Fishburn Hedges

19.01.2010

With the realities of the economic climate really beginning to bite across the public sector, the debate on reform of public service delivery is gathering pace.

At our recent ‘What’s next for… public services in the ‘age of austerity’?’ event, a panel of experts gathered to consider what the future looks like for our public services. The panel was:

- Matthew Taylor, Chief Executive of the RSA
- Andrew Haldenby, Director of independent think-tank Reform
- Michael Sobanja, Chief Executive of the NHS Alliance

What's Next for...Public services in the ‘age of austerity’? - Vox Pops from Fishburn Hedges on Vimeo.

Our panel argued that service providers can live up to the cross-party rhetoric of ‘value’, ‘quality’, ‘personalisation’, ‘choice’ and, importantly, ‘more for less’. But this will rely on some tough decisions being made at the top, based on a longer-term view than is arguably being taken, and one that is more focused on outcomes than process.

Can providers deliver more for less?

Against the backdrop of a ‘huge’ national deficit, and increasing pressure on spending, can public service providers really live up to the promise of better services, delivered for less money?

The answer, for Andrew Haldenby, is a clear ‘yes’. In his view, 20% cuts are easily achievable and should be the ‘rule of thumb’ across public services. These could be achieved through greater efficiency in two areas – people and buildings.  Haldenby cites examples of police services cutting back on non-essential use of uniformed officers, and the NHS shutting down poor performing hospitals.

For Matthew Taylor, not only are cuts possible but, in his view, the tougher economic situation presents an opportunity to put into practice innovative strategies that will deliver a higher standard of services, without relying on higher budgets. For example, he believes we will see greater pooling of resources across services in local areas.

So if it’s that simple, why isn’t it happening already?

For Haldenby, it comes down to politics: managers know how, and are prepared to make cuts to achieve necessary efficiencies.  Conflicting messages from politicians at the centre, about protecting budgets, serve only to confuse matters and make it harder to push changes through.

The challenge

There is a natural inclination to look at prioritising certain budgets when times are tight, according to Michael Sobanja. But he argues that there is an inherent risk in doing this, due to clear and growing interdependency between public services – the most obvious example being local health services, managed by the NHS, and care services, managed by the local authority. You simply can’t cut one without impacting the other.

For Taylor, the challenge lies not in what budgets are being spent on, but who they are being spent by. The big question in his view is whether Government will be brave enough to truly de-centralise power to the local level.

If so, he believes this will prompt genuine innovation and creativity in the public sector - despite this period of austerity – based on better relationships with citizens and more empowered and cohesive local communities.

If not, and if control remains at the centre, in his view the next few years will be about pain minimisation rather than creating innovative ways of delivering services.

‘Selling’ it to the public

Another challenge for providers will be taking people with them as services change. But how do they achieve this with an often cynical public?

For Haldenby, it all comes down to provision of quality services. Providers must prove themselves in order to gain buy in from the public.

In Taylor’s view, there is a more fundamental need to tell a better story. The public are broadly unrealistic he says, citing Ben Page of Mori, who believes that what we all want is Swedish welfare on American tax rates.

There is clearly a need to engage people to understand the choices available. If local agencies are going to make brave decisions on spending, then they have to find new and better forms of engagement with the public - whether it’s citizen’s juries, online polls or decentralisation to neighbourhoods for example - in order to get them to buy into the choices being made.

At a national level, Taylor believes there is a ‘short term-ism’ in the way decisions on services are currently made, which makes it difficult to sell them to citizens. People are hearing that deep cuts need to be made, but that this or that service will be saved – what they are not hearing, according to Taylor, is a medium term account of how we should restructure spending in the best interests of the country.

For example, he suggests that the NHS, police and schools, which have seen year-on-year budget increases over the past decade, can find efficiency savings going forward.

Instead, if we are really concerned about the country’s medium term economic prospects, we should potentially be looking at spending on higher education and science, which will provide the basis for our future economy.

If the public are to agree to difficult choices, Taylor concludes, they need to hear that decisions about public spending are being made within a genuine strategic framework, rather than as a response to the latest focus group.

For Sobanja, it’s about a focus on outcomes rather than process. He argues that the health service, for example, has been preoccupied with targets that are process driven, rather than focused on real health improvements.

Mechanisms like the NHS Constitution will be increasingly important going forward, in setting out the right for individuals to understand the rationale behind how decisions are made, and why they are made – in the context of health outcomes for local populations.

In short, transparency is key, not just so that the authorities can defend their decisions, but so that the public feel involved in the process.