While England doesn’t have a written constitution, we do have an NHS constitution. We value equity in public services nationally, even if we also want a say in services locally. Pollsters repeatedly point to this ‘inconsistency’ in attitudes. But the public are astute: the countries with best public services have both clear national entitlements and more local input into services.
Two years into the coalition, services seem suspended somewhere in between local and national layers. Whitehall has lost some of its power, but it’s not clear where it has gone to. Public sector professionals, let alone parents or patients, are unsure who is responsible for what, what the minimum provision is, and what can be done when services aren’t fair or good enough.
As well as funding cuts, confused accountability puts quality and equity at risk: look at the rise in waiting times and fall in NHS satisfaction. But Labour can’t just say ‘we told you so’. Nor should they reverse reforms like free schools. Instead, they should develop a few new entitlements within public services. These should build-in means of direct redress when they are not met, including enabling people to access alternative services privately or as a community group.
While basics like waiting times and core curriculum and police response times matter, entitlements also need to reflect new issues. Unlike the coalition, Labour has to offer, unapologetically, something for families that are not ‘troubled’, and pupils who don’t get free school meals.
Mental health is one example: many people are held back in work, their health and relationships by emotional struggles. But access to evidence-based psychological therapies remains limited. Culture as well as money is a barrier. Some good employers have found there is a strong business case for offering four initial counselling sessions; the NHS might well find so too. If their local health services fail to offer it, they should pay for those who need it to access these privately.
Entitlements in education could be to a choice of extra-curricula activities decisive for social mobility. If the school fails to offer it, groups of parents should get the money to source or run them otherwise. Entitlements don’t need to be complex or costly: to boost reading at all abilities, why not do a deal with the makers of e-readers to give every child one?
The paradox of localism is that the public feel empowered when their rights and roles, nationally and locally, are clear. A few bold entitlements, with real means of redress, could shore-up support for public services, and create space for a meaningful local empowerment.
Sophie Moullin is a Fulbright Scholar at Columbia University, and formerly a Senior Policy Adviser at the Prime Minister’s Strategy Unit.
This article was originally published in the Fabian Society’s Summer edition of the Fabian Review. It forms part of the Fabian Society’s Next State project. We’ll be publishing other articles from the series this week.