Calling our public services “broken” was once considered extreme. Now it’s a widely accepted fact. On the NHS, it’s even the government’s official position. But our public services are more than broken; they have become a battleground. Those who once had faith in the system are now forced into a weary fight.
To secure a doctor’s appointment, you brace yourself before entering the lottery at 8am in the morning, ready to argue the case for the help you think you need. You arrive at the surgery and the sign on the reception reads “our staff will not tolerate abuse”, suggesting that this is exactly the place where abuse happens. Job centres, meant to help people into work, have been weaponised in a punishing benefits crackdown; Special Educational Needs (SEN) assessments have become bureaucratic battles, ill-fitting for the human conditions they serve.
The data confirms that something isn’t working. Since 2016, complaints to ombudsmen across public services—spanning the health system, the department of work and pensions, higher education, local authorities and justice services—have risen by a third. I think of the burning injustice felt by the mother I met whose children were taken into care because she was too unstable to look after them—before she had been offered secure housing or anything more than an online course in CBT. A friend who is experiencing a mental health crisis is rejected by the “complex needs” service because her needs are “too complex”.
It’s a nightmare for those who work within public services too. Kirsty McNeill MP, who previously worked in war zones with international charities, has likened the experiences of public servants today to the “moral injury” suffered by humanitarian workers, whereby they suffer psychologically because they are complicit in systems that seem set up for conflict. No wonder schools can’t recruit teachers, and the few new recruits leave too soon. No wonder the NHS and social care has a vacancy rate of 10 per cent, or that one in seven prison officers left the service in 2022. No wonder that a parliamentary report recently found that a third of local authority senior managers don’t have enough staff to run acceptable services. The doom loop continues.
The underlying cause is a combination of rising demand for services and under-resourcing from years of austerity. Public services are overstretched. The government has, at some political cost, put £22.6bn into the NHS through the latest budget. It’s an eye-watering amount, but it won’t touch the sides. The government has embarked on reforms to local government funding that will only go a fraction of the way of restoring the 20 per cent real terms cuts since 2010 to council budgets—in a period when need for their services have soared. Something radically different is needed.
During the last sustained wave of public service reform—the Blair government’s New Public Management—it was thought that copying the private sector’s pursuits of markets, managerialism and targets would bring public sector efficiency. Reforms of this era promised choice and raised expectations. But after a decade of austerity there is less choice and trust has been destroyed.
Top-down targets are now often stopping frontline public services from solving problems for the people who need them, because they constrict innovation. They have reduced the system of public service provision to series of transactional tests, thresholds to pass and referral pathways which people are bounced between. People feel frustrated because they intuitively know that these clunky systems are letting them down.
The government desperately needs to find and embed a new approach, transforming public services so that they cater to real human needs and building strong relationships between the state institutions, public servants and citizens. At Demos, we’ve been developing proposals for “liberated public services”, which means devolving responsibility for public services to the frontline, trusting public servants to do their jobs well rather than trying to control them through targets and brutal accountability systems. The central argument is that poor productivity levels in the public sector are caused in large part by government trying to control everything from the centre. Setting people free creates a more efficient system, not less.
Some have found that guitar or carpentry lessons have been the thing, others it might be poor dentistry that is holding them back. It’s about what matters to people.
The idea was first developed in Gateshead, where the council was spending huge sums providing services to a small number of people with complex problems, while still failing to address the problems themselves. They identified one man who had cost the council £2m over nine years, involving 3,300 interactions with services because he was being referred through all the approved services and nothing was helping him. Eventually the council tried something different: they gave him a team of the most experienced key workers and gave the team the freedom to try creative solutions. They found him secure housing, a treatment plan that worked for him and ways for him to form social connections. Some have found that guitar or carpentry lessons have been the thing, others it might be poor dentistry that is holding them back. It’s about what matters to people. A commonsense plan developed with empowered key workers can cost less and produce far more sustained results. Local authorities such as Camden and Wigan have tried similar approaches and have also improved outcomes and saved money.
To prevent a free-for-all, there must be clear systems of accountability and stable funding. We argue for “earned liberation”, a bargain in which public service professionals gain more autonomy hand in hand with greater responsibility to deliver better outcomes for people. It is liberated public services, not libertarian public services. The freedom to do, not the freedom from accountability.
At Demos we have set out a roadmap to devolve public services to combined authorities across England, which would be responsible for developing local reform plans, tailored to their communities. Local areas would still have targets to meet, but these would be based on outcomes (such as higher life expectancy), rather than activities (such as the number of hospital treatments). Public servants would be free to design the right way to achieve the goals for their communities.
New services would be scrutinised by local citizens’ assemblies to ensure the public have a voice in these plans. Funding would be reformed into single devolved pots giving local areas freedoms to move money to where the source of problems are rather than pigeonhole into nationally conceived planning. We suggest the government publish a new “respect charter”—an accord with public servants to clarify duties and responsibilities and encourage innovation.
This could happen in stages, not in one big move. The more established combined authorities, convening their constituent local authorities, could form pilot areas to assume the new responsibilities for public services. In these “Innovation Zones”—they could be considered “Social Freeports”—the combination of new measures could be trialled to assess roll-out to the rest of the country. It amounts to a radical plan for the centre to renegotiate its role with local areas, local communities and public servants in order to fuel a new wave of innovation and improved productivity.
Starmer’s government must now decide its approach to fixing and delivering public services. There are contradictory signs of which way it might go. On one hand, there’s a growing sense in Whitehall that this can’t be done from the centre: the government is strongly committed to devolution, and recent announcements of children’s social services reforms and the white paper on employment point to more devolved public services delivered differently, by empowering frontline works. Georgia Gould, the cabinet office minister, has been tasked with looking at public sector wide reforms. “People have to be at the heart of how we deliver public services,” she told a conference of public sector leaders last month.
But the tendency for centralisation is still present in Labour. Michael Barber, the respected New Labour architect of new public management, is back advising the prime minister on how to deliver the missions. This week, the prime minister will likely announce new targets on issues such as hospital waiting times, suggesting a return to command-and-control centralised targets. NHS leaders are already warning that a focus on waiting times would strip resources from mental health, community care and emergency medical care.
Labour need not choose between liberation or accountability. It can choose the best of both, if targets set by central government are clear and focused on the outcomes for the people they are intended to help, and if devolved responsibilities are coherent, funding is stable and long-term, and a workforce desperate for change is empowered by earning the freedom to innovate. Public servants could drive state renewal. Already, NHS workers are telling them they won’t resist change—they know it’s needed and want to be part of it. The only way Labour can end the battle in public service is to declare peace and reach a new accord.
