Resetting the State
Senior Researcher
On Thursday, the Prime Minister will set out his ‘Plan for Change’ and with it, a positive vision for the future of the Parliament, with targets to guide each of the Government’s five missions.
Separately, we’ve heard that this is “not a reset” and that the new milestones have been informed by advisers like Alan Milburn and Sir Michael Barber since the “early days of government”. Both advisers previously worked in government under New Labour, and will be aiming to emulate the success of public service reforms undertaken during Tony Blair’s premiership.
Reset or not, what’s clear is that to make a success of missions, fundamental reform is need.
Take health, for example, where the challenges are more complex than ever and where even the substantial cash injection seen in the Autumn Budget is still proportionately far less, in real-terms (3.4 per cent), than the average seen from 1997 to 2010 (5.7 per cent).
Certainly, prioritising the elective backlog will be important in bringing the NHS closer to its constitutional waiting targets. But what about the maintenance backlog (now over £13 billion) in the NHS estate, which has a direct impact on capacity in hospitals? Or the crisis in adult social care, which contributes to delayed discharges, and so affects hospitals’ ability to carry out elective treatments?
Pursuing the wrong target could be equivalent to grabbing the fire extinguisher before turning off the gas.
And targets cannot be met in isolation. For example, the inaccessibility of primary care has a real impact on people’s ability to work, and the failure of local government services, upstream, makes it harder to reduce certain kinds of crime.
Some of usual prescriptions apply here — yes, we need a more preventative State. Yes, Whitehall should be less siloed and enable public service delivery across departmental boundaries. Yes, the UK is far too centralised and devolution is a key part of the answer.
But unless a serious attempt is made to understand why and how public services are failing to rise to the challenges of our era, we’re unlikely to see a meaningful transformation in outcomes.
Why is it, for example, that economic inactivity has fallen across the EU since the pandemic (by more than 2%) but risen in the UK? Or that a fifth of children and young people in the UK now live with a probable mental health disorder despite increasing investment in mental health services?
Starmer is right to learn lessons of the past — and it’s welcome he’s brought in genuine experts from previous governments to support this.
But if he simply takes from a grab basket of once-successful solutions — or relies on the more obvious policy prescriptions proffered by vested interests without doing the hard yards of working out how public services have become quite so broken — his Plan for Change won’t change much.
Now is the time to reset the State, and radically reimagine how public services are delivered.