Everyone recognises that UK public finances are under great strain with at least £77 bn needed in savings by 2018/19 to get the deficit under control. As more public services will feel the impact of cuts to public spending, we need to make sure ‘cuts’ and ‘reform’ do not become synonymous. This must be avoided because we have a golden opportunity to transform our public services to better meet the needs of 21st century Britain.
The first challenge society faces is preparing for old age. As the baby boomers reach retirement, we are experiencing a rapid growth in the number of over-65s – an increase of 39 per cent by 2030, compared with a nine per cent rise in the overall population, meaning that we need to refocus spending on areas where it counts.
It is great that people are able to live longer, healthier lives, but it also means more people will live with long-term, chronic, manageable health issues. I worry that our NHS and social care system is not up to the task.
The second challenge relates to people’s changing needs and expectations. The structure of society is changing, and so are people’s needs – for example, 3.8 million people over 65 live alone – 70 per cent of them are female. 60 per cent of people will need costly social care in later life.
And the way people interact with others – businesses, friends, government – has fundamentally changed. In 2004, less than two per cent of us owned a smart phone – that’s now two thirds, and rising. Yet while 80 per cent of people interact with businesses online – only 40 per cent interact with government services online. So outdated, paper-based systems, cluttered ways of accessing services, and disjointed ways of keeping records and interacting with service users need to change to keep pace.
Public confidence is the building blocks to reform, and without a solid foundation of public support for change, service reform will not get the necessary buy-in. We have to find new ways to build public backing for changes in services – and to bring more people with fresh ideas in to help shape and improve those services.
But it’s also important to remember that public services are fundamentally different to other organisations that the public interact with. The public have different expectations and associate public services with a distinct set of values – such as equal access and being free at the point of use.
This means that solutions can’t simply be drawn up in Whitehall, or even in the offices of a local NHS trust, without first listening to the public and advancing a positive vision for how services can be improved while also saving money.
Drawing on these three challenges, the CBI’s report Our Future Public Services attests that there are no easy answers – but three big solutions which will begin to address these challenges.
Firstly, joining-up public services is the only way we can be prepared for the demand that will arise from our ageing society. It allows us to save money by improving how services are delivered, rather than simply cutting budgets. Secondly, we need to accelerate the digitisation of public services. We need to shift the vast majority of interactions with government from paper forms and face-to-face consultations to online, and thirdly, we need a national conversation about the future of our public services. This is the only way to give people confidence that reform is the right way forward and that they should support it.
Joining up public services is most important in health and social care. In the 21st century, it’s no longer feasible to regard healthcare and elderly care as separate. We need to ensure that funding, information, and care flow seamlessly across hospitals, GP practices, and care homes.
Accelerating digitisation is fundamentally about improving how services fit around people’s lives. People and business have already embraced digital services, but the public sector lags behind. Government needs to be bolder and reflect its digital ambitions across the entire public sector.
We need to move towards a situation where the vast majority of interactions with government take place online. In practice this would mean e-prescriptions to your smartphone, and the option of online consultations with your GP or Job Centre adviser. It can reduce costs while increasing effectiveness. Business can help – many companies have already made this shift and can lend their experience.
Much as Lord Turner’s Pensions Commission managed to build consensus over some big issues for pensions, we need a national conversation about future public services in light of these challenges.
Business’ preferred approach is an independent, cross-party commission with citizen participation. We recognise that public services are complex and contentious, so the new commission will have a tough task. This makes it even more important that future reform is not just decided by politicians, but by the public at large.
Our new report is a rallying call to whomever takes the reigns in May. We welcome all, government, business, charities and voluntary organisations to engage with us through our CBI Public Services Network and tell us what you think are the biggest issues to face future public services.
Jim Bligh is head of public services at CBI