What are the Implications of Public Service Reform for Social Inequality?

A major theme in public service reform is user empowerment through greater opportunities for choice between alternative providers. This raises major challenges for policy-makers since income inequalities have grown rapidly in recent years and better-off people have greater choice across most areas of life. Can reformers achieve more equal outcomes by giving more choice to everyone?

. This chapter considers health and social care, education and early years provision, chosen because they are all high-profile policy areas with substantial reform programmes and because they offer examples of empowerment reforms through choice in more or less competitive markets. Much of the reform programme has had insufficient time to achieve its full impact and available evidence is inconclusive. Despite obvious problems of adverse selection by providers and differences in the capacity of users to make effective choices, the outcomes indicate modest progress in advancing equality. Where empowerment programmes are linked to extra resources targeted on more vulnerable groups or areas in the context of good information, a functioning market and support in decision-making, they appear to have a positive effect. However the achievements of the reform programme are limited. It is hard to make much headway in advancing more equal outcomes in an unequal society unless more money is directed toward poorer groups..