Should services be conditional?

Spending cuts will bring pressure to link responsible behaviour with entitlement to public services

By Dion Watts

Local authority chief executives chose a phrase with an interesting double meaning when they settled on ‘challenging behaviour’ as the theme for their conference last month. On the one hand, it refers to attempts at affecting cognitive behavioural change through the likes of social marketing and choice architecture; and, on the other, to the types of behaviour that the next Government is going to have to curtail – not least, in order to minimise the impact of budget cuts. Excessive drinking, smoking and borrowing, unhealthy eating, inactivity, drug abuse and energy inefficiency all cost Government dearly in the long term.

When the cuts come, government will be unable to provide services at same level as before, and this could necessitate what Matthew Taylor, chief executive of the RSA, calls ‘conditionality’. Citizens would be required to adhere to certain conditions in order to qualify for public services; for instance, only those who refrain from smoking might be eligible for free treatment through the NHS. This would represent a significant shift in thinking from the current principle that everyone who acts within the law should be entitled to equal treatment by the state. However, there are some significant moral issues, as such changes would create an ideal standard for people uncodified in law. This begs the question of who should set the standard, and what gives them the legitimacy to do so?

Government requires the support of a significant majority before it can legitimately act to overturn our freedoms. One can imagine the public dissent if there were an attempt to ban tobacco-smoking outright. However, smoking indoors is illegal, and this ban is not only accepted but widely supported, often even by those who still choose to smoke. This is largely due to a massive campaign to change people’s attitudes to smoking in the run-up to the ban. Social marketing campaigns made us aware of the dangers of passive smoking and the antisocial stigma of lighting up in the company of non-smokers.

In order for government to impose conditionality on public services, therefore, it must first convince the people. There must be a general consensus that certain parts of the population are taking more than they give when it comes to public services, and that it is acceptable to penalise them for it. This may be fairly clear-cut when it comes to smokers and healthcare, but in new policy areas (such as carbon reduction, recycling, community cohesion) there is as yet no such consensus on the standard that government should enforce. Moreover, many of these areas are simply not of a kind that can be controlled by top-down state coercion.

Some of the themes of public policy are closer to people’s hearts than the smoke from their cigarettes. How we eat, how much we exercise, and how we treat people from different cultures and backgrounds are behaviours we learn from friends and family growing up. If government wishes to influence our deep-seeded attitudes towards these things, it is going to require the involvement of the very people who helped shape these behaviours in the first place.

Co-production, so-called, represents a shift in thinking from people as passive recipients of public services to active subjects involved in both their design and delivery. The idea is that those who make use of services should be in the best position to advise on how they can be made better, particularly when improvements must be prioritised according to the resources available. The involvement of local people is also essential in building up a concept of social good on which to base the conditionality of public services. Only the people can draw the line between a society of responsible individuals, and an Orwellian nanny state.

However, this is where human irrationality intervenes. In the past, policy-makers have assumed that the choices people make are based purely on the accuracy of information available to them. For instance, people who eat unhealthily are assumed do so because they are not fully aware of the consequences for their health. However, we are beginning to realise that there many other factors at play, from conditioned behaviour to social norms. Therefore, if the people are to be trusted to create a concept of social good for themselves, this must also take account of the irrational choices we make.

The key here is not to try and find a single theory to explain our irrational decisions, but rather to draw upon insights from many sources. The search for a concept of the good life beyond the dictates of law dates back to Aristotelian philosophy. The Greeks’ eventual  theory was really no more than a collection of so-called ‘virtues’, many of which were only relevant in the context of the time.

Today our virtues are likely to be quite different, and those of tomorrow even more so. Thus, the basis for any policy of conditionality must be free to evolve alongside our changing attitudes. Every generation looks back on those before it, astounded that certain practices were allowed to pass, and the same will be true of future generations looking back on ours. For instance, the number of people killed and seriously injured each year in road traffic accidents is phenomenal, yet we accept the risks and continue to drive because that is they way it has always been. This is conditioned irrationality, and it will not change until there have been significant improvements in automobile safety. Once the people start to see that risk-free road travel is possible, they will insist on the policies to enforce it.

In conlusion, it seems the question of whether public services should be conditional will eventually give way to the fact that they must be. Budget constraints are going to require radical new ways of working to cut costs, so it is important to begin thinking about these now. How we frame a system of conditionality, what degree of flexibility we build into it, and how we enforce it, are fast becoming the more pertinent questions.

To find out more about this article, visit: http://www.guardianpublic.co.uk/solace-kerswell-goss-introduction

9 November 2009

Dion Watts. Local Government Research Consultant, Policy Review Intelligence