Sitra study trip
Service Voucher and Customer Right to
Choose Social and Healthcare Services
Anna Walker: Member of Consumer Focus Board
Introduction to Consumer Focus
21 May 2010
Anna Walker – background note
• Wide experience of regulation gained across
government and regulatory authorities
• From 2004 – 09 Chief Executive of the Healthcare
What is Consumer Focus?
• Created by an Act of Parliament – Non Departmental
• 2008 merger of National Consumer Council,
Postwatch and energywatch
• Independent of government and industry
• Able to work across all sectors of the economy
• With particular responsibilities for energy and postal
What do we look like
• We have a devolved structure
– Consumer Focus; Consumer Focus Scotland;
Consumer Focus Wales; Consumer Focus Post
• Responsible to a UK Board
• Around 180 staff with a core budget of £15 million
• We do research, policy development and advocacy
• We directly support consumers at risk of disconnection
from energy supply
• We are also home to the National Social Marketing Centre
Our statutory functions
• To represent the interests of consumers
• Undertake research into areas of consumer detriment
• To refer ‘supercomplaints’ to regulators requiring
them to investigate areas of consumer detriment
• Provide information and advice to help consumers
and to improve standards of service
• Use general powers of investigation to require
regulators and companies to provide information
• We must assist vulnerable energy or postal
complainants and energy disconnection cases
Our Planning Process
Criteria for Work
Focus Gap Horizon
2009/10 Roll‐ Scanning
* Consumers, Estate Agents and Redress Act 2007
How do we act?
• We campaign for a fair deal for consumers and to
make markets and services work better
– Energy prices and standards of service
• We represent consumers across public policy,
industry and regulatory debates
– Reform of financial services
• We report on consumer experience of the economy
– Consumer research on copyright law and file-sharing
• We help consumers make more informed choices
– Web advice, working through the media and with advice agencies
• Take action on behalf of vulnerable consumers
– Our ‘Extra Help Unit’ stops consumers from being disconnected
from their energy supply
What drives our work
“we will make a difference to people’s lives as
consumers, particularly the most vulnerable, by
championing policy changes that can help make
people as powerful as the institutions that serve then.
we will engage, inform and support consumers to act.
Where they cannot act for themselves, we will act for
them by working to improve the performance of those
who serve them.”
Our priority areas
• Public and Community Services
– Engage consumer experience to get more effective and efficient
• Building service delivery around the user experience
• ‘Community levers ‘ how can local communities engage without being asked?
– How good are public services at customer service
• Jobcentre Plus and the personalisation of service delivery
• Police and responding to citizen complaints
• For vulnerable and disadvantaged consumers
– Articulate the real experience of consumers in debt
– Provide expert knowledge to front line advice agencies
– Challenge the poverty premium where the poor pay more for
essential goods and services.
Our priority areas
– Keeping companies honest
• Challenge assumptions about price
• Monitor standards of service
• Refer poor behaviour to regulators
– Consumers and the low carbon transition
• Make sure costs are fairly distributed
• Contribute to the design of energy efficiency programmes
• Help consumers understand the changes
– Protecting the most vulnerable
• Drive fuel poverty initiatives
• Work with regulator to improve standards of debt management
• Extra help unit
Our priority areas
• Post and Post Offices
– Better value and service from Royal Mail
– A modern post office network that people can access, want to use
and are happy with their
– post office as a community hub for banking and access to
• Financial Services
– Reform of regulatory regime
– Promote the interests of those neglected by mainstream banking
Our recent impact
• Directgov - online access to public services
– Created a community of online users to improve the government’s
information and services web portal
• Savings market ‘supercomplaint’
– Referred the ‘cash ISA’ market to the Office of Fair Trading
• Energy debt and disconnection
– A joint review of the performance of energy supplier in relation to
energy debt with clear recommendations for improvement
• Proposals for a community bank in Post Offices
– Welcome for our proposals for banking products tailored to the
needs of low income post office customers
• Stand up for consumers on copyright
– Working with regulator to protect consumers threatened with
having their broadband cut off for copyright infringement
HEALTH CARE AND SOCIAL CARE
VERY DIFFERENT IN THE UK
•Healthcare : largely public money
•Social care : - debate on funding
- much less money
- more self financing
•Healthcare : patient choice
•Social care : some vouchers
? In healthcare for long term conditions
Independent healthcare regulation in UK
Long tradition of professional regulation
But this of individuals
Recognition that healthcare requires systems for
Public enquiry into deaths of children from heart
surgery in Bristol: quality of care issue.
Concerns about access to care.
Led to establishment of an independent
Against a Background of
General Healthcare Reform
Huge additional finance since 2009
£47 billion → £120 billion
approx. 9% of GDP.
Moves towards a less centralized
Determination to improve access to
More of a role for the private sector.
• All healthcare:
o Now has to be registered
o And meet government standards.
• Public Sector (National Health Service) also:
public annual ratings:
o Excellent, Good, Fair, Weak.
National Quality Board to look at standards
New government : full economic regulator.
The overall approach
A regulatory system based on risk.
Emphasis on hospital’s responsibility:
Self assessment against standards.
We checked taking account of:
All available information
Views of local government
Patients’ / staff views: major surveys.
Measuring what is important to:
Aim to encourage improvement.
Areas covered by assessment:
• Standards - covering, e.g.
o Public health
o Clinical governance.
• Targets - mainly for access
o Accident and emergency
o Waiting time for operations
o Cancer treatment
o Choice issues.
• “Patient Pathways” - between organizations
o Heart disease
o Maternity service
In depth look at individual
Approx. 100 concerns raised with
Healthcare Commission per
We looked at : e.g.
o Infection control
o Maternity services
o Mental health/learning
17 investigations over 5 years.
But effect of investigations was
Handling of national concerns:
Hospital associated infections
High in UK Public Sector
Government asked for annual in depth inspections
of every hospital
We looked at processes and outcomes
This resulted in tougher standards
And real reductions in infection rates.
It is very powerful
We used it for comparisons
The right information has to be
On a uniform basis
And published so it can be
It ensured we did our job
Identification of deaths in Mid
Crucial for patient choice
Independent healthcare regulation of systems
is comparatively new in the UK.
It has proved its worth.
It covers quality, safety and access.
All healthcare organizations have to be
registered and meet general standards and
targets for access.
We looked at both processes and outcomes.
And our aim was to encourage improvement.
In depth investigations into areas of concern
were also very important.
Collection and publication of comparative
informative is a very powerful tool for patient
Better health and
Anna Walker, Vice Chair, Consumer Focus
21 May 2010