From GP appointments to school timetables, more flexible systems will give people more choices Photograph: Custom Medical Stock Photo / Ala/AlamyAt the start of this year, I finished my work for the UK government as an independent reviewer on barriers to choice.
Someone from outside government was needed to look dispassionately at the way people were using their choices in public services and decide what barriers there were to prevent them.
I listened to a dizzying number of roundtables and must have spoken to well over a 100 service users face to face, and almost as many professionals.
But one person in particular stands out. She had muscular dystrophy and had to see her consultant every six months, which meant a two-hour round trip plus 30 minutes or more in the waiting room. It meant going over a large river and paying a toll. And all she said to the doctor when he asked her how she she felt was: 'I'm fine'.
What this woman really wants is to check in occasionally by phone, and see him when she's not fine. But she can't, because his slots are full seeing people who are also fine.
What struck me most forcibly was that she was asking for something quite simple, though important to her as a long-term patient. It was a 'choice' about her treatment, in a sense, but not one that is recognised currently by the system in the UK.
The new emphasis would be less about choosing between regulated options, and more about making services flexible enough to suit individuals better – closer to the 'personalisation' agenda in social care, where service users can get budgets they can (theoretically, at least) use in ways they believe are best suited to their needs.
The best approach may be to find ways to give service users the confidence to ask for something different, and perhaps provide duties on service providers to consider this. I imagine this would be like a 'right to request' flexible service delivery.
In each case, the provider would not be obliged to provide flexibility if it is impossible, but they would be obliged to explain why and make that explanation public.
This would help people cut through systems or bureaucratic arrangements. Perhaps they want a consultant who won't mind them asking lots of questions, or to study Spanish at A-level when all that prevents them is their school's time-tabling system, or to go to bed later than 5pm when their carer comes round.
This is basic flexibility which articulate people can often get now by being assertive, but which others can't.
There are possible objections to this kind of approach. Patients may choose badly. They may fail to take responsibility for the wider system, by misusing the flexibility they are offered.
There may also be higher costs from treating people more individually, and the costs will come before the potential savings are available. Financial innovations that tie professionals too closely to narrow numerical outcomes, like the current experiments with payment by results, may also make flexibility more difficult to achieve.
More flexibility would require up-front investment and mean fewer set systems, but more human connection.
David Boyle is the author of The Human Element: Ten new rules to kickstart our failing organisations (Earthscan) and a range of other books. This article is based on a piece commissioned by the British Council for its Equality Exchange forum on public services
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