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Once upon a time there were public services that treated everyone the same, and people had to take what they were given.
Patients, school children, students, welfare recipients were grateful and deferential, and prefaced all their requests with ‘if it’s not too much trouble’. There would be an audible gasp if ever they did an Oliver Twist and dared to ask for more.
Then came Margaret Thatcher with her faith in markets and a feeling that government would run a whole lot better if lots of things were privatised, and those public services that remained were run like businesses. Users were encouraged to be customers of public services and to demand what they wanted, and to shop around.
Of course, this is an oversimplification– the welfare state never treated everyone the same, and before Thatcher there were groups of people who combined together to demand different kinds of public services.
But beyond this simplistic picture, a cross-party assumption of governments has been that public services will flourish through adopting the entrepreneurialism, efficiency, and customer focus of the market.
We have seen the customer language and approach take hold in a range of public services. Customer language is applied when people pay directly for public services (e.g. tuition fees); have choice over services (e.g. state schools and elective surgery); and/or are treated in an attentive and respectful way (good ‘customer service’).
There has been a huge growth in performance data about public services as well, so that we can be smart customers, shopping around between providers to get the best fit for what we want. We can see the death rates of surgeons before we choose a hospital; we can see the punctuality rates of trains and perhaps decide to take the car instead. The pressures of customer competition keep providers on their toes: if they want to keep customers and the money that comes with them then they need to keep those customers happy.
There are a number of problems with this, and I’m going to focus on four:
The language of customer is individualising. It focuses on what you want to get out of public services, not on the broader collective goals of those services, which are often public in the first place because they are about shared and equal access to a good life. Prioritising people’s individual demands risks intensifying inequalities in access to services, and in generating collectively undesirable outcomes such as over-prescribing of antibiotics in response to patient demand.
It draws a false equivalence between private customer service and quality improvement. When I’m shopping for car insurance, I like being able to pick a different provider if I’m not happy with the one I’ve got, but it took me a few goes at buying car insurance before I learned how to compare them properly and make a good choice. A lot of public service choices are sticky: people make a choice once and after that it is difficult to change university, school, care home, hospital consultant. You’ve often had to work quite hard to get those services in the first place. And often (despite the plentiful performance data) the quality of the service isn’t really clear to you until you are in them. There’s little scope to make a poor choice and learn from it the next time, and that means the signals we send to providers by our choices are not a reliable guide to service quality.
The language of customer shifts the blame for bad services onto the individual. If we make consumer choice the engine of change in public services, then – if I’m not a very articulate or motivated customer – isn’t it my fault that the service isn’t better? Making choices about certain things is really difficult. We know that it’s hard to compare energy prices and mobile phone tariffs because they are designed to be difficult to compare. Now imagine choosing a care home to live in, because of advancing dementia or a medical crisis which has affected your mobility. It’s a hard time to make a choice, and we need to have more to offer people facing poor quality underfunded services than blaming them for not being good enough at making choices.
It puts staff and service users in conflict. Underpinning the customer language is the view of public services as a battleground between staff and customers, where customers have to keep their wits about them and be ready to complain, switch and be generally awkward in order to get what they want. You can see this in the language around students as customers in higher education in which tuition fees are seen as flexing customer muscle over wayward academics.
But this conflictual model fails to recognise that the interests of users and providers can be closely aligned. Successful delivery of public services often requires high trust relationships between users and providers on the front line.
We need to get better at supporting good relationships, at harnessing relational power. In our 21st Century Public Servant research into the future public service workforce, we repeatedly find that people want public services and organisations that feel human and treat them as humans.
And that’s not easy. In the many presentations we have given to public service organisations what’s clear is that taking relationships seriously is a radical challenge for them. Big organisations in the public (and indeed private) sectors are not good at being human. Large organisations work through the efficient processing of people – the customer service algorithm – rather than the building and sustaining of relationships.
Creating good relationships is small-scale work. We need to find ways for even big organisations to feel small. There may be ways to nest the insights of small organisations in bigger ones, so that within large hospitals and large schools we have wards and classes where relationships can be developed and sustained.
We need to get better at understanding the places where good relationships exist and celebrating and copying them, rather than allowing adversarial narratives (‘them and us’) to take hold and thrive.