Image © Techa Tungateja/iStock
The traditional “new public management” model, with its focus on targets and market mechanisms, holds us back from applying interconnected initiatives to today’s complex issues. This outdated model fails to serve today’s society, individual lives and communities. It’s time for a new description of a positive role for the state and an assertive role for the public finance professional within that.
Recent years have seen episodes of policy solutions that have missed the mark in terms of systems thinking in my own area: health.
I’m not persuaded that adding more ambulances solves queueing at hospitals, that recruitment targets for health visitors don’t impact the wider workforce, or that virtual wards will succeed as planned unless implemented well and owned at the local level.
Effective public policy needs a different regional and local focus to avoid broader unintended consequences.
In healthcare, the call for change is urgent. The NHS may be broken, but it perhaps isn’t the participants that have broken it. Rather it has been a reluctance to really integrate beyond the structures we currently inhabit.
This leaves me asking: how can we redefine the role of public sector organisations and public finance professionals to deliver better services for better lives?
A New Vision for Public Services
One promising step in this direction is captured in the think-tank Demos’ latest report, Liberated Public Services: A New Vision for Citizens, Professionals and Policy Makers. The report calls for a bold reimagining of public services, emphasising the need to empower frontline workers and engage citizens more effectively.
I am increasingly interested in lean thinking approaches, as in the Toyota Production System. The focuses on whole-organisation participation, empowering staff to improve efficiency and quality with the goal of organising their activity to deliver greater benefits and value while eliminating waste. In Leeds and Coventry hospitals, projects such as Leeds Way and UHCW improvement system are already showing how empowering frontline staff can lead to meaningful improvements. Embracing such quality improvement methodologies could drive significant change across the public sector.
Looking Ahead
The NHS impact framework, with its emphasis on shared vision, investing in people and culture, leadership behaviours and embedding improvement in our management systems seems to provide a good start on this journey.
Over the next five years, we’ll see a different approach to delivering healthcare – more personalised, predictive and far more integrated with other areas of the public services.
We need to deliver technological change much faster to ensure value and we need stronger community engagement. A new NHS commission could help us navigate these changes and ensure that our healthcare system meets the needs of a modern society.
In the realm of NHS finance, there’s work to be done. We need to develop a health and care production system, which will involve collaborating with other agencies and professions. This will involve not only closer partnership with local government, but also work and pensions and the criminal justice system to really deliver effective services and help to truly address the huge costs of socially determined disease.
We need to be better at value-based healthcare and the efficient operation of services more widely. A new finance regime, with improved measures of high value health care which rise above cost reduction and some of our old production currencies, could improve costing for waste and costing for value.
Public finance professionals, beyond embracing artificial intelligence, will likely need to adapt to a new role and enhance skills around quality improvement, understanding waste, value stream mapping and building improvement capability.
Adopting such changes could truly enable a focus on population health management and enable us to carry on delivering the NHS and wider public services in a more economic, efficient, and effective way.
In short, we need a robust approach to public sector management, to enhance public investment and rejuvenate our public institutions in a manner which we can all support and galvanise around, to deliver the service change modern society needs.
CIPFA supports the Future Public Services Taskforce, led by Demos. Liberated Public Services: A New Vision for Citizens, Professionals and Policy Makers is the second report from the Taskforce.
