Public services are dying a slow death, but what comes next? Lord Adebowale and Henry Kippin set out a vision for a move towards “services to the public” – a vision that requires us to re-think the needs of citizens, the reality of a mixed economy, as well as the relationship between citizens and the state.
Public services as we know it are dying. Squeezed by austerity, overwhelmed by demand and subsumed by Brexit, there is little-to-no chance that we will reach 2030 with a set of services that are analogous with those we experience today. Top-level data tells the story. The Institute for Fiscal Studies estimates that one in ten councils have already cut adult social care spending by a quarter. Figures from NHS Providers suggest that an extra 5.2% of cost pressures will need to be absorbed during 2017/19 on a 1.3% increase in funding over the same period.
But this is not just about austerity. Over the longer term, demographic change, increasingly complex needs, and a recalibration of the relationship between growth, public spending, and societal wellbeing will change the picture even more. The Joseph Rowntree Foundation, for example, estimates that over half of families classed as living in poverty have a family member in work. Theresa May’s notion of people ‘just about managing’ barely covers it.
We are entering the slow death throes of William Beveridge’s vision of public services as things to invest in and celebrate. His famous report, published in 1942 as a blueprint for the post-war welfare state, responded to what he characterised as the ‘five giants’ of ignorance, want, disease, idleness, and squalor. His ‘comprehensive survey of social insurance’ developed in response set the basis for the post-war welfare settlement. And whilst the very notion of a fixed national settlement might today be misplaced, the lack of a high-level discussion about our rights, responsibilities, and relationships with each other as citizens is lamentable. We should be angry about this. But then we need get on with defining and building what happens next.
The future should be defined by a subtle but important shift: from public services, to “services to the public”. As we explore in our forthcoming book, this signifies a much broader range of public goods, reflecting both the contemporary needs and wants of citizens, and the reality of a mixed economy in which the public sector cannot deliver better outcomes on its own.
Beveridge himself would recognise this if we could transport him to 2017 Britain. His contemporary ‘giants’ might include social isolation, inequality, chronic low-level mental health, poor aspiration. He would recognise that the role of Tesco, Vodafone, Ladbrokes or the high-street banks is as important to the root causes of wellbeing as health or social care services. He would recognise that, as the old assumptions about place, work, gender, politics and technology have changed, so should the way we think about welfare and the relationship between citizens and state.
We need to start doing the work now to define what tomorrow’s services to the public will look like. The mix of specialist, personalised, clinical and social will need to look different: quite possibly costing the exchequer less; very definitely blurring the artificial lines between economic growth, public service reform and community development. What links rich, poor, young and old is the need for bespoke services that are enabling and valuable – yet Collaborate and Ipsos MORI research from 2014/5 suggested that only around 15% of people say they consistently feel they have influence on the services that are provided on their behalf. This is the reality of taking back control.
Early evidence for the shift we articulate can be seen in policy areas like accountable care, inclusive growth and integrated local services – all of which seek to bend sector lines and reorient services around place. In places like Suffolk for example, the interdependence of business, public services and communities is a base principle of county-wide reform plans. In Greater Manchester, the focused care model (originated in Oldham) is changing the way general practice works at scale – much more proactively addressing the wider determinants of health inequalities. In South Yorkshire, Sheffield Money has been established to reduce downstream service demand though disrupting the high-street loan market with a state-backed alternative.
Tomorrow’s public service settlement must take these examples and push their logic further, addressing some shibboleths on the way. We might do this along three principles:
The first is that welfare is good for you. It might challenge a few lazy Benefits Street-style stereotypes, but we need to start redesigning welfare as something for everyone; as a means by we support each other to build the country we want to be a part of. Experiments in universal basic income or what the economist Diane Coyle recently called ‘universal’ should be seen as parts of a broader movement that emphasises the role of services to the public as social investment in our future competitiveness and growth.
The second is that services should be collaborative by default. The waste inherent in our silo-based public service system is phenomenal, meaning that things like children’s centres are shut whilst established institutions stagger on as the wider world shifts towards agile working. So we need a new presumption: requiring us to justify where services are not being delivered in collaboration, with central government playing a more effective role learning, sharing, and diffusing practice.
The third is that good leadership is place-based. Accepting the reality that social problems are often systemic, and that even the best institutions cannot operate in splendid isolation forever. Health and social care is the clearest example of this. We are already seeing good hospitals skewered by the Care Quality Commission for what are whole-system problems (like nursing shortages). The success of Sustainability and Transformation Plans will hinge on whether organisational leaders can create effective coalitions for change across a place; understanding how the world thinks and feels outside of their service lens.
The sociologist Richard Sennett famously talked about “the capacity (of people) to collaborate in complex ways”. We need to transpose his comment about human nature to the organisational challenge within public services. Woody Allen said that “I’m not afraid to die. I just don’t want to be there when it happens”. Well, where public services are concerned, it’s happening already. Let’s make sure that we are here for the rebirth too.
Lord Victor Adebowale is Chairman of Collaborate CIC.
Henry Kippin is Chief Executive of Collaborate CIC.