There is nothing random about local control of public services

Both Sunder Katwala and Grant Shapps are quite wrong: not only is local variation a price more than worth paying for local control, but it would end the phenomena of postcode lotteries.

“Postcode lottery” is a cliché, and a peculiarly British one. Why is it, for example, that the only references on Google to “zip code lottery” I can find are articles in the US referring to the UK? Surely Americans, with their far greater local control of public services, would be screaming about the phenomenon and demanding a massive centralisation of services? Yet strangely they don’t.

Can it be a coincidence that the UK is both obsessed with postcode lotteries and happens to be one of the most centralised developed countries in the world (if not the most – depending on how you measure. Malta is unquestionably more centralised but has a population the size of Kirklees or Devon)?

There is local variation in public services around the world; the difference is that in most other countries people are able to do something about it. It is no coincidence that a country like Denmark devolves healthcare down to the local level yet can provide a consistently higher level of care. The gap between aggrieved voter and accountable politician is much, much closer. What’s more, the fact that the grass seems to be greener next door proves to be an excellent incentive for local government to always be on the lookout for ensuring that services are as good as they can be: the price they pay for failure is getting booted out of office.

Sunder Katwala may not realise it, but he is in fact an advocate of postcode lotteries. The system he seeks to preserve could indeed be called a lottery because how you cast your vote has almost nothing to do with the level of health services you go on to receive.

Nonetheless, he is correct to point out that this is an argument that has not yet been won in the UK. Oddly for a country so seemingly unconcerned about the widening equality gap, the British public are fixated on the idea of a national health service providing an identical service from Lands End to John O’Groats (and beyond). This idea has been encouraged by the courtly dance between the media and a political class all to happy to indulge it. It is no coincidence that we are not just more centralised than ever, but we have spent the last 50 years doing so. We’ve come a long way from the reforming zeal of Joseph Chamberlain. Nonetheless, local variation of public services is a fact whether you have local control or not. It is simply dishonest to try fooling the public into thinking that somewhere out there is a magic formula that will enable Whitehall to impose a standard service across the land. The con has worked for half a century; it is now time to start treating the electorate as adults.

Grant Shapps, as a paid up member of a party which claims to be localist, ought to know better than to fan these flames. His report doesn’t appear to have any positive suggestions at all, merely pointing out that there is significant variation in IVF provision and that it is all that wicked Gordon Brown’s fault. Playing the postcode lottery card makes it harder for a future Tory government do actually do anything about it.

This suggests that the Tory commitment to localism is only skin deep. The fact that the Tories remain steadfastly opposed to giving local authorities the single most important tool for local control of public services – greater tax-raising powers – only encourages this view.

It is encumbant on people who like to bang on about postcode lotteries – whether they are on the left or the right – to say what they propose to do about them. The Liberal Democrats, as true localists, have an answer. Can Fabians and Conservatives say the same?

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8 comments on “There is nothing random about local control of public services
  1. Simon R says:

    Amen. Completely agree.

  2. David heigham says:

    The NHS gives the impression that its postcode lotteries are not random.
    Overall they seem to reflect the differences in levels of local health provision which were there when the NHS was set up; more than 50 years ago. (I recall that doing away with these differentials was one of the advertised objectives of the new NHS.)

    If you wany to keep our ‘tradional’ postcode lotteries for another 50 years, vote conservative – Labour or Tory. If you want to do something about them, vote LibDem for services which will respond to local needs.

  3. Charlieman says:

    Sorry, James, but not an easy essay to follow. I think that I got it second time around.

    Popular objection to postcode lotteries is based on a variety of doublethink. People like the idea that their local services will be constructed according to local need, whilst resenting that their neighbours may have superior healthcare in a particular specialism. Accountability and decentralisation are not going to remove this cognitive bias.

    We also need to remember that regional differences in standards of healthcare often reflect our industrial heritage. If a patient suffers from a condition that is associated with an occupation, the best treatment and research will occur where that condition most often occurs. There is no point in spreading experts in, for example, pneumoconiosis across the country.

  4. Richard Gadsden says:

    There are two problems with “postcode lotteries” – postcodes and lotteries.

    Postcodes are symbolic of the post-1974 despoilation of local identity. I certainly don’t claim that the pre-1974 local government system was perfect – far from it! – but what it was much better at than any system since is that it aligned the boundaries with local identity and local loyalty. People who lived in small towns could identify with an Urban District Council far better than they can with the inflated post-74 Metropolitan Boroughs or Unitary Authorities (ex-District Councils) that most of them were lumped into, without even a Town Council (a parish in powers) to call their own.

    The pre-74 counties, now the ceremonial counties, still have real loyalty – look at Lancashire and Yorkshire for two counties that have survived everything that Heath, Thatcher and Blair could throw at them.

    But even our present local government structures, however lacking in real identities, have the great advantage that people know which one they are in. Ask people which Primary Care Trust they’re in, or which Acute Trust (and how many even know the difference?) and you get blank looks, or wrong answers. Where England has been divided up into different units, they don’t match up at all. Police Authorities, Fire Services, Ambulance Services, PCTs, local DSS offices, JobCentrePlus boundaries, local councils, Acute Trusts, regional government offices, passenger transport authorities, magistrates courts, crown courts: no two have the same boundaries, and it’s not just that they are all different sizes, as they aren’t simple combinations of each other either. This destroys any chance of a local identity forming, and so any prospect of people accepting that their area is different from someone else’s – because the area they live in is in no sense “theirs”.

    Returning to postcodes, they are arbitrary, centrally-imposed local units with no identity, loyalty or attachment from those that live in them. For addressing letters, that’s fine; the identity, loyalty and attachment is on the two or three lines above the postcode. But they symbolise the despoilation of locality.

    The second problem is the one that James identified; the lottery aspect – the sense that the reason that one area gets something and another does not is nothing to do with the choices of the people of that area, and little to do with the needs and requirements of the area. It seems to be more the variations in administrative ability and political skill of the appointed managers of the various “local” bodies.

    Of course, it’s arbitrary rather than truly random, that is there are reasons for the variations, but when the reason is “your local PCT Chief Executive is less good at negotiating funding out of NHS HQ than some other PCT CE” then there really isn’t anything that the local person can do to change it. If they could vote for the PCT CE or for a Trust board that appointed the CE, then they could vote them out (or vote in a new board committed to sacking him) and therefore anger is likely to focus on the local rather than the national authority – but at the moment, it’s the Secretary of State for Health that sacks PCT CEs.

    Restore real local government, based on localities that mean something to the locals, with meaningful powers to hire-and-fire and real control over their finances, complete with proper tax-raising powers and abolish the cap.

    After all, people don’t complain that Europe allows France to get better health care than Britain – they complain that Britain isn’t keeping up with the French. That can happen locally too.

  5. James

    It is a fair enough argument to make in response, but I would note that you do considerably overstate the position which I was arguing in reading it as a rejection of any variation by local choice. That wasn’t my intention, and isn’t what I think, though of course it is a position which some might take.

    Rather, the argument was that there is certainly a trade-off between local choice and variation in services, because that is the point of greater local choice. It seems to me that any advocacy of greater localism needs to acknowledge that. So I think we are making a similar criticism of Shapps, in that he seems to be offering an opportunistic argument at odds with the rhetoric he adopts elsewhere.

    I suggest that a key political question is “can we agree that variation [in this particular area] would be legitimate if democratically chosen”. I think that some variations will not be perceived as legitimate – on fairness grounds – in some areas, while it would be accepted in others. For example, I think it is much more difficult to win support for applying that to core clinical treatments in the NHS than in preventive health services; or in culture, leisure and arts provision. Accepting that different people will argue for more or less local variation both in general and in specific cases, the larger point (on which I think we might agree) is that the legitimacy of variation depends on the perceived fairness of the process which leads to it. And getting localism to fly might well be helped by entrenching what can be guaranteed as not subject to variation.

    I wouldn’t challenge the general point about local tax-raising powers and government needing some power to make a difference, including in fiscal terms, to be a site of genuine political engagement. The Fabian Tax Commission a decade ago made that point part of its argument for discussing the reconnection of the public with both taxation and spending; I am sure LibDems and others have been making it for considerably longer.

    But, again, there are complexities here, which are too often glossed over. In particular, I am sure you would support scope for meaningful local variations being introduced on the basis of a starting point which seeks to reflect differences in both resources and needs – eg between Kensington and Chelsea and Middlesborough – for example, when it comes to health.

    That seems to me essential for an equitable localism: if not in place, then I think we would be faced with too stark a trade-off between equity and localism, so the framework of national redistribution within which localism is sited seems to me a key issue for social liberals in particular. One does not need to advocate the claim that there is some magic bullet for uniform provision to accept that it is an appropriate goal of democratic government to, for example, seek to narrow current inequalities in life expectancy, assets and wealth, educational opportunity, and so on. These inequalities are structured by social class, but also by place. I assume that social liberals would argue that greater localism would prove an empowering route to addressing these differences, but that would need to be reflected in its design. One would not necessarily expect such Progressive Conservatives as one can find to place a great deal of emphasis on this point.

    None of that need be anti-localism, even if some of the arguments could be used in that way. Rather, these questions seem to me they would be at the core of a contentful localism where that was not being advocated simply as a front for a minimal state agenda, which is probably the motivation of some Conservative localists but I would imagine rather fewer LibDems.

  6. James Graham says:

    Some fair points there Sunder. I certainly agree that there a political challenges to localism that are rarely addressed.

    I certainly agree that people need to be assured of basic minimum standards although I suspect I would be less prescriptive than you in term of precisely what. My personal view would be that we need social and economic rights enshrined in law (and preferably a constitution). The UK political class is extremely wary of such things but I think most of the objections don’t apply in practice. I think the South African model could be made to work here.

    In terms of ensuring some balance between the extremes of wealth between (eg) Kensington and Chelsea and Middlesborough, you certainly need some kind of equitable redistribution model. I don’t however think the current rather arbitrary model will do. My own preference would be a national land value tax, the revenue of which would get shared out on a per capita basis. But even in Middlesborough there would be real scope for tax raising powers.

    But the fundamental problem I have with your article is not your assertion that localism = variation but that variation = lottery. We need to move beyond what has become an unhelpful media cliche. In that regard, I accept that the real villain of this piece is Grant ’1234′ Shapps.

  7. Richard Gadsden says:

    I think it is much more difficult to win support for applying that to core clinical treatments in the NHS than in preventive health services; or in culture, leisure and arts provision.

    And yet we seem to accept variations between countries on core clinical treatments. I suspect that variations between Scotland and England would be seen as more acceptable than ones between Berkshire and Buckinghamshire.

    Yes, it depends on the issue at hand, but it also depends on the level of identity with the particular polity.

  8. Oranjepan says:

    This is pet topic of mine (and Richard mentions Berkshire, too!).

    I’ve collected a variety of local examples where ‘local’ service provision and accountability are seemingly at odds here.

    Generally I think variation in provision is essential because there is natural variation in need, but there remains a big question about what the precise responsibilities of particular localities should be and how accountability within them is maintained.

    The idea that the state can control services adequately or effectively from the centre in perpetuity is unrealistic, but equally moves to outsource services independently are nothing more than inefficient stopgaps. A balance must be found.

3 Pings/Trackbacks for "There is nothing random about local control of public services"
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  3. [...] country varies enormously. After writing about it last week, I am loathe to use the phrase “postcode lottery” but what is clear is that all the national standards in the world can’t get you an [...]

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