CHOICE OR CONFUSION?

[Stanley]

CHOICE OR CONFUSION?

1 July 2004


Political buzzwords come and go. ‘Stakeholders’ seems to be one of the latest euphemisms and has replaced a whole raft of collective nouns like clients or customers, it may well replace pupils and patients shortly. At the moment we are being bombarded by another word, ‘choice’. As the General Election campaign has started I suspect we are going to hear a lot more of it.
Choice implies that a client or customer is presented with alternative products and can choose the one which best fits their beliefs, desires, needs and purse. It pre-supposes that the customer has enough intelligence or knowledge to be able to make the choice between the alternatives on offer. This is an insidious concept in the present context because it implies a choice between bad and good or better and best. My argument is that once the range of ‘choices’ reaches a certain level of complexity, confusion reigns and clear judgement leading to the best alternative is lost.
I remember standing in an American supermarket one day in front of a range of cool cabinets that held approximately 50 different brands of margarine. I commented at the time that I couldn’t understand why a customer needed so many brands of something that was fundamentally bad for you anyway. Of course I knew the reason, it is ‘product differentiation’. Each competing manufacturer tries to gain a larger share of the market by making their product more 'attractive'. A useful component of this sales ploy is confusion, suggesting that the product is ‘just like butter’ or contains ‘dairy products’ or that one type of vegetable oil base is better than another. The antithesis of this is that you will never see a margarine proclaiming that it contains hydrogenated oil and there is a very well-founded suspicion that this is bad for you. In other words, the plain truth has to suffer to a degree allowed by the labelling and advertising authorities in order to sell the product.
The latest example of the political use of ‘choice’ is in health and education. We are told that choice is a good thing and therefore we should all want it. The question arises, ‘Why are they assuming that this is what we want?’ We all know that what we actually want is efficient, effective local schools and hospitals that work. So why the constant political emphasis on ‘choice’?
I’m sorry to have to say that I believe this is smoke and mirrors. Confusion is being introduced into a very simple concept in order to make it more difficult to judge the overall performance of the schools and hospitals at local level. The idea of choice accepts the fact that some schools and hospitals will be better than others. Therefore, for whatever reason, these inferior institutions will deal with a disadvantaged sector of society. Disadvantaged by reason of poverty, lack of easy access to transport by family and friends or simply bad advice in that they are pointed towards these facilities because the more desirable ones are running at full capacity.
We have all seen this system in operation. I know people who have moved house to get into the catchment area for a better school or paid out vast sums for private treatment and operations. The result is always the same, a two tier system in which the affluent can gain an advantage over the poor.
So please think carefully when someone offers you ‘choice’. Question why they are doing this and try to educate them into the recognition that what we actually want are local institutions within easy travelling distance that work. There will always be room for the national centres of excellence in rare medical procedures but by far the greater proportion of operations and treatment are bog standard and could be done at the nearest hospital. What we want is the resource and organisation put into these institutions to guarantee that we don’t need choice.
Put yourself in my position. I live on my own and have very definite ideas about food. I refuse to buy anything that is not a natural ingredient or a simple and well-understood technology like sugar-refining. Imagine what proportion of the goods on sale, the ‘choice’, looks like to me. Just wasted shelf space and smoke and mirrors aimed at profit. Then realise that if you agree with me and simply want good local schools and hospitals, you are in the same position that I am in the supermarket if ‘choice’ is forced on us. Do you really want ‘product differentiation’ by league tables and clever manipulation of statistics introduced into the equation? Or do you just want honest to goodness, old fashioned skill and service on your doorstep? This is the real choice but I doubt if we will hear much about this from any party that thinks they stand a chance of winning.

1 July 2004