Top down – or bottom up?

1. Top down – or bottom up? Simon Courage

2. LanguagePolicy levers. Or instruments

3. What’s available - examples • Taxation • Raise money • VAT • Reward and penalise certain behaviours • Zero-rated VAT on food

4. What’s available - examples • Regulation • To permit • Civil partnerships • In favour of • Vitamins in bread • Against • Theft

5. What’s available - examples • Performance management • Targets • Hospital A&E admission times • Inspection • Ofsted in schools

6. What’s available - examples • Ensure provision of services • Direct • Police • Procured • Bulk waste disposal

7. What’s available - examples • Exhortation • Leadership • Local authority convening of partnerships • Evidence base • Research, evaluation, data warehouses

8. What happens S-curve

9. What happens Perverse effects

10. What happens Professional resistance

13. 4 Cs Competition Contestability Introduce threat of competition Reduce barriers to entry Open up, say, 15% to private or third sector Keep public sector on toes NHS elective surgery • Providers compete for contracts • Price and quality, plus other desired effects • Open up to private and third sectors • Work Programme for unemployed people

14. 4 Cs Choice Civil society State rolled back to make way for civil society Farmers’ markets Civil society organisations deliver services on behalf of state Recycling Civil society creates new services Pocket parks - dowry • Parent, patient – client, user – chooses • Expresses preference from range • School admissions • NHS Choose & Book • Choice-based lettings

15. To make this work • Requires good information for users • League tables • Schools • Which XX? lists • Universities • Inspection reports • Hospitals • Good advice • Especially for disadvantaged • GP as gateway to hospitals • Understand the limits of markets • We don’t really understand health, can’t prepare • Pathways

16. Where next? • How far could you take this? • Choice of police inspector? • Where shouldn’t you use this? • Judiciary • Q&A