Public services have to do more with less resources and find efficiency gains in the process. Difficult but not impossible say the authors from Demos who articulate their solutions to these increasingly complex challenges.
When Gordon Brown delivered his eleventh and final budget earlier this year he signalled the trend towards tigher spending in the coming years. Three weeks ago the new chancellor Alistair Darling stood up in the house of commons to confirm a round of collective belt-tightening. The challenge for the public sector will be to do more with with less in the future.
The key question for decision-makers in local authorities, who still receive the bulk of their funding directly from central government, will be to discover how deliver greater value for less money. How can social outcomes be improved without spending increasing at the rate that it has done since 2000?
Whitehall’s response to this is ‘Gershon’: the man commissioned by the treasury to find £20 billion in efficiency savings for the public purse. On delivering his report, Gershon identified a raft of potential savings through meausures like reducing the number of staff posts, finding back office savings and identifying ways to improvement purchasing and procurement.
These measures will undoubtedly result in some savings – time will tell how much – but one thing is also clear: most of them can only be done once. Rather like insulating your house, you can’t make savings from reducing the number of staff posts twice. Beyond the Gershon agenda, then, the question remains: how can authorities continue to find significant savings and to produce improved social outcomes in the future?
Ironically, one of the most likely answers to this riddle comes from another government commissioned report: the Wanless review of the health service. In his review Derek Wanless was categorical: the personal and public costs of chronic illnesses, related to lifestyle, are becoming unsustainable. The key factor determining the cost of healthcare in the future, he argued, will be “not the way in which the service responds over the next 20 years, but the way in which the public and patients do”.
According to Wanless, the future of a cost-effective NHS lies in patients being “fully engaged.” In short, organisations can become as lean and efficient as is possible, but if they are unable to transform the public from passive consumers of services into active participants in creating better social outcomes then genuine efficiency will never be attainable.
This challenge suggests some important shifts for the way in which authorities deliver services in the future. First, services need to work with, not just for, the public – helping people to help themselves. Engage people in their own health, or enlist them schemes for safer neighbourhood and more becomes possible.
And second, early intervention is crucial. This philosophy is at the heart of the Every Child Matters agenda, which seeks to promote five key outcomes through identifying and addressing problems in cases before they become serious. Work with parents or carers and children to address issues early on and fewer children will end up with acute problems that can be both difficult and expensive to overcome.
So far so good. The difficulty, however, is that many services are not set up to work in this way. Customer service is becoming increasingly important to managers in authorities and watchful policymakers in central government. But responsiveness to what the customer want does not guarantee that everyone will access services before cases become serious, or that those services will address core challenges. Responsive services provided to those who already suffer from obesity are still expensive services.
Similarly, those delivering services have often understood their role not as partners of communities, but as experts making decisions for them. Professionals are qualified for a reason – to identify what is best for people. Yet to ensure that people play an active role in solving problems themselves, professionals increasingly need to find ways to negotiate and compromise with the families and communities that they are working with.
The results of qualitative research done by Demos/IDeA suggest the need for a step change in two areas to overcome these problems. Firstly, both local and central government need to find the metrics that will support a way of working that genuinely focusses on outcomes over the long-term. Savings can easily be calculated from reducing staff posts, or finding economies of scale in purchasing, but how to you put a cost on someone not becoming obese, or a parent accessing a service before their child’s case becomes an acute one?
When spending becomes tight the first services to go are the prevantative measures and the relationship-building activities that find ways to connect with the ‘hard-to-reach’ groups. Sexual health budgets are cut-back when health budgets become tight, saving money in the short-term but storing up much bigger personal, social and economic costs in the future. Methods like tracking individuals’ progression over time or making careful comparisons between control groups will be needed to identify the cost of not taking preventative action.
And second, those working for local authorities need to address the issue of trust. If people are to access services in hope of tackling a problem, rather than desperation when it becomes serious, then relationships between service providers need to be strong and trusting. Judgements about trust aswell as traditional undertandings of professionalism and efficiency need to be factored into decisions about how services are delivered. These are heady questions for many authorities still coming to terms with the rigours of responsiveness and customer service. But in the new spending environment they are questions that can’t be ignored.
Duncan O’Leary is a researcher and Simon Parker is a Head of Public Services Research at Demos. Demos is working with the Improvement and Develpment Agency on personalisation and its relationship with professionalism.