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Published: 28/08/2003, Volume II3, No. 5870 Page 18

Far from fostering diversity, 'choice' in public policy leads to inequality and cherry picking, says the Fabian Society.

Lyn Whitfield assesses their challenge Gordon Gekko's assertion, in the 1987 film Wall Street, that 'greed is good' has come to sum up a decade.

Perhaps the milder 'choice is good'will come to epitomise economic and political attitudes at the turn of the 21st century.

Certainly, choice is one thing the government wants to see the public services delivering. The NHS has made a start with its patient choice initiative, soon to be expanded.

So far, most of the criticism of 'choice' has come from the political right, which would like to see things moving faster. Right-of-centre think tanks complain that even 'patient choice' delivers less choice than the internal market, with its system of extra-contractual referrals.

However, it was inevitable that the whole idea would eventually be subjected to a sustained challenge from the left, and this has now happened with A Better Choice of Choice, a report issued last week by the Fabian Society.

Main author Roger Levett rejects the argument that 'greater choice automatically increases well-being'.

A consumer economy, he admits, has 'dazzling success' in increasing 'the variety of consumer goods on offer to those with the money to buy them'.

But this 'comes at the expense of delivering other types of choice, notably about public and social goods' and at the risk of increasing the 'deprivation of the poor'.

As a result, he argues, we should think about 'choice sets' or 'package deals' that lay out the context of particular choices and expose their knock-on effects. A Better Choice of Choice is mainly concerned with two sorts of effects. The first is the impact on the environment, which is hardly surprising since it was commissioned by the Sustainable Development Commission, the government advisory body chaired by Jonathon Porritt.

The second is the impact of the government's obsession with importing 'choice' to the public services. It does not deal with the health service as such, but it does deal with other public policy areas, such as education.

Education is much further down the 'choice' road to 'reform' than health, but the principles are much the same.

Choice is supposed to foster diversity and allow parents to 'exit' bad schools, forcing them to improve or close.

However, Levett argues that since new schools are rarely set up, what actually happens is that popular schools are able to recruit good pupils, while unpopular ones are left with the rest. This is a well-known argument - and it can be made for health.

Popular hospitals (foundations? ) will be able to invest in services and, perhaps, choose more motivated and lower-risk patients, while the rest will struggle on for the 'unlucky'majority. National standards and inspection might stop this, although they do not seem to have performed this trick in schools.

The wider conclusions of A Better Choice of Choice are that policy should be made to pursue environmental objectives and improve quality of life, and that choice should be used as a means to this end, rather than as an end in itself.

As far as public services are concerned, 'standards should be recognised as more important than choice and the state a more effective provider than the private sector'.

Accepting that, of course, means accepting lots of other things: that there are public and social goods that cannot be secured through individual choice; that inequality matters.

It also means accepting 'it is the job of the political process to articulate and negotiate the kind of society we want' and that it is the job of government to draw up policies to deliver it.

Levett describes this as 'a rediscovery of some old truths' - but these 'truths'were never uncontested, and they are not much in favour now, even on the Left.

A Better Choice of Choice: quality of life, consumption and economic growth By Roger Levett, Ian Christie, Michael Jacobs and Riki Therivel.

Published by The Fabian Society.

www. fabian-society. org. uk