The undoubted intellectual high point of the conference was reached this afternoon when Julian Le Grand gave a shameless plug for his recent book. Professor Le Grand is the Richard Titmuss Professor of Social Policy at the London School of Economics and has recently started a 6 month secondment as health policy advisor to the Prime Minister. Simon Stevens, his predecessor at Downing Street was to have presented in the morning, but stood down in the light of his recent defection to the private sector.
Julian Le Grand has a major interest is in the motivation of professionals, which he believes is the key to policy design in the public sector. His recent book asks how professionals in public services can be motivated to deliver quality:
Can we rely on the public service ethos to deliver high quality public services? Are professionals such as doctors and teachers really public-spirited altruists - knights - or self-interested egoists - knaves? And how should the recipients of those services, patients, parents and pupils, be treated? As passive recipients - pawns - or as active consumers - queens?
[He] argues that the original welfare state was designed on the assumptions that those who worked within it were basically altruists or knights and that the beneficiaries were passive recipients or pawns. In consequence services were often of low quality, delivered in a patronising fashion and inequitable in outcome. However, services designed on an opposite set of assumptions - that public service professionals are knaves and that users should be queens - also face problems: exploitation by unscrupulous professionals, and over-use by demanding consumers, especially middle class ones.
He suggests avoiding situations where ‘knightish’ and ‘knavish’ incentives work in opposite directions (e.g. private practice), and try to get them pulling in the same direction—as with GP fundholding.
