the voluntary sector saying to you ‘yes give us more money’, though we would like more money, it isn’t about that, it is about saying be more effective and efficient in that area and release the potential of the third sector to really deliver.
And I think in terms of 21st century public service delivery, the partnership between the third sector and the private sector will become even more important. And I think it is quite unique that we have this conference today between the leading organisations in the third sector and the private sector. It probably wouldn’t have happened 20 years ago. We are doing a lot of work with the CBI on level playing fields, competitive neutrality, we want to do work on looking at longer term partnerships, different forms of ownership, joint finance. I think it is really quite exciting stuff.
And just to end is really the question. I was in Australia recently and I have seen what has happened in their employment and training services, reforms seven years ago now mean that employment and training services in Australia are provided 50% by the third sector and 50% by the private sector. It has driven down costs and actually driven up outcomes. That is a pretty impressive result. So my question is when are you going to do that here?
John Cridland (CBI):
The citizens’ juries, Prime Minister, that this network has been undertaking, very much confirmed your message about what people are looking for in public service delivery. And I just want to ask a question drawn from my experience as a business consumer. You asked the question, what is needed from the centre in this reform agenda, and I think there are three things I would just like to touch on and then end with a question: your role in commissioning of services; your role in reorganising the back office, particularly shared service provision; and then finally, and then the question, delivery skills.
On the commissioning question, I think both the private sector and the voluntary sector in this room suffer from feast and famine. We still have stop-start policies, which make the mixed market, which is here to stay, difficult to make truly sustainable. I have got members of my organisation who have played a key role for example in helping deliver a modern National Health Service through the independent treatment centres who will not be involved in the next wave because of the high cost of cancelled schemes. And I think there is an issue about the skills set of government procurers and commissioners that still has some work to be done.
Secondly, the bit that is entirely frankly government’s job, which is the back office where government departments are doing things, I am thinking about finance, which is providing a service to other public officials. [indistinct]…..In government you are spending 2.5% of your administration budget, and there is probably a quarter of a billion pounds a year to be saved that can then be transferred to the frontline services of the people in this room by driving forward your shared service agenda. You don’t need me to tell you that, you are doing it, and there are some excellent examples. I was looking at what the Prison Service is doing across a very disparate set of establishments, which I think is very impressive. But there is low hanging fruit there that we still haven’t fully grabbed.
And my third point takes both of those, which is in both areas, whether it is government as a commissioner, or government organising its own back office, it is about skills for delivery. You mentioned delivery as a particular priority, and there is something the private and the voluntary sector can bring here, because we have different skills, which we can blend with the best of the public sector, but strengthening the gene pool within the public sector I think is very important. I think the departmental capability reviews that you have now initiated, a huge arrowhead into this issue, your Professional Skills for Government programme, a national school for government, are all vital initiatives.
But my question then Prime Minister is about capability. Has enough yet been done to give public officials the management and other skills they need to drive the impetus of reform down through the public sector, from Permanent Secretaries right the way down to the woman and man on the frontline?
Ed Mayo (National Consumer Council):
Thank you very much again for your words. The National Consumer Council, obviously a lot of what we do is talk to people up and down the country who use public services. We have initiated tomorrow the first ever Citizen’s Forum in housing, so we are going to be putting together 100 tenants with the National Housing Federation, you know looking at the services from their perspective, developing their agenda. And that is an incredibly positive and energising thing to do to hear people talk about public services, but it also I think often talks to the real sense of urgency that you kind of expressed in terms of modernising and improving services. Because the biggest barriers, whichever the sector is, remain between service providers and users. One woman said to us that: ‘Oh yes there is a public service ethos all right, they will do you a favour if they provide what you need.’ And yet in other areas we find that people are quite passionate about public services and where they go right they can be incredibly positive about them, and whichever sector provides them they kind of want them to look and feel a bit more like public services rather than less, which I think again is a very positive take.
My question is around targets, if that is all right, and targets that reflect what service users really want, because obviously there are a set of targets across the piece from waiting lists to testing children. And what we hear people tell us in terms of services is that some of the main things that matter to them are not reflected in those, and they are about how people are treated, whether they are treated with dignity, whether they are given information, whether staff listen - the soft side if you like of public services. So whether there are more targets or less, which is not my question, I wonder what steps you can take to help ensure that the targets that we have reflect what matter to service users and capture things like customer satisfaction for example.
Tony Blair:
Right. Steve, do you want me to go to the Australian model straight away? I think there is a great deal more we can do in the employment service to open it up, and the point that I would make is this, I don’t want to get into the business of actually setting a specific target on this, but there is no ideological barrier for me at all. The person who does the best job in getting someone who is a disabled person and who wants to work but needs obviously particular help, that to me is just a completely practical question, who does it best? And the reason why I keep going on about contestability, which is a sort of ugly word but it is for a very simple concept, is so that the whole time we are testing whether the traditional way of doing things is the best way. And that is why I think these barriers between the independent and voluntary sector come down.
So my view is that, for example how we deal with offenders within the Probation Service and Prison Service and the whole national offender management service, we should be just opening up, we should be saying to people look if you can tackle this better, come and do it. So as I say without specifically committing myself to the precise thing the Australians have done, I think the basic principle is to do as much as we can with it.
And also incidentally, and this is the purpose of the stuff we are doing on community equipment, once we say this market is open, people will come forward with better and more creative solutions. Once people also know that this is not a stop-gap or it is not something simply to get the state out, almost as the opposite ideology because we want the state to withdraw from public services, then I think some of these longer term questions can be resolved more easily because people know there is a framework based on certain key principles that the voluntary sector and indeed the independent sector can access.
So my view, as I said when I met some of your colleagues in Downing Street a short time ago, is I feel a sense of urgency about this because the process of government works so slow, and yet there is so much out there that people could do.
On the points that you are making basically I agree with them. On the skills set for commissioning, this is difficult because it is happening again fairly slowly. On the other hand, we are starting to introduce new skill sets into government. We are now throwing open senior civil service positions to a far broader range of people and there are people coming in now from the outside. I think we should get a far greater interaction between the civil service, independent and voluntary sector. Some of the best people that we have brought in actually over the past few years have been people from the voluntary sector.
And you see again what we have got to do is to get away from what I have always thought is the central myth about public services. When people talk about public services and business, you get into this completely arid dispute in my view about values. You know of course a public service is not a business, but a lot of what a public service does has the same characteristics as what a business has to do. So how you buy your equipment, and whether you change your working practices, some of these things are perfectly transferable, and this is what is so crazy about having this debate is if when you involve the private sector with the public sector, somehow you end up displacing the public service values. When I sat down with a whole lot of foundation trust people the other day and businesses that they are linking up with, the reason why the hospitals found it really important was because some of the business processes about how you handle procedures and how you work out particularly procurement, but not simply that, these are identical things.
So we have to build our skills set, that is absolutely right, we have to make sure that we are fit on the delivery side and again there are a lot of things that are happening here, but we need to make them happen even more quickly and one way of doing that is to have greater interaction between the different sectors. The capability reviews will be very important, but I remember after I had been about a year in office having a meeting with all the senior Permanent Secretaries at the time, and we went through everything and then at the conclusion of the meeting one of them said to me: ‘I think I know what you are saying, what you are saying is that our departments should really focus on delivery.’ And I sort of thought - what have you been doing up to now? And actually what they had been doing up to then was focusing on policy advice in a very traditional way, they had not in fact been focusing on things like project management, you know the delivery of specific systems and so on. And you see when you have got the information technology and all the changes that have to be made there, I mean the private sector has enough problems with this, the public sector obviously has as well, but again you need to be getting the capability to deliver there.
And one of the reasons why it is so important to break down the barriers as to who delivers what is that as you break down those barriers you will also break down the barriers at a professional level between people who work in the civil service and people who work in the other sectors. And what you are saying about the back office is correct. I hope we will say some more about this in the next few weeks, but you know any organisation should be looking at what it is doing there. And the point that I would make is this, for every single pound we are spending unnecessarily on administration, that is a pound contravening the values of public service, and that is as I say why we need to get away from this dichotomy.
Now Ed, what you were saying on consumers and targets. First of all just on the targets, we are trying to shift away from an excess of targets, which I know people think has been the case. However, it is still important. I don’t know many people who you talk to in the Accident and Emergency Department business as it were who wouldn’t say that the targets had been a necessary part of raising performance. And you know when people say they don’t care about targets, that is true, but they do care if they are waiting 18 months for an operation. So the fact is the important thing to say about targets is use them with care and only ever as a means to an end.
The second point, which you are making is, how do you get to a broader picture of what people really want, because you are right, they don’t just want to be in quickly, although they do want that. They don’t just want to be in in a convenient way, but they also want to be treated with dignity and so on and get proper information. Now the reason why I think that putting more power in the hands of the consumer is important, whether it is in schools or it is patients, for example you take chronic disease management, which is what the health professionals would call people with long term diseases that will be managed over a long period of time, for many of those people they have more information now today, they have a better knowledge about what they are doing, they have very, very strong views about the best way to access that. It is not a foolish thing therefore to think over time that you put more and more power in their hands for example to decide how the money that is spent on them should be spent.
Now some people will rush along and say we are privatising the service. We are not, but what we are saying is the way to ensure that you get a better quality of service, as opposed to simply speed or access, is, and I am sorry to have to be absolutely brutal about it, but to make sure that the professionals within the service know that there is always the possibility that you might go off and go elsewhere, and that is life. Now that is not to say that the professionals don’t do a superb job in these services, because they do, but the fact is, and this is the point about the independent treatment centres, which is why we will have a second wave and we need your participation in it, there were areas of the country where people were telling us there is absolutely nothing you can do about getting the waiting times down for things like cataracts. Until an independent treatment centre was mooted in the area and then suddenly it did become possible. And that is the way it is.
Now all we need to realise, and this is part of the changing world, in every other walk of life people expect to be more in charge and control, and in public services it is no different. And therefore the more that we can be giving control to people and actually allowing them a real say over how the money that is spent on them is spent, and what it is spent on, then the better we will be in my view in giving them the type of quality of service that they want.
Chairwoman:
Thank you very much indeed. Now some people I know have sent in written questions, we are going to take one of those first and then I am going to throw it open to the floor.
Roger Howard (Crime Concern):
Prime Minister, you kindly mentioned, and you thought you would get away from crime I suspect today, but I won’t let you. You talked about the national offender management service and the opportunity there and the good work that the voluntary sector is doing, and we mustn’t forget why we are doing this is for future generations of potential victims and communities, which are so debilitated by crime. That is the outcome that we all want and one of the ways that we do it is working with offenders and trying to rebuild their lives.
Now I won’t mention the reoffending rates, we have one of the highest reconviction rates of offenders in the developed world, and I am not going to mention Australia, it is much lower, but the interesting thing there is they had this mix - we will all move to Australia, won’t we, nirvana - but the thing is they have a very vibrant mixed economy with the private and the third sector there delivering services to offenders. You mentioned the national offender management service, many of us three years ago when the government took that decision to set it up, innovative, you mentioned contestability, Amen, because that was the opportunity.
Now you will forgive me for saying, and asking, is the government in the current climate back-peddling on that commitment to begin to introduce contestability there and to genuinely have a mixed economy, because the outcomes will be much, much better, you will get safer communities in the long run?
Tony Blair:
The answer is we won’t back peddle, and we are committed to it and we should do it, and the reasons for that are that the evidence is absolutely clear on it. Actually I will be talking about crime, both today and tomorrow - but one of the things I will be saying is that part of the problem is that if you want a modern criminal justice system, taking the system as a whole, if you want that you have to focus on the offender and not simply the offence. And the whole purpose of the national offender management service is to try to get to the point where you deal with some of the issues that the people have who are committing the offences, otherwise what you do is you get into a debate about sentencing, which we can all have our views on, but the truth is if for example someone has got a drug addiction problem, or if somebody has got a mental health problem and the vast, probably the majority of people in prison have got one or other of those things, if not virtually all of them, then if you don’t deal with that problem you can have a person come out of prison but it is not going to be long before they are reoffending and back in again. Now the truth is the expertise lies far more in the voluntary sector to deal with some of those issues than it does in government.
Jenny Edwards, Chief Executive, Homeless Link:
Prime Minister, we represent the homeless sector. I want really just to draw attention to the perhaps unsung success of the partnership between government and the voluntary sector in this area. You rightly identified when you came to power that rough sleepers were the most excluded of all, and that partnership between the two sectors has been going on perhaps out of the public gaze and supported very much by the programme Supporting People. That is delivering in many cases a very holistic service that meets the service users’ needs in every area, there are the problems that have been identified in the way that it operates sometimes, but nevertheless service standards have really risen. And my plea is really not to reinvent the wheel but to build on the success of this programme, which is really delivering to people who have been written off, as really being beyond hope, but actually so many people have resettled successfully and gone on to lead independent lives.
Chairwoman:
Are you in danger of being re-organised?
Ms Edwards:
No, we are not actually, things are looking good, but the Supporting People programme has the normal budget limitations and there are problems in trying to get the resources to do things. The biggest problem is in getting public agencies to engage, because they are people who are challenging, who live across boundaries, who are often seen as not being of our community and are not tracked in most of the measures that are used to track exclusion. And so that is really the main challenge at the moment.
Question:
I am the Director of a homeless charity in Ipswich, a small charity dealing with non-… homeless people. And I guess I wanted to talk about how it feels to us. You know I guess we feel a bit like the small organic farmer who is now being told we have got to contract with the supermarket. And there are a couple of things we know about supermarkets: first of all we know they don’t do ugly, they want their vegetables in nice neat rows, they don’t want any blemishes, they don’t want any bubbles on their carrots; and the second thing we know is they don’t want to deal with the whole variety of growers. So my question really is how can the government ensure that the supermarkets, ie the local authorities, embrace and welcome our diversity, our independence and our ugliness?
Steve Hilliers, Bevan Britain:
Prime Minister, you mentioned long term conditions and there has been a recent excellent White Paper on out of hospital care. If you were to collect together a room of health professionals and ask them about the service models that they would see in this new landscape with movement of services out of acute care, you would see an enormous amount of unanimity, there would be a lot of common ground between them in terms of how they would describe the services. If you ask them who is going to provide the services, there would be complete and utter silence. It is well understood that PCTs take a very, very large chunk of the £90 billion NHS budget in providing out of hospital care for long term conditions and chronic diseases, but there is a complete lack of policy and direction in a market which is clearly moving towards contestability and separation between commissioning and providing as to what is the role of the PCTs and who will provide services in this market. And until that question of who is given some direction, then this market is heavily stymied. So my question, Prime Minister, is can you give us an indication of where policy is going in out of hospital care and the PCT role?
Chairwoman:
The question of the strength of commissioners is something that has come up very powerfully this morning before you were here, and a sense that it needs to be much more professionalised.
Tony Blair:
It does need to be more professionalised, but I also think it needs to be incentivised as well, which is why I think that over time, just to deal with this last point, that over time you see the practice-based commissioning that we want to happen with GPs, in the end there are incentives now in their new contract, much criticised in other areas, but actually important incentives whereby if they can get a better quality, as well as better value service, outside the traditional boundaries then they are incentivised to do so. I think what is lacking from us as a government at the moment, although we are going to try to correct this, is to try and push the PCTs where the practice-based commissioning is not properly established, and the practices themselves to really go with that. Because you see for every time that someone gets a better way of managing their condition and they are not going in and out of hospital the entire time, then actually that is of enormous benefit to the system. And I hope you will see some fairly clear movement on this over not just the push from government but with the GP practices.
And one of the things we have got to do, which I think will strengthen commissioning, is to find a far better way of spreading the good practice that there is and showing people how it is possible to provide a different service through a better route. And one of the problems that you have got is that in any of these public services the question is how you make sure that other people in the service get to know about it. And the whole purpose of our reform programme is in the end to get to the point where it is what I would call self-sustaining. Because let me be absolutely honest with you, the biggest problem that you have got in government is that government is a very unwieldy instrument of adapting to change. Government catches up with changes that are happening and at varying rates. What government is not good at, you know we used to talk about picking winners in the old industrial sense, it is not actually very good at picking winners in any sense. Although someone said at a public service seminar that I was at a short time ago, you know all the people who usually fail to deliver are very good at picking governments.
So you have a situation in which for us I think what is important is to put incentives in place that make the system what I would call self-sustaining, and that is the purpose of all this contestability and choice, so that we are not constantly coming in as government and trying to predict the latest innovation or more creative way of doing things, the system itself is operating in a way in which there is a natural, and as I say self-sustaining, mechanism behind it. And you will know this better than me, but the thing with chronic disease management is that for many of these main diseases, the science is changing so quickly, the new forms of care are changing so quickly that if we have to catch up the whole time from the centre it won’t work. So anyway I think as I say we can and will move further in that direction.
I don’t know quite what the answer is to the local authority, were you talking about this earlier or not?
Mr Mayo:
No …
Tony Blair:
You have not been on yet. You mean I am just your warm up act? OK, that’s politics for you.
So I think, you see one of the things we are looking at with the local authorities as well is I think they feel very constrained from central government, and what we are trying to say to them is look there is a way in which if you are prepared to loosen up in the way that you deliver, we can loosen up from the centre. And I think there is a deal to be struck with the local authority sector there because this is always the problem, this idea of we don’t do ugly, it is a problem because some of the most intractable and difficult problems are the ones that aren’t necessarily ever going to hit anyone’s headlines, but actually out in the community they make the most difference.
And in that regard I just want to raise one other thing, which is social exclusion. You know thanks for what you said about the issues to do with homelessness and rough sleepers and we will try not to mess up what has obviously worked successfully, but I think in relation to social exclusion, increasingly there will be a debate that focuses on how do we at a very early stage of development, how do we try to get the best and most intelligent way of intervention so that we are not cleaning up afterwards with the huge problems that we face. And the interesting thing, just to revert to what Roger was saying about crime, is that the evidence now is overwhelming, that there are kids who really from a very, very early age are on a path where it is quite tough to deal with them. Now Sure Start in my view is a very, very good programme, it has done a lot of good work, but the truth is it still relies on people coming into the programme and in a sense people have almost taken the decision that they are going to change their lives. Now this is fantastic for them incidentally, don’t misunderstand me, but there is a sort of hard to reach group of people out there who aren’t in the system at all and they have become socially excluded and then many, many of the problems that we know arise from that. And then of course what you get is that once the situation has reached the critical stage you will get a huge, a mass of organisations from government that will descend upon these families in various different guises, Heaven knows how much money is actually spent on it, but it is very, very late in the day to deal with it.
Chairwoman:
Thank you very much indeed. I know you have got to go and catch a train. You are each allowed one minute each to make a final summing up point before the Prime Minister goes, but it has to be one minute, trains don’t wait, even for Prime Ministers.
Tony Blair:
Best not actually …
Mr Mayo:
I am very happy to give you a copy of this, which we launched last year, which called for the opening up of the independent living equipment market, so I am going to pass that to you, and I know there are others that have done a lot of work on that within the voluntary sector. So I thank you very much for your comments. The National Consumer Council I think will continue what we run as a long term campaign to get take-up of metrics of customer satisfaction across public services, not because that is the only measure of public service outcomes because there is a whole set of different service relationships that are there, but it is a very good way of building consumer views into what matters in terms of public services. And I am delighted to say that actually we have done the deal that you suggested with local authorities, so we are working with the Local Government Association to develop a template for applying customer satisfaction measures on local services up and down the country, and I think alongside further deregulation of the central local relationship, that is a very good way of empowering users.
Mr Cridland:
My only regret today, Prime Minister, is that more citizens aren’t able to listen to the debate we have just had, which in a sense is a debate of those of us who are somewhat involved in the issue. Because I think they would have been intrigued that virtually every question we have had, and with respect every answer you have given, have been about practical coalface issues affecting ordinary people, it hasn’t been a policy … debate, the like of which most of us normally spend our time having, it has genuinely been issues at the coalface. And I do think that has something to do with, one, where the debate now is, but some of those controversial and ideological issues are behind us and are actually drilling right down to what really matters; but secondly, if you don’t mind me saying so, I would just like to end with the uniqueness of this coalition. We have actually got people here who in my case are interested in making a profit for shareholders, in the voluntary sector’s case have got trustees and have got missions, but we all have a contribution to make to helping you deliver what citizens want. And I think today has very much been about that.
Mr Bubb:
Mine is really just a personal comment to you Prime Minister. You have made public service reform very much a feature of your leadership. Keep at that. There are siren calls from vested interests in the public sector, who want to slow the pace of reforms. Don’t listen to them.
Chairwoman:
On that controversial note, thank you very much and thank you Prime Minister.
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