After the Budget, the challenge for public services is unchanged

Michael Trickey, Director of the Wales Public Services 2025 programme, discusses three ideas to watch…

Now that the dust is settling on the Budget, it is worth noting things that did not grab the headlines. The IFS commentary points to five more years of deep spending cuts, especially in ‘unprotected’ areas. This is no great surprise but it underlines the pressure on public services to find new ways of doing things to make limited budgets go further, as well as make difficult choices about what – and what not – to protect.

We are currently seeing more of a debate than for some years about the fundamental changes needed and how to make them. And of course, the Williams report on Public Service Governance and Delivery has important things to say beyond the argument about local government boundaries.

Here are three ideas to watch:

Prudent healthcare

The Bevan Commission is arguing for transformation in the NHS in Wales under the banner of Prudent Healthcare to deliver better care with limited resources. It goes back to the internationally renowned work of Professor Archie Cochrane in Cardiff and the Rhondda valleys on making medical practice more efficient and effective. Prudent Healthcare covers action in over twenty areas of practice, examples including early intervention and prevention, cost-effective prescribing and incentives based on patient outcomes, nurse-led triage, greater use of pharmacists in medicine management, speedy discharge schemes, eliminating unnecessary tests and over-treatment. It chimes with so much else – but making it real on the ground will be a big challenge.

Demand management

‘Demand management’ is becoming a buzzword in local government and health services. The argument is that public services will manage demand pressures more effectively if they have a better understanding of why and how that demand is arising and take action to reshape services accordingly. Some argue that ‘real’ demand is not rising – the problem is demand being created by the failure of public services to get it right in the first place. For others, demand management is a posh word for rationing. As reflected in the RSA’s recent report, there are a number of themes about shifting from a top-down approach to services to rebalancing the relationship between services and citizens to achieve better outcomes. These include include redesigning services with citizens based on a co-production or community capacity approach, the potential for integrating services locally around the needs of the user, and intervening early to improve outcomes and thereby reduce long-term reliance on the state. The associated concept of an enabling state will come more easily to some local authorities and professionals than others.

Public service leadership and development centre

To carry through changes of this magnitude will require a matching transformation in the way public services are led, their values and culture. One of the striking recommendations in the Williams report is for a new public service leadership and development centre for Wales owned and managed by public services as a whole. It would build on the pioneering work of the Welsh Government’s Academi Wales and its various predecessors. The report emphasises that this is about leadership at all levels, not just the top. As the work by the Birmingham Public Services Academy illustrates, we are talking about a very different concept of the role and attributes of the 21st century public servant. Williams refers to leadership development models in New Zealand and Ireland. There are also programmes, for example, in Singapore and Australia. Wales would not be alone. The centre is just one of a series of related recommendations in the report – how the Welsh Government responds will reflect its measure of the challenge ahead.

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