Change. It’s what we all want, apparently. It’s the reason for a belated surge of interest in the election campaign, the eruption of Cleggmania, and a seismic shift in the polls.
The emergence of the I-agree-with-Nick tendency was perhaps to be expected after 13 years of New Labour government, shocking expenses revelations and the worst economic convulsions since the 1930s.
But what kind of change is good for public services? In the midst of all the turbulence, it’s easy to lose sight of what – in the long run – has a real impact on people’s lives.
Take health. So far, this has figured little in the campaign. Yet there are few areas of public policy where more change has occurred. And few that are more important to the electorate.
As the King’s Fund points out this week (see cover feature), countless legislative measures, targets and initiatives have radically reshaped the health service in England. Huge levels of investment have brought health spending up to average European levels.
It might be unfashionable to say so, but throwing all these funds and performance targets at the NHS appears, in the main, to have worked.
Waiting times for diagnosis and treatment have fallen dramatically, and the scandalous pile-ups in A&E are largely a thing of the past. Research this week from the Centre for Market and Public Organisation draws similar conclusions on the success of targets (see page 9).
There are still many problems, particularly in the area of public health. But the improvements are so stark that no party dares suggest that the NHS – the sacred cow of British politics – should not be sheltered in the austerity era to come.
This is where change gets tricky. All parties are signed up to at least £15bn–£20bn of NHS productivity gains by 2013/14 and significant efficiency savings.
None has spelt out how this squares with ambitious treatment ‘guarantees’, or promises of better drugs and more patient choice.
Nor have they explained how any of this can be done without hitting vulnerable frontline services – or without vigorous use of the much-maligned targets.
But these are problems for another day. Change is coming to the NHS – and all public services – that’s for sure. But not necessarily the sort we want.
Public sector managers should examine the options closely. It’s they – not the politicians – who, in the words of the old song, must turn and face the strain.
