Yesterday at a Kings Fund conference I attended a session entitled “Ensuring Excellence”, where one of the speakers was the National Programme Director of the LGA’s “Towards Excellence” program.

For me this is a huge shift from the current model, which you might call “Getting over a low bar” or “Avoiding starring in the next Panorama”.

Since the Care Quality Commission dropped the star rating scheme (and forgot to come up with a replacement) there has been very little incentive for a care provider to shine. In fact the only incentive I can think of is Pride (which is a deadly sin, surely). When the push to private provision was started we were told that the market would drive price down and quality up. I suspect it has done the former (though I don’t think the way public / independent sector hourly rates are compared is a level playing field), but I don’t think quality has improved as much as it has in other business sectors over the same period.

In retail, you can see very quickly whether you are doing a good job, because your customers exercise choice - both in coming into your store and (if they get inside) in filling their baskets. These decisions are being made all the time, and the retailers (and their consultants) measure and respond. The good retailers grow quite quickly (look at Tesco’s growth since Community Care Act in 1990) and the less well run fail (no shortage of data points here, unfortunately). Cast your mind back (if you are old enough) to 1990 and remember what super-market shopping was like: the lines that were carried, the quality of customer service, the car parking arrangements - I could go on. It is barely recognisable. I contend that the improvement is the market at work, in the way it was meant to work in care - but care has not moved on anything like as much.

The difference is that in retail the customers exercise their choice often - sometimes every day. In care the customers may make just one choice in a life-time. The only people who could buy care frequently enough to influence the market - the local authorities - have taken the decision, in the main, to make purchasing decisions once every 3 years, by going out to tender for block contracts or frameworks. Even where personalised budgets are available the service users are often strongly guided. Once a company has won a contract there is very little incentive to improve - they just need to defend. Not mess it up too badly.

This is failure by design.

I do hope that people with the word “Excellence” in their job title can sort it out. There is a finite number of years before I could be at the receiving end, and cultural change is very slow in government.