Second, we face many complex social, economic and technological challenges – chronic disease, climate change, security and an ageing population – and the cost of these if we fail to address them will dwarf the cost of the recession. For example, if we do not become better at preventing chronic disease, it is estimated that this alone will consume an additional £45bn a year by 2050 – more than half the money that goes into the entire National Health Service at the moment (Professor David King). Third, the investment of huge resources in UK public services since 1998 has not generally led to their transformation.
What all of this means is that we have to find ways of providing better services at less cost in a challenging policy environment. This in turn means that we have to be innovative when we have more often been risk-averse, radical when we have been cautious, and empowering when we have been controlled. Perhaps, most of all, we need to realise that rhetoric and good intent never did transform organisations, let alone governmental systems riven with bureaucracy and vested interests. So we need to apply influence, pressure, sanctions and incentives where they will have an impact, and, where necessary, be prepared to confront the producer’s vested interest in order to benefit clients and citizens.
The good news is that public services in the UK continue to comprise highly motivated people who want to make a positive difference to the lives of the many citizens who continue to rely on their support. However, our public servants are often frustrated by the barriers placed in their way. The challenge is to free them up, empower them to influence the design of policy and systems and enable them to use their initiative when delivering services on the frontline. But how to do this?
