Power is not more meetings – with or without MPs. It’s not even more reports. Police and Crime Commissioners and Clinical Commissioning Groups show the folly of providing more professionals without any actual day to day accountability to the public. It’s also not just about choice. Or voice. Power is the difference between being given the ability to choose between two poor quality options, and the right to say no to either. Power is the difference between being ignored by service providers and being listened to when you say something isn’t working. Power is services competing for your attention rather than struggling to get theirs.”
The following is the full text of a speech Stella gave to the CBI on Thursday 30th October at the launch of their new report into Public Service Reform:
I want to start with an apology as many of you were expecting Rachel Reeves tonight. It’s a bit like booking tickets for a Minogue and getting Dannii not Kylie. Or thinking you’ve downloaded James Bond on Blinkbox and it turns out to be Johnny English. Or worse still, tuning in to see Andrea in the X-factor and getting Stevi.
However I’m grateful to the CBI for inviting me as I think their report is really fascinating and challenging. I also want to also take up Cathy’s challenge about honest politicians. Henry Kissinger famously said of politicians “Ninety percent of the politicians give the other ten percent a bad reputation”.
I want to share my own shock at being elected and thinking that, when we started, we would get a job description. You are given an envelope at the count. But it simply says inside ‘Go to parliament on Monday’. So if you think we are all making it up as we go along – at least we have an envelope, on the back of which we can write.
The truth is that it is hard for many of us to think of blue skies when there are such dark clouds around:
- £163 million is being spent daily on interest paid on personal debt– the equivalent of buying Christiano Ronaldo AND Gareth Bale or the cost of over 5,000 qualified nurses for a year. In one day.
- The nature of the jobs being created — chiefly, those at the bottom of the pay scale — explains why tax revenue is not being generated as fast as expected. Even now, the economic recovery once forecast is almost two years behind.
- Because it is not just families struggling with their finances. Our deficit is actually rising, not falling – and this doesn’t include promises made to future generations around provision of healthcare or pensions.
- If George Osborne was a finance director of your company, and kept getting his numbers wrong like this and then kept asking you for more cash! your shareholders would want to sack him too!
Little wonder that when times are tight the idea of having someone to blame is appealing- whether immigrants, welfare claimants, unmarried mothers or climate change deniers- or all of them.
But I think the frustration that the electorate feels isn’t just about cash, whether in your pocket or in the public finances. It is deeper than that. It’s about a sense of change and knowing whether it is a good or bad thing.
Previous generations have faced big enemies but they, slow moving, clear targets: prejudicial laws, corrupt monopolies, visible poverty. In our world today, things are moving so fast that it is hard to keep up with the targets: Is it big business? Is it authoritarian governments? Is it uneducated prejudice? Is it educated prejudice? Is it all of the above?!
Frankly, in answering these concerns and building a country that can thrive in the global economy, if we focus on the money we have, rather than outcomes we seek, it is a recipe for failure.
No one knows that better than this Government –their record is now a growing catalogue of the problems that come from trying to muddle through change rather than face it head on.
- Closing fourteen prisons, and so creating a shortage of capacity and provoking Ministers to have to change tack and commission new even more expensive ‘Titan’ prison projects
- Road projects like the A14 withdrawn, and then re-instigated two years at a much higher price
- And not forgetting the bedroom tax which is costing more than it saves
In raising these examples, I know it is not enough to be an opposition. In fact, I think it is even more important when faced with this to set out the alternative. To show we are here to do more than be better at managing difficult public spending decisions nicely.
Let me be explicit- Labour is clear we need to balance the books. To get our national debt falling by the end of the next parliament. Ed Balls at our conference set out our red line that we will not have any policy in the manifesto paid for by new borrowing. There are and will be tough choices to be made. But our Zero Based Budget review is rooted in a recognition that the best way to do this is to think long term and ask how we can actually prevent, rather than ameliorate, waste.
And by waste I mean of both public funds and public potential. My colleague Chris Leslie will be setting out the detail of how this will work in the coming weeks – and given how hard he’s worked, it is more than my life is worth to pre-empt it!
But my point is to say we get it. We know that reducing national debt and living within our means is the starting point, not the end, of good governance. That debt makes long term planning harder to do and undermines our ability to reform and innovate.
And innovate we must. Because the world we face now is different from the world in 2010, let alone 1997 or 1945. Think of just some of the challenges our generation- and by that I mean all of us here in the room not just of a certain age- face:
- In a country working longer hours than ever and where there are now more people over the age of 65 than under 16 who is going to look after us as we grow up or get old?
- We have the lowest rate of social mobility in the world so how are we going to change the fact our fathers incomes will determine not only his retirement but our careers and our kids chances at university?
- One in every ten pounds we spend on healthcare goes on the problems caused by diabetes, who is going to stop our kids being fat and our families being frail?
- And in a world where air pollution is getting worse how will any of us breathe?
The one thing we can see as we look at the world around us and the world to come is that our old systems and institutions will struggle to cope with any one of those priorities let alone all of them. That we cannot go on as we are.
To do this, the first thing that has to be reformed is our take on politics, of the idea that all we need are 650 MPs to get this right. That doesn’t make sense of how either change happens or the changes we have to make. This is a job for us all.
Making that happens means doing the thing that politicians sometimes seem to find hardest to do: give away control. To show that we know the public really do know best. And that politicians should interfere less. That we need– as Ed Miliband has argued- people powered public services.
Terms like people power and empowerment are often bandied around- but like fat free the devil is in the detail. Let me try to set out what we think this means for public services and why we think this will not only save money, but also get better outcomes.
People power requires the public to have much greater rights, not simply to access services, but to directly shape and change them both for themselves and their communities. To be able from the grassroots to reform services to meet their needs, not have their needs decided for them. Because whether its parents getting involved in their kids early education, or helping people with chronic conditions manage their care it gets the best results.
Now at this point you may wish to quote Oscar Wilde on the problem with socialism being that it takes too many evenings. Or Boris Johnson – that people go and see their MPs when they have run out of better ideas.
Let me be clear. Power is not more meetings – with or without MPs. It’s not even more reports. Police and Crime Commissioners and Clinical Commissioning Groups show the folly of providing more professionals without any actual day to day accountability to the public.
It’s also not just about choice. Or voice. Power is the difference between being given the ability to choose between two poor quality options, and the right to say no to either. Power is the difference between being ignored by service providers and being listened to when you say something isn’t working. Power is services competing for your attention rather than struggling to get theirs.
- Personal care payments have started to revolutionise the provision of social and health care.
- Steve Reed’s amazing work in Lambeth with Tenant management organisations like the Blenheim Gardens project show possible not just to deliver better services, but also surpluses in managing estates previously considered uninhabitable.
- In Plymouth an energy cooperative is predicted to save the city’s residents £1m a year, and investing in renewable sources.
Examples of saving money and securing better outcomes. Rights backed up by three key tools – information, advocacy and redress.
Information and access to it is the best way to shine a light for users on what their money can really buy. We know many service providers try to pre-empt service user decisions, or block their ability to pool their funding. That’s why we sought through the Consumer Rights Bill to make sure information on all public sector contracts and services was available and why I’m disappointed that the Government opposed this.
Projects like “I want great Care” which collects patient feedback for hospitals highlight how information helps both service providers and users improve standards of care. Data can also drive innovation too – as Camden Council found by releasing data for a public hackathon with users, technical experts and council officers. They created tools to better target housing repair services, address street cleaning- and identify gaps in data which might be holding back further service improvement potential.
So I welcome challenge and ideas from CBI about how digital can help services reform- but we need you to be even more radical. Your report talks of booking doctors appointments online. As a local MP I can tell you my second most popular campaign at present after tackling rip off estate agents – as I do represent somewhere in London!– is healthcare access. This is about people struggling to get GP appointment, and so either putting off treatment and becoming much more sick and so costing more to treat or ending up at A&E. Yet doctors also tell me that as much as 40% of their appointments are missed.
So we don’t just need online booking. We need to find ways to share all appointment times and records, create missed appointment alerts, circulate free slots at short notice for those waiting. To build links with pharmacists. Track what happens next. And above all give patients the powers to get doctors to respond to when people want to see them – and where.
Too much of my casework as an MP is public service decision making done badly, leaving me to be the person – the independent advocate and adviser- who hassles providers to get it right or tells a resident something isn’t possible. If we truly empower the public ‘ you should go and see your MP about that’ will stop being an acceptable brush off.
Again, this report talks of publishing schools data- I wish we could have all the school catchment areas published so that parents could make better decisions first time and I would deal with fewer requests for appeals as a result.
In Nottingham, one study showed that 40% of cases dealt with by advice agencies involved preventable failure in the public sector. Right now this government is losing 45% of appeals against work capability assessment tests highlighting how expensive poor decision making is- and how it is hitting the most vulnerable the hardest.
Advocacy isn’t just about when things go wrong- it is also about breaking down the barriers which hold people back and lock in waste. With 50% of jobs not being advertised but filled by word of mouth, too many employers miss out on talent that isn’t part of their network, and too many job seekers never get a look in because they aren’t ‘in the know’. The Backr project is changing that by creating advocates for unemployed to break into those networks. Who then, in turn, help others get on as well.
And finally we need redress- because its no good having rights that aren’t backed up. And that means clear lines of accountability instead of fragmentation. The NHS is now a merry go round of acronyms and public bodies- CCGs, PPGs, CQCs, NHS England, Patientwatch, Hospital trusts- making it a process of attrition to complain rather than resolution. That’s why we have pledged to repeal the Health and Social Care Act– and we won’t stop there.
Liz Kendall’s ground breaking work on integrated care shows people power is about starting with the person first. We want to create truly integrated care, with one point of contact, one care coordinator and one team working with the patient. Working across different agencies- health, social care, mental health and housing – from the perspective of the person whose involvement matters the most. The user.
Now at this point some of you may raise an eyebrow thinking this way of working could upset the producers of public services. As someone who spends most of my life working with service providers in both public, voluntary and private sector, to put right problems for my constituents, I find it offensive that any are always seen as a foe rather than friend to users. ‘Computer says no’ is an attitude to be found in all sectors- as is professionalism and a deep commitment to care.
The challenge lies in reforming services to get the best out of each other rather than set ourselves against each other. Unison’s care workers partnerships with their clients and Worcester University enabling patients to interview student nurse applicants are examples that show, first hand, innovations already taking place that is changing this relationship.
Which? have highlighted that many public service users fail to complain about services for fear of reprisal. Let me be clear. Labour will always be in the corner of those vulnerable people who are not heard – challenging the culture as well as the structure which cuts them out of decision making.
- To be able to pick the service that works for them – whoever offers it.
- To hold to account those who don’t respect those they work for- whether through sanctions for doctors who don’t offer appointments or the ability to sack tenant management officers who don’t respond to their tenants.
- Or, as Ann Coffey has argued today, empowering young people themselves to help fight sexual exploitation.
The world has long moved on since my predecessor as Walthamstow MP Clem Atlee introduced the NHS. Or even from when Tony Blair began the choice agenda. Interestingly, both never sent an email or text whilst in office! But this isn’t about technology. Through all this work is a common thread, the progressive thread, that has always been at the heart of Labour – a recognition that we should want for everyone; every child, every parent, what we would want for our own.
Labour’s commitment to people powered public services reflects how, whatever the level of resource, we know services which harness the day-to-day insights of users create value and value for money. Put simply the public really do know best- and we think it is about time we didn’t just ask them what they want but gave them the chance- and responsibility- to make it happen.