David Gauke is a former Justice Secretary, and was an independent candidate in South-West Hertfordshire at the 2019 general election.
Reforming public services was once one of the great issues of the day. It became one of Tony Blair’s great causes and, as a consequence, it became of source of contention within the Labour Party. Gordon Brown – the “roadblock to reform” – was always suspicious of the Blair agenda, and was (and continues to be) more interested in constitutional reform.
Under David Cameron, welfare reform and schools reform provided ambitious policies that had a prominent role in the 2010 general election. Subsequently, reform of the health service also became a significant policy (rather to most people’s surprise and, as it turned out, regret).
And then the issue disappeared. This was in part a matter of where we were in terms of policy reform. By 2016, for example, the big policy decisions relating to Universal Credit or the introduction of free schools had been determined, and the question was now one of implementation. But it was also the case that governmental bandwidth was consumed almost entirely by Brexit whilst the Labour Party – under the leadership of Jeremy Corbyn – had nothing sensible and relevant to say about the matter.
Post-2019, with Brexit supposedly “done” and Corbyn defeated, there might have been an opportunity for focus to return to public services reform, but it was not to be. Just as Brexit was almost all-consuming, the Government’s attention now had to be fixed on one issue – the pandemic. This created an environment in which some reforms progressed very quickly out of necessity (for example, services being provided digitally rather than in person), but it was also a period during which long term and strategic reform had to be de-prioritised in favour of addressing an immediate crisis.
It would also be fair to say that major reform usually has to be driven from the centre and requires a Prime Minister with a deep interest in policy, a close attention to detail and willingness to devote a great deal of time performing the unglamorous task of scrutinising implementation. We have had Prime Ministers who meet this criteria but Boris Johnson was not one of them.
It is now very clear that the sabbatical from thinking deeply about public services reform must come to an end. Our fiscal situation is grim, with tight public spending plans for the immediate future (given high inflation and the pressures on public sector pay) and even tighter plans for the years after 2025.
Even before we enter these difficult years, there are concerns that our public services are inadequate, with a sense that nothing properly works. Delays in passport applications or driving tests cause great aggravation for those affected, whilst delays in medical treatment could easily dominate politics in the next few months.
Some of this is as a consequence of Covid. Many large organisations – public or private sector – are struggling to cope with losing staff because of ill-health or because people are choosing to retire earlier. It is a legitimate point of mitigation but it is not likely that this will satisfy disgruntled voters at the next general election.
Alarmingly, there is also a sense that we have gone backwards in terms of efficiency. The National Audit Office recently observed that “NHS officials both nationally and locally have expressed concern about reduced overall productivity, meaning the same staff and infrastructure are currently completing less work than before the Covid-19 pandemic” and quoted NHS England’s estimate that, in 2021, the NHS was “around 16 per cent less productive than before the pandemic”.
It is a direction that needs to be reversed – and there are early signs that both the main parties are more engaged than previously in this agenda.
Jeremy Hunt announced in his Autumn Statement that two prominent New Labour figures – Sir Michael Barber and Patricia Hewitt – are to help advise on skills policy and the workings of integrated care boards respectively. (Barber has been assisting the Government on various issues for some time and I worked closely with him whilst I was Chief Secretary to the Treasury).
The nature of the Cabinet also suggests that there is greater capability for devising and implementing reform. Hunt brings vast Ministerial experience, Michael Gove is back and is a very capable operator, Steve Barclay brings an eye for detail to the Department of Health and Social Care and Rishi Sunak will be much more focused than Johnson (to the extent that some officials worry that he gets too much into the weeds for his own good).
Meanwhile, Labour is talking more about reform, at least at an abstract level. Generally, that is very sensible for an Opposition (where it is almost impossible to develop sensible detailed policies) at this stage in a Parliament. They are, however, sufficiently engaged that it would clearly be a mistake for the Government to vacate the ground.
All of this is all very well but, of course, there is also the question of what type of reform should be pursued. How do we improve the quality and efficiency of public services?
I would break this down into three broad and interconnected areas. How do we improve accountability? How do we embrace new technology? And how do we allocate resources more effectively?
One the last question, I have written elsewhere proposing a new Office for Spending Evaluation that would classify spending on the basis of the value this will have to either increase future economic growth or reduce future demand on public services. This, over time, would increase pressure to divert resources towards those areas likely to bring long-term benefits rather than address short-term needs, such as spending more on effective rehabilitation programmes and less on expanding the number of prison places.
On technology, it would be worth taking a closer look at what happened during the pandemic in terms of using new technology to deliver public services to understand what worked and what did not. There has been a tendency for politicians and newspapers to be very quick to condemn the use of remote GP consultations, for example, and demand a return to face-to-face services as a matter of course. A sensible policy approach does, however, have to take into account cost and efficiency. We may have to do things differently, even if this is not always popular.
As for improving accountability, there are essentially three options – top down targets combined with greater transparency; giving end-users greater choice; and (currently very much in fashion) further devolution with more accountability at a local level. There are pros and cons to each of these methods and no one approach will provide the right answer to every problem. All have a role to play.
None of this is straightforward and nor is it directly a route to popularity. Talk of reform will worry some consumers of public services and, certainly, many producers, especially when combined with talking about finding financial savings. It is, however, a test of seriousness for a Government or aspiring Government that it demonstrates both determination and thoughtfulness on this matter. We cannot afford as a country to ignore this issue any longer.