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Choice and Voice – A Review

Published online by Cambridge University Press:  01 April 2008

Ian Greener*
Affiliation:
School of Applied Social Sciences, University of Durham E-mail: ian.greener@durham.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

‘Choice’ and ‘voice’ are two of the most significant means through which the public are able to participate in public services. Choice agendas position public service users as consumers, driving improvements by choosing good providers over bad, which then thrive through greater allocations of funds as money follows their selections (Le Grand, 2007). Choice-driven reforms tend to be about trying to make public services more locally responsive (Ferlie, Freeman, McDonnell, Petsoulas and Rundle-Smith, 2006). Voice-driven reforms, on the other hand, tend to position public service users as citizens, suggesting an emphasis on accountability mechanisms to drive service improvements through elections, with the possible removal of low regarded officials, or a greater involvement of local people in the running of services (Jenkins, 2006). Voice implies that citizens hold the right to participate in public services either through the political process, or through their direct involvement in the running or delivery of the services themselves. Of course, it is also possible to combine choice and voice mechanisms to try and achieve greater service responsiveness and accountability. In this review, choice reforms will be treated as those which are based upon consumer literature, and voice reforms those based upon attempting to achieve greater citizenship.

Citizenship and consumption are two areas with significant literatures in their own right, but whereas the citizenship literature is widely cited in the social policy literature, the consumption literature appears rather more selectively. This review examines each area in turn in terms of its application to social policy, and then presents a synthesis of commonalties in the two literatures, which represent particularly promising avenues for exploring the relationship between public services and their users.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2007

Citizenship

Within the social policy literature there now exists a vast range of writings on citizenship which address the questions of ‘who provides welfare’ and ‘what are the terms and conditions attached to that provision’ (Dwyer, Reference Dwyer2000: 211). However, arguably, the social policy literature often appears to have a lack of theory to ‘provide the tools to explain the development and balancing of pubic rights and obligations in advanced industrialised societies’ (Janoski, Reference Janoski1998: 3).

Most accounts of citizenship begin with the work of Marshall, whose ‘Citizenship and Social Class’ (Marshall, Reference Marshall1950) analysed citizenship in terms of the development of civil, political and then social rights, in the eighteenth, nineteenth and twentieth centuries in England. Marshall suggested full citizenship was only achieved when social rights were granted to the public, so as well as having protection under law (civil rights), and the right to vote and to stand for office (political rights), they were also granted state-offered social protection, typically in terms of areas such as education, healthcare or housing (social rights).

There are many difficulties with Marshall's model, but it remains hugely influential and widely cited. It can appear a rather whiggish interpretation of the history of England, with little application outside of that country, and to focus excessively on rights at the expense of responsibilities (Giddens, Reference Giddens1998). Equally, Marshall's phases of development of civil, political and social citizenship appear rather too neat (Roche, Reference Roche1992). Marshall's work can however provide a critique of the ‘rolling back’ of social citizenship rights in neo-liberal states from the 1980s onwards, and the possible implications for societal cohesion (Harris, Reference Harris, Marquand and Seldon1996; Lister, Reference Lister1997).

Two typologies in the recent literature present the diverse range of approaches that writers on citizenship have addressed. Fitzpatrick (Reference Fitzpatrick2001, chapter 4) presents a view of citizenship based upon two analytical spectrums, the first running from equality to liberty, and the second considers a range of positions from the political right to the left. This gives us four ideal types. The first (liberty, political left) represents a liberal prioritising of rights and the egalitarian prioritising of needs (p. 66). In this model, individuals have a right to the fulfilment of their basic needs, and welfare systems should be geared to that aim. The second model (equality, political left) has a communitarian prioritising of duties and egalitarian prioritising of needs. In this approach, welfare systems should be organised around communal bonds of mutual obligation but with needs fundamental rather than entitlements based on desert. These two models share the egalitarian prioritising of needs, but with the second implying a more residual welfare state than the first.

The second two models are based instead around the political right. The third model (liberty, political right) suggests a liberal prioritising of rights and a free-market prioritising of entitlements. The rights the individual holds are to private property and exchange, and so to basic civil rights only. The presumption is that citizens should stand on their own feet, free from state interference with only basic safety nets to fall back on. Finally, that leaves us with a final position (communitarian, political right), which stresses communitarian duties and conservative deserts. In this approach citizens must bear duties and define themselves in these terms rather than through the rights that they have. ‘Desert’ is a deliberate choice of wording as an individual's merit is held to be more important than their rights. State welfare must be geared in this view to reinforce responsibilities and shore up civic forms of mutual assistance.

Dean (Reference Dean2002) uses different analytical spectrums, but his model has much in common with Fitzpatrick's. He too presents what we might regard as ideal types based upon four models of citizenship (p. 190). Dean uses different analytical spectrums with a range of possible positions running from contractarian citizenship through to solidaristic citizenship on the one side, and systemic assumptions through to agential assumptions on the other.

This presents four alternative combinations. First, there is systemic-contractarian view with its ideal type citizen as the ‘heroic consumer’. The neo-liberal state is regarded as the ‘enabler’ (p. 193) with the welfare state providing a constitutional role within which market forces can function. Skilled labour should be produced and reproduced and citizens should provide for their own welfare as much as possible. The individual in this model is constrained by negative rights towards fellow citizens but free to exercise rights as a consumer in the marketplace. The principle of equity is based on merit so should allow a ‘level playing field’ for all (p. 192). Participation is civic duty (p. 200); reform is rights-based (p. 203). This is therefore very similar model to Fitzpatrick's combination of liberty and the political right.

Dean's second model is a combination of systemic and solidaristic assumptions, with the ideal type being the ‘juridical subject citizen’. This model is found in social-democratic regimes in which state furnishes the constitutional means for the regulation of markets and the protection of labour and welfare services (p. 193). Individuals are constrained by their duties to other citizens (by paying taxes) and receive in return the right to receive services (p. 191), with the state pursuing an aim of social justice (p. 192) by correcting the market where it leads to unfair outcomes. Participation in such a system is an ethical responsibility (p. 200), and reform is administrative (p. 203). This has parallels with Fitzpatrick's equality, political left model.

In Dean's third model of citizenship, which is a combination of contractarian and agential ideas, the ideal type is ‘passive citizen client’. This is the type found in a paternalistic, confuscian welfare state, which relies upon tradition for its legitimacy. Dean claims there was something of this approach at the time of the founding of UK welfare state, especially through Beveridge (Reference Beveridge1942: 194). This approach to citizenship has an element of what Dean calls ‘social Darwinism’ (p. 192) about it in that only the fittest subjects are allowed to participate. Those that seek to disrupt the system should be excluded from the rights of the national state, and it is the responsibility of the state to make this happen. The good citizen is ‘self-seeking, but is obedient; a passive client’ (p. 192). Participation of the majority is therefore based on conditional obedience (p. 200), and reform is likely to come from anarchistic resistance (p. 203). The type in Dean's approach has no real equivalent in Fiztpatrick's typology.

Finally, there Dean's fourth type, with a combination of solidaristic and agential assumptions with the ideal type citizen being the ‘active participating agent’. This approach is based upon a compromise between the sovereign power and representatives of society's principle interests in which provision of social welfare can be brokered. Welfare cements the social order (p. 194). The right to participation or membership covers everyone, with those disadvantaged too having the right to belong. State intervention is based on promoting inclusion or promoting societal inclusivity (p. 193). The individual has rights, but is constrained by duties to society. Participation is moral obligation (p. 200), and reform comes through popular resistance (p. 203). This again has similarities to Fitzpatrick's model of the communitarian right, the combination of liberty with the political left. The two typologies are summarised in table one.

From Table 1, there is considerable crossover between the two models, with complementary categories providing additional analytical dimensions. There are, however, two exceptions. First, Fitzpatrick's combination of liberty with community, in which liberal rights are combined with egalitarian needs, and which appears to be a residual model of welfare that meets basic needs only within a liberal state. Second, Dean's approach which combines contractarian and agential assumptions to present a passive citizen client, which he indicates may have resemblances to the discourse found in the UK at the founding of the welfare state. This gives five models of citizenship and a notion of their theoretical relationships to one another.

Table 1 Fitzpatrick and Dean's models of citizenship

Both Dean and Fitzpatrick's models of citizenship are primarily based at the national level. There is, however, an alternative that tries to create what might be termed ‘local’ citizenship through the movement known as the ‘new localism’. This view suggests that greater public engagement can occur through more local democracy or public participation in local services. The political aspect of this comes through what Stoker calls: trying to achieve a ‘politics for amateurs’ (Stoker, Reference Stoker2006), through which a greater engagement can be achieved. In terms of public services, experiments in local membership are taking place in healthcare and education that offer the promise of increased democracy (Birchall and Simmons, Reference Birchall and Simmons2004), but with many commentators suggesting little will change in practice because of the lack of opportunity and time for local people to become involved in the most important decisions made (Klein, Reference Klein2003; Wilmot, Reference Wilmot2004). Finally, politicians have asked, particularly in the 1960s and 2000s, for the public to volunteer to have a greater role in the actual delivery of public services. Even though there are substantial difficulties in achieving greater responsiveness for local services through local citizenship, especially in a country such as the UK where local government power has declined so dramatically since the 1980s, it makes a great deal of sense to offer the public as many means as possible to participate in the running of local public services so as to increase political engagement.

An alternative form of localism comes through the increased use of market mechanisms in the public sector; the ‘systemic, contractarian’ model (in Dean's terms) closely resembles a consumer. That consumerism can be linked to citizenship initially appears odd (consumerism will be treated more fully below), but the move between individualism and collectivism can be made if Adam Smith's maxim of the ‘invisible hand’ is accepted. Smith's claim was that, by individuals pursuing their own narrow self-interest, societal good occurred. This is because by producers selling high-quality goods and services, and buyers seeking them out, everyone appears to benefit (Aldridge, Reference Aldridge2005). However, there are substantial difficulties with this, with the economic theory of the market often being confused with the empirical reality of exchange, as will be explored below. For the moment, however, it is intriguing that consumers appear in typologies of citizenship, but also that citizens-consumers appear in one typology of consumer types (see below). As such, it would seem that, despite their apparent separation, the literature seems intent on finding linkages between choice and voice.

The key element of theorising citizenship is attempting to find a balance between the rights offered by the state, and the responsibilities required of citizens in return. Each of the models outlined by Dean and Fitzpatrick present a different way of viewing this balance. The original Marshallian conception of citizenship, appearing with the introduction of social rights, places a strong emphasis on citizenship in terms of receiving rights from the state to alleviate individual risk. This seemed to imply that merely paying tax in return was the only responsibility required of citizens, with there being a significant lack of means by which the public could participate in the formulation of policy either nationally or locally, or in the running of public services. The emasculation of local government from the 1980s onwards in the UK exacerbated this further (Jenkins, Reference Jenkins2006), with the state strongly centralising the running of public services and greater affluence leading to an individualisation of society in which it appeared rights become the dominant discourse (Clarke, Reference Clarke2004). This led to a polarisation of politics with the political right proposing models that were increasingly marketised, and with the left responding with the discourse of the Third Way.

The Third Way has held most influence in the UK, but is also recognised in ‘progressive’ policy networks in countries in Europe and Asia, and attempts to create a model of active welfare in which the state becomes a loss-adjuster for individuals, allowing them transitional periods of ill-health and unemployment, but with a clear focus on work as the means for achieving both individual and societal goals (Giddens, Reference Giddens1998, Reference Giddens2002, Reference Giddens2007; Lee and Woodward, Reference Lee and Woodward2002; Mouzelis, Reference Mouzelis2001; Westergaard, Reference Westergaard1999). Those unable to work are cared for by the state, but everyone else is required to take greater responsibility for themselves in terms of being prepared for the job market, but also in making healthy choices in terms of lifestyle and being financially responsible for old age (Jessop, Reference Jessop2002). The emphasis becomes on consumerist rights in terms of standards of public service delivery (M. Barber, Reference Barber2007) and individualised responsibilities to be productive, financially independent and employable.

The Third Way appears to indicate that both political right and left appear to be converging on a model of citizenship that takes an increased account of the public conceptualised in terms of consumerist notions. It is therefore to that literature that the review will now turn.

Consumerism

The idea of the ‘consumer society’ is not a new one, and, depending the particular definition used of the term, can refer to Victorian Britain (Flanders, Reference Flanders2007), with its explosion of department stores and the availability of non-essential goods, or more recently can be tied in with the ‘Fordist’ expansion of mass-produced goods (and welfare) in the post-Second World War period (Jessop, Reference Jessop2002). Despite the extension of public services, especially at the local level, at the beginning of the nineteenth century, and the significant growth in the public provision of welfare from 1945 onwards, the idea of consumerism in public services is a much more recent phenomenon, becoming more visible from the 1960s onwards (Abercrombie, Reference Abercrombie, Keat, Whiteley and Abercrombie1994).

Welfare consumerism finds its roots in a variety of sources. Feminist discourses of the 1950s and 1960s were hugely influential as a means of organising women to challenge the often discriminatory basis upon which services and benefits were offered to them (Daly and Rake, Reference Daly and Rake2003), and showing that the post-war assumptions about male breadwinners were both patronising and unsustainable (Clarke and Newman, Reference Clarke and Newman1997). Feminism created space for women to challenge public professionals and policymakers, and therefore showed how service change and improvement could be demanded for wider constituencies including for the disabled and people with learning difficulties (Welshman and Walmsley, Reference Welshman and Walmsley2006).

A second major element in the growth of welfare consumerism has come through the rise in the public's average level of income. As the public become richer, the theory goes, they demand that public services become as responsive and dynamic as the private services they consume (for a clear statement of this view see the introduction to Secretary of State for Health, 2000). More people utilise private welfare services as either themselves or their employers offer additional job perks such as private health insurance, and find public services wanting in comparison. This disaffection becomes even more widespread when the public experience private service within the public sector through the use of policies such as waiting list initiatives, which utilise the extra capacity of the private sector through public funding, or by some services becoming ‘contracted-out’ by responsive and capable private providers (6, Reference 62003).

There is some evidence to support this view. Those who experienced private care ‘on the NHS’ in the 1980s and 1990s probably received considerably more personal attention than they would have if referred within solely public provision. Equally, there are some areas where the use of private provision has driven up the standard of service considerably, particularly in local government. However, there are also clear limits to this argument. The excellence of the private sector can certainly be over-stated; the experience of excellent customer service is the exception rather than the norm in either public or private provision, and the assumption that private service is automatically best is a poor one (B. Barber, Reference Barber2007). The customer service departments of many of our largest private companies, particularly where telephone calls are needed to get in contact with them, are often pilloried in the media.

There are two main archetypes of consumers' behaviour (Paterson, Reference Paterson2006). The first is that of the chooser, the rational decision-maker who is able to process large amounts of information and make the best possible decision based upon it. Welfare policy that depends upon users to drive reforms depends upon consumers as they must drive out bad provision by not choosing it, and reward good providers by both choosing them the first time and by going back to them. Rational decision-making welfare users are well informed and committed to finding the best providers and avoiding the poor ones. In the UK, education policy is often held to be an example of where this user rationality has become dominant (Minister of State for Department of Health, Minister of State for Local and Regional Government, and Minister of State for School Standards, 2005), and so where the government claims policy based on choice has ‘worked’.

Underlying the rational decision-maker model is economic theory, and so the suggestion that the best way of improving the responsiveness of public services comes through introducing market or ‘quasi-market’ mechanisms into public provision (Le Grand, Reference Le Grand2007). In this context, choice is part of a reform process to try and introduce competition into public services, typically through the entry of private providers. This competition is meant to act as a spur to efficiency as well as making services more customer-responsive, creating a virtuous circle of supply-side improvements because of competition, and demand-side drive from users for improved services under threat of them moving to another provider. As such, choice is clearly linked to users making use of the threat of ‘exit’ rather than ‘voice’ based mechanisms for service improvement (Hirschman, Reference Hirschman1970), although again the two can be used in tandem.

The second consumer archetype is that of the dupe. This is the individual who is unable to make the best decision him- or herself because they are easily mislead, or because they are constrained from making a choice in the first place because of societal influences that might lead them to think that choice does not matter. Where consumers are easily mislead, marketing is usually blamed, with promotional strategies highlighted that aim to confuse or influence user decisions based not on the quality of the service, but instead on more intangible appeals such as those to brand loyalty. The dupe may also be the result of his or her societal position, with structuralist and often critical sociology suggesting that the influence of social class might lead to those with little education making poor choices, or believing that choice is irrelevant to their or their children's futures (Sayer, Reference Sayer2005). Critiques of the same educational reforms celebrated by advocates of choice have shown how the middle-classes tend to be the biggest gainers of the introduction of choice reforms as they are better able to manipulate the system and to understand the information about which schools are best, leaving a number of children from poorer background with the worst schools in local areas (Ball, Bowe and Gewirtz, Reference Ball, Bowe and Gewirtz1995). Equally, for there to be choice in education this carries with it a presumption of at least some redundancy of school places (usually in unpopular schools) and so the problem that the system as a whole may become less efficient than the central allocation of places by a Local Education Authority (Jenkins, Reference Jenkins2006). This is not to say that a bureaucracy allocating places is an inherently superior form of place allocation than parent choice, but it may well carry with it a higher level of efficiency.

As such, the dupe role is useful in reminding public market advocates of the dangers of extending choice-based policies to those either unwilling or unable to make the ‘right’ choices for themselves. Where public users lack reliable information upon which to make choices, or are unable to understand the information presented to them, there is no guarantee of poor providers being driven out in favour of good. Equally, where the capacity of good providers is exhausted and users are allocated to providers they would not otherwise have chosen, they may unwillingly assume a kind of dupe role because of having limited choice. In secondary education, even if 90 per cent of parents get the first choice of school for their children, that still leaves a nationally significant 10 per cent that do not, and the potential problem that this 10% of parents is likely to be disproportionally located in areas with poor alternative school provision.

Equally, critiques of the rational chooser model appear in both the sociological and social policy literature. Bauman (Reference Bauman2007) gives a rich account of the often-negative effects of consumerism on identity as individuals find they have to market themselves in a globalised market economy, and the ever-rising dissatisfaction they experience in consuming goods and services which are marketed to them as meeting needs they cannot possibly meet. This links back to Galbraith's analysis of the ‘affluent society’ (Galbraith, Reference Galbraith1958) in which the author envisaged a future of private affluence and public squalor through the public becoming increasingly resentful of the tax burden placed upon them, and Schwartz's (Reference Schwartz2004) examination of the ‘paradox of choice’ in which the public begin to experience choice as bewildering and disconcerting because of the sheer range of choices available in every sphere of life.

As such, there is evidence in the social policy literature of an awareness of the categories of rational chooser and dupe, even if they are not always referred to with those explicit names. Within the consumption literature more generally, however, there are a range of other possible positions with varying degrees of relevance to welfare. Gabriel and Lang (Reference Gabriel and Lang2006) suggest a nine-fold typology including the chooser (the rational choice model), but also the communicator (using goods to communicate, as would Veblen, Reference Veblen1970), the rebel (who subverts the consumption process to utilise goods or services in her own way), the identity-seeker (who consumes as a part of a group), the hedonist or artist (who consumes for pleasure), the victim (the dupe effectively), the activist (consumes to make an ethical point), the consumer/citizen (seekes voice through consumption) and the explorer (the bargain hunter). Consumers become ‘unmanageable’ through their ability to move between these positions, in some circumstances being rational choosers, but in others activist or any of the other possibilities. This adds far more depth than the rational chooser or dupe models, and clearly has potential application to welfare through empirical studies that could attempt to explore the changing roles played by users in different services. The key point is that in some circumstances we may find ourselves interacting with services in the manner of the chooser, but prefer to be activists or even dupes in others (Greener, Reference Greener2002). It seems unlikely that individuals interact with every public service in the same way. Table 2 gives the Gabriel and Lang typology of consumer roles.

Table 2 The ‘unmanageable’ consumer

Note: I am grateful to Nick Mills for his original drafting of this table through the ESRC project funded under the ‘Cultures of Consumption’ programme upon which we both worked.

Source: Gabriel and Lang, Reference Gabriel and Lang2006.

Gabriel and Lang's typology of consumers presents a significant challenge to literature that suggests markets can provide the most effective means of reforming public services. If choosers are only one of the many positions consumers adopt in their exchange relationships, the implications of them potentially adopting these alternative positions must be more carefully thought through. Le Grand (Reference Le Grand2003, Reference Le Grand2007), for example, suggests that the range of behaviours of the public can be analytically reduced to that of pawns (with little or no choice, but with clear linkages to that of the dupe) or queens (with services designed around them as rational choosers), but a range of other positions needs to be explored to capture the full richness of the interactions between the public and the welfare services offered to them.

Recent work in economic sociology would go further even than Gabriel and Lang, and suggest that the operational details and rules of public services themselves constitute the specific rationalities within which both professionals and users interact (Callon, Reference Callon and Callon1998; Callon, Meadel and Rabeharisoa, Reference Callon, Meadel and Rabeharisoa2002). This would suggest that the specific interactions between professionals and users needs to be studied within their own particular contexts to examine the precise roles each adopts in relation to the other. Public service users may be citizens or consumers or occupy a range of other roles that we require in-depth empirical studies to explore.

This implies that it becomes important to study policy and its implementation without presuming that what is being implemented is a ‘market’ (which remains an extremely problematic term) or that the public are automatically constituted as ‘citizens’ (which, again, can refer to a range of very different positions). These terms have now become so loaded that it is imperative for us to be far clearer what we mean when we talk about choice or voice.

Conclusion – choice and voice

There are significant problems in terms of exploring social policy in terms of either choice (as a proxy for treating service users as consumers) or voice (as a proxy for treating them as citizens). Both terms are now both so loaded and ambiguous that care needs to be taken in their use. Two main conclusions suggest themselves from the review above.

First, that if policy is now concerned primarily with treating users in consumer roles, it becomes important to try and work out how the significant difficulties present in such an approach can be overcome. One approach is to try and find what we might term ‘bridging notions’ that work across the consumer and citizen literature to try and capture the best of each model whilst at the same time not reproducing the worst.

One such bridging notion is that of complaint. Public service users often feel that their complaints are not treated seriously, or that they are fed into a bureaucracy that fails to introduce change in response to complaint, even where it is manifestly needed. There is certainly an element of truth in this (see Allsop's paper, for example, in this themed section). However, complaints are interesting in that they represent an opportunity where a public service user can make a difference to service provision for everyone through an act at the individual level. The practical difficulty of this comes in joining up the individual act of complaint with an improvement for all users – of examining the complaint to see if it has merit, and then mobilising it to improve things for other users. This difficulty is not insurmountable however – if public organisations were required to employ user advocates who could assist in their representation and were responsible for driving service improvement, then the difficulties of the complaints system might begin to be overcome. By finding bridging notions that give individuals the chance to make collective changes it becomes possible for services to engage a wider range of users (Lister, Reference Lister1997).

Second, because of the increased interest in the citizenship literature in how consumers might be incorporated, and in the consumer literature in how citizens might be included, new ‘hyphenated’ terms are increasingly being used. Consumer-citizens might be defined in terms of citizens who make individual contributions that could be successfully combined to make a collective difference – as through complaint. Citizen-consumers on the other hand might be consumers who make choices with collective aims in mind (as in Gabriel and Lang's activists – see above). In either case, an awareness of both choice and voice is taken into account, sometimes by organisations becoming more careful and aware in the way they treat their users (as with complaint), sometimes by individual consumers being more creative and aware in their choices (for a critical review of policy along these lines see Clarke, Newman, Smith, Vidler and Westmarland, Reference Clarke, Newman, Smith, Vidler and Westmarland2007; Needham, Reference Needham2003). Each of these positions begins to treat the public in a more sophisticated way than simple typologies suggest, whilst at the same time offering practical suggestions for how services can be improved.

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Figure 0

Table 1 Fitzpatrick and Dean's models of citizenship

Figure 1

Table 2 The ‘unmanageable’ consumer