How can we make the case for public services? This has been the theme of the What’s it Worth? project running across the Guardian’s Society Professionals networks.
As part of the project, we brought experts from across the public and voluntary sectors together in an online Q&A. We discussed how to champion the role and contributions of the UK’s public services; this is what they had to say.
How have five years of austerity affected public services?
Nushra Mansuri, professional officer at the British Association of Social Workers: “The last five years have been pretty devastating across all sectors. We have seen so many important services simply vanish as their funding has run out; check out the large numbers of children’s centres that are now gone and women’s refuges. In the social care sector this means a lot of good preventative work is being sidelined and we are seeing more children and families in crisis, unfortunately, which has a direct bearing on the sharp increase in numbers of children coming into the care system.”
Sophie Wilson, researcher at the Institute for Government: “It has been really tough for public services across all sectors, including health which is sold as getting large increases in cash spending without regard for cuts to public health and adult social care budgets. It is going to continue to be tough following on from the spending review but there is potential for doing things differently and you can see areas that are re-thinking the way they deliver services.”
Colin Wiles, independent housing consultant: “I think many public services are reaching a crisis point. I have close relatives who work in the NHS and many hospitals appear to be close to the edge, relying above all on the goodwill of staff. This winter will test them to the limit. In terms of housing, all of the recent changes such as pay to stay, right to buy and the rent cut will lead to a reduction in the amount of social rented housing and will increase the levels of homelessness and the housing benefit bill. The government’s sole focus is on home ownership and yet all of their initiatives are stoking demand and not addressing supply issues.”
Do public services need to become more efficient to survive?
Barbara Young, former chief executive of Diabetes UK: “The redesign of services to be more integrated and to reduce waste and inefficiency is not being enabled by policy. Rather, it is being driven by the very blunt tool of austerity and that harms services in the places that are less competent to implement new models of care. Also where join up is needed across functions, it isn’t happening; such as the cuts in social care and their impact on healthcare.”
Wiles: “I think we all need to make the case for investment in public assets and services and how this contributes to overall wellbeing and prosperity. The notion that the state has to be as small as possible and that somehow this will make everyone better off has to be challenged.”
John Perry, policy adviser at the Chartered Institute of Housing: “I don’t want to be the voice of local government here, but having worked for half a dozen different councils in the past I suspect that the problem about ‘reimagining public services’ is that they are losing/have lost their best strategic staff. They are also trying to work out how to make drastic cuts while keeping some semblance of a service – including whether they see whole services go, as we’ve seen with libraries. But [they] will soon have to be even more far-reaching in their impacts.”
Peter Beresford, professor of social policy at Brunel University: “We need a new narrative for public services. Not one based on special pleading or saying we’ve got to look after disadvantaged people, but one which highlights that it is not a cost, it is actually a bringer of wealth. The NHS is maintaining a fit workforce [...] the same applies to so many public services, from providing safe recreation for toddlers and small children, to safe streets at night for women, disabled and older people. We must be positive not pleading.”
Should we accept that there are some services that the state used to provide that it can’t any more – such as parks and libraries?
Mansuri: “I personally think that if we go down that road, it is the thin edge of the wedge and so my answer is no. All of these things are essential rather than luxury items that enrich our society. If we take parks and libraries away what do we think is going to happen? Potentially more social unrest and mental health issues.”
Wilson: “I don’t think looking at some public services as ‘more valuable’ than others is the right way to go. But there is potential for local authorities to take on a more facilitative function – supporting local communities to use the assets they already have to design services that really meet their needs, defined by themselves.”
Helen McKenna, senior policy adviser at The King’s Fund: “In terms of the public’s view, we conducted some research (working with Ipsos Mori) in 2013 which found that while the public support the current funding model, there is some appetite for restricting treatment for ‘lifestyle related’ diseases/treatments, eg cosmetic treatments, use of services due to alcohol abuse, etc.”
Perry: “Do service providers have to do something more dramatic to draw attention to what they are being forced into? For example, if homes for the elderly are under threat, maybe a council should say instead of throwing so many old people on to the streets (or forcing them into hospital beds) we are going to turn all our street lights off at 11.00pm every night? If every council did that, wouldn’t it have an effect?”
How can we make the case for public services?
Young: “We need to articulate the economic case for public services, since that’s the narrative of the moment, while demonstrating how real progress in quality and reach is being jeopardised. The squeezed middle will come into play shortly as cuts deepen. But alas many silent and disadvantaged [people] will have had a hard time by then. So volunteering, charities and individual action to support communities will become even more important. I must admit, I fear future civil unrest and worry that immigration and population growth will act as the spark for that.”
Wilson: “We can make the case for public services with better evidence (whether that is user experiences or randomised control trials), better sharing of what works, and greater involvement of communities to help determine what services people really need and what assets are available to support this (such as making better use of libraries as community hubs or bringing together old and young people to share stories).”
Beresford: “Public services must prioritise public, patient and user involvement. They must highlight their humility; that they don’t know best and they must challenge the pressures to bureaucratise them. Their leaders should be prepared to be paid less and all staff should receive the living wage. They also need to communicate what they do a whole lot better.”
