The next ten years


The next ten years is a book published by the independent think tank Reform on 1 March 2012. It contains 73 essays from people at the top level of politics, the civil service, business and public services.

These essays were commissioned to mark the tenth anniversary of Reform. We asked people to highlight the trends that will be important over the next decade and to investigate the types of policy responses that will be required in the light of these trends.

They demonstrate an important truth about reform: reformers can come from right of centre and left of centre parties – and from no party.

The next ten years

Title: Human, dodo or cockroach
Author: Charles Alessi
Category: Health
Summary: “We need to enjoin our populations in the design and delivery of health and social care; localism shows us a new way of delivering this…”

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Title: Reconnecting capitalism
Author: Iain Anderson   [Director & Chief Corporate Counsel, Cicero Group]
Category: Growth
Summary: “If public policymakers and private sector investors can get the incentives right for both sides – only then will we reconnect capitalism. The wake-up call has come but at the moment the alarm clock appears to be on snooze”

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Title: Localism is the real deal
Author: Colin Barrow   [Former Leader, Westminster City Council]
Category: Government
Summary: “I also want to set out a new and different role for local government, one in which it becomes the central player or ‘guarantor’ of future domestic public services, the benefits of which are value for money and more responsive services”

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Title: A state school system without the state
Author: Dale Bassett   [Research Director, Reform]
Category: Education
Summary: “School autonomy implies and requires school responsibility. In the current system, responsibility and accountability lie with the state. How about giving responsibility for the quality of education to schools and teachers and the real lever of accountability – choice – to parents?”

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Title: Mentoring the next generation
Author: Peter Bazalgette   [Former Chairman, Endemol UK]
Category: Growth
Summary: “There is a solution which, in a fragmented sort of way, is already beginning to bear fruit. It involves harnessing the vigour, intelligence and compassion of today’s college achievers to inspire the next generation. It’s a powerful idea”

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Title: The tug-of-war between national politics and globalised markets
Author: Rafael Behr   [Chief Political Commentator, New Statesman]
Category: Growth
Summary: “Where politicians have been unable to demonstrate credibility to the bond market, they have been ousted and replaced by technocrats…What this all demonstrates is that political power, as exercised within national jurisdictions, is no match for globalised market forces. In a certain sense, the same conclusion can be drawn from the situation in the UK”

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Title: Fix diabetes and you fix the NHS
Author: Viggo Birch   [Chief Executive, Novo Nordisk UK]
Category: Health
Summary: “As a Private Eye column recently stated, ‘fix diabetes and you fix the NHS’”

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Title: IPOD to ACES
Author: Nick Bosanquet   [Emeritus Professor of Health Policy, Imperial College London]
Category: Growth
Summary: “This generation stands out as the ACES Generation – Adaptive to new opportunities, Capable of delivering on their plans, Enterprising in their ability to build new businesses and Secure in their grip on lifetime savings”

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Title: Open for business
Author: Mark Britnell   [Chairman and Partner, Global Health Practice, KPMG]
Category: Health
Summary: “When the National Health Service was created, it was the envy of the world – and can be again if it is prepared to innovate and meet the challenges and opportunities presented by the globalisation of healthcare. In doing so, improved performance can help the global competiveness of the UK and expand GDP, to which the future prosperity of the NHS is inextricably linked”

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Title: Britain needs a wake-up call
Author: Jeremy Browne   [Minister of State, Foreign and Commonwealth Office]
Category: Growth
Summary: “Britain needs to be far more competitive in a fast-changing world. We need to overhaul our thinking and our attitudes. The alternative, even allowing for Britain’s existing areas of advantage, is benign decline”

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Title: Opening up public services to the third sector
Author: Stephen Bubb   [Chief Executive, ACEVO]
Category: Public services
Summary: “A greater third sector role in public service provision thereby helps to fulfil the two key aims of the Coalition Government – the elimination of the deficit, and the empowerment of citizens and communities”

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Title: Professional judgement
Author: Liz Calderbank   [HM Chief Inspector of Probation]
Category: Law and Order
Summary: “The return to exercising professional judgement requires a conceptual shift…”

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Title: Penal policy – a journey
Author: Patrick Carter   [Chair, NHS Co-operation and Competition Panel]
Category: Law and Order
Summary: “Penal policy in England and Wales has, over the last 13 or so years, travelled on a very distinct journey; and, only in understanding this journey, can one then outline and appreciate the course upon which current trends are headed”
 

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Title: Tomorrow’s NHS
Author: Peter Carter   [Chief Executive and General Secretary, Royal College of Nursing]
Category: Health
Summary: “Without the intelligent reconfiguration of services, many of our NHS organisations will either fail to make the savings required, or adopt the short-sighted and predictable cuts to staffing numbers that always hit patients hardest”

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Title: Matching-stick-to-carrot
Author: Douglas Caster   [Chairman, Ultra Electronics plc]
Category: Growth
Summary: “Ensuring that the punishments for executive and non-executive negligence match the benefits for good performance would go further than governance legislation and regulatory oversight in establishing a culture of effective management and business success”

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Title: Doctors and nurses
Author: Thomas Cawston   [Senior Researcher, Reform]
Category: Health
Summary: “Ministers have failed to tackle the one thing that is at the centre of the health system: the workforce…Without improving flexibility of the workforce the disruption innovation that the NHS needs for the next ten years will be left in the waiting room.”

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Title: Targets, transparency and public service reform- lessons for the future
Author: Suma Chakrabarti   [Permanent Secretary, Ministry of Justice]
Category: Government
Summary: “The idea is simple – put the performance (and other) data out there, and let the public and civil society make of it what they will, including asking difficult questions that will force public service managers to up their game. As Antonio Gramsci might have said, I happen to like this new opiate”

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Title: Innovation on demand
Author: Sophia Christie   [Director, UK Prime]
Category: Government
Summary: “In other industries, it is the customer who drives innovation. In the NHS, adoption has been dependent on take-up by those who have a vested interest in the legacy system…Patients and carers have rarely been given the opportunity to make the choice themselves”

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Title: The case for halving the size of the state
Author: Tim Congdon   [Chief Executive, International Monetary Research Ltd]
Category: Government
Summary: “In its second decade, Reform should set out the intellectual, moral and practical case for reducing government spending from a half of national income and output to a quarter”

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Title: The role of the welfare state
Author: Paul Corrigan   [Former Senior Health Policy Advisor to the Prime Minister (Tony Blair)]
Category: Government
Summary: “Above all, we need economic success, not just to provide the taxes but to provide the opportunities for people to go out to work, and help to realise those aspirations for themselves”

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Title: One lost decade or two
Author: Rupert Darwall   [Former Special Advisor to Norman Lamont]
Category: Growth
Summary: “Unless policy is re-focused on improving economic efficiency for the economy as a whole, and within the public sector, the big question facing Britain is whether Britain is going to have one lost decade or two”

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Title: Reengineering the care model
Author: Stephen Dorrell   [Chair, Health Select Committee]
Category: Health
Summary: “It is, for me, counter-intuitive to imagine that a system which is recognizably the same system as it was 60 years ago is ideally structured to deliver modern care to world which has seen unprecedented technological and social change. Every other sector of the economy has changed beyond recognition. Healthcare has, of course, changed too but not, I believe, enough”

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Title: Mind the gap
Author: Alan Downey   [Partner, KPMG LLP]
Category: Government
Summary: “The size of the gap is not surprising when we consider the revolution that has taken place in the business world and the comparatively slow pace of change within the public sector”

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Title: Trading for growth
Author: Mark Elborne   [President & CEO, GE UK and Ireland]  
Category: Growth
Summary: “In order for the UK to be economically successful and create sustainable jobs and technologies for the generations to come, we must target the next generation of markets and consumers overseas. We simply cannot have world class industries, technology, and prosperity without being successful in emerging markets”
 

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Title: Responsible citizens
Author: Peter Fahy   [Chief Constable, Greater Manchester Police]
Category: Law and Order
Summary: “For public services to be effective, they need citizens to make their own efforts, whether it is sensible crime prevention measures, looking after your health or making sure your child gets to school on time”

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Title: The politics of decentralisation
Author: Mike Farrar   [Chief Executive, NHS Confederation]
Category: Health
Summary: “This time localism needs to be real if we are to succeed”

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Title: How changing life chances will change the distribution of income
Author: Frank Field   [Former Minister for Welfare Reform]
Category: Government
Summary: “I do not accept the validity of the messages like that in The Spirit Level, where correlations on income inequalities are presented as determinants of a whole range of social outcomes… Changing life chances is possible within the existing distribution of income – through it is jolly hard – and by changing these life chances we will change the shape of the distribution of income”

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Title: An enterprise revolution
Author: George Freeman
Category: Growth
Summary: “We need an ‘enterprise revolution’ and for this the Government needs to rethink its role. It should be about interfering less and doing what only government can do, but doing it better. We need to create the conditions to draw in the innovation and enterprise from the private sector required to trigger our recovery”

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Title: Making tax transparent
Author: David Gauke   [Exchequer Secretary to the Treasury]
Category: Government
Summary: “In ten years hence, what may appear to be somewhat dry, bureaucratic reforms to the way in which tax information is presented may prove to be a transformational change in the relationship between the state and the people”

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Title: Contemporary politics – the art of the impossible
Author: Tim Hames   [Director of Strategy, BVCA]
Category: Politics
Summary: “We have moved from closed economics, closed media, and a closed electorate, to a far more open version in all three realms”

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Title: Competitive markets need strong frameworks
Author: Matthew Hancock
Category: Growth
Summary: “The financial crisis which began in 2007 didn’t just rupture our banking system. It also exposed the complacency of uncompetitive, unaffordable governments throughout the Western world…”

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Title: More for less – the art of the possible
Author: Richard Harries   [Deputy Director (Innovation), Department for Communities and Local Government]
Category: Government
Summary: “Necessity is the mother of invention in the public sector, just as much as it is in any other walk of life…”

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Title: Productivity and sustainability-wealth, health and welfare for an ageing population
Author: John Hutton   [Former Secretary of State for Work and Pensions]
Category: Politics
Summary: “The principal responsibility for retirement saving must rest with the individual and not the state”

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Title: Change in government-the agenda for leadership
Author: Bernard Jenkin   [Chair, Public Administration Select Committee]
Category: Government
Summary: “Radical change is needed. Yet the centre of government provides neither the necessary strategic leadership, nor a governance framework to enable departments to manage their change programmes”

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Title: The future is Open-why transparency will be the organising principle of 21st-century public services
Author: Tim Kelsey   [Executive Director for Transparency and Open Data, Cabinet Office] 
Category: Government
Summary: “Today, despite all the progress, we still cannot answer vital questions about our public services. How effective is my local authority? How good is my child’s teacher? Is my mother’s care home safe? In a decade, we will wonder how we ever tolerated such collective ignorance”
 

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Title: Four ways to secure the future of the NHS
Author: Norman Lamb   [Parliamentary Under Secretary of State (Employment Relations, Consumer and Postal Affairs), BIS]
Category: Health
Summary: “By focusing on these four priorities – integrated care, getting the incentives right, using IT effectively and empowering staff – we can help secure the NHS’s financial footing, while also delivering improved patient health, a system that is easier for patients to navigate and more adaptable to their needs, and a workforce that has a genuine voice in the service that they staff.”

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Title: Innovation is best supported by competition
Author: Andrew Lansley   [Secretary of State for Health]
Category: Health
Summary: “In healthcare, the term ‘competition’ is often used pejoratively by vested interests with something to fear from change. But the vast majority of the NHS – including the many world-beating services we have which already compete with other health providers on a global scale – recognise that there is nothing to fear from competition.”

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Title: Putting patients in charge
Author: Christoph Lees   [Consultant in Fetal-Maternal Medicine]
Category: Health
Summary: “A system of universal healthcare, proposed by the Beveridge Report of 1941, envisaged mandatory social insurance, whilst allowing individuals to pay above that amount where they wished”

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Title: Continuity and change-public service reform from Thatcher to the Coalition
Author: Julian Le Grand   [Richard Titmuss Professor of Social Policy]
Category: Public services
Summary: “The Big Society will complement, not displace, the Big State”

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Title: Reforming the market-recasting the financial sector
Author: Chris Leslie   [Shadow Financial Secretary to the Treasury]
Category: Growth
Summary: “The British Government must realise that it can no longer determine the rules by which financial services are governed in the wake of an international crisis which has sparked an internationalist response”

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Title: Benign complacency
Author: Tony McGuirk   [Former Chief Fire Officer, Merseyside Fire and Rescue Service]
Category: Law and Order
Summary: “The reality is that in many parts of the world, communities enjoy a merged fire and emergency medical service”

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Title: Balancing benefit and risk in probation services
Author: Mike Maiden   [Chief Executive, Staffordshire and West Midlands Probation Trust]
Category: Law and Order
Summary: “Public services must lose epithets like ‘blinkered, bureaucratic, turgid, inert’ and so on, and competition will help them do so”

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Title: The great British school day-breaking the Victorian shackles
Author: Greg Martin   [Executive Head, Durand Academy]
Category: Education
Summary: “Whilst the benefits of a traditional approach to teaching and learning are increasingly recognised, society seems reluctant to abandon the antiquated timetabling of the school year – a system which is almost completely at odds with today’s social, political and economic context. The 9am to 3.30pm school day, with six week summer holidays, is not only no longer relevant to the lives we lead, but also puts significant and unnecessary strain on teachers, parents, and children”

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Title: Engaging the next generation with its future
Author: Trevor Matthews   [CEO, Aviva UK plc]
Category: Growth
Summary: “As people are faced with an expanding array of financial choices and service providers, governments can help by setting out clear settlements in areas such as pensions, working age benefits and old age care”

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Title: The long term case for reform
Author: Theresa May   [Home Secretary and Minister for Women and Equality]
Category: Law and Order
Summary: “A fairer country for working people also means reforming public services to make sure that they are the best they can possibly be”

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Title: What a difference a decade makes
Author: Philip Middleton   [Head of EMEIA Financial Services Government, Ernst & Young]
Category: Growth
Summary: “We are now entering a new era for financial services during which we shall witness a fundamental global restructuring of the industry, partly in reaction to the financial crisis, but also in response to tectonic shifts in the patterns of global trade, demographics, and geo-politics. Part of that restructuring will involve a major revision of the role played by the state in financial services and the nature of the relationship between the state and the financial sector”

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Title: Preparing for the perfect storm
Author: Alan Milburn   [Former Secretary of State for Health]
Category: Health
Summary: “An era of low growth and indebted government means the accent will have to be on finding new ways of getting more out of health care for what is put in”

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Title: A lot more for a lot less
Author: Julie Moore   [Chief Executive, University Hospitals Birmingham NHS Foundation Trust]
Category: Health
Summary: “I strongly believe we can support economic recovery and growth through innovations that ensure efficiencies are delivered with no detrimental impact on our services”

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Title: Making the Civil Service fit for purpose
Author: Bill Moyes   [Former Executive Chairman, Monitor]
Category: Government
Summary: “One practical step would be for the statutory responsibilities of Ministers to be summarised and published”

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Title: The end of entitlement
Author: Patrick Nolan   [Chief Economist, Reform]
Category: Government
Summary: “Everyone knows we are getting older but few people seem to grasp the fundamental challenge this poses for the welfare state”

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Title: The future of policing
Author: Hugh Orde   [President, Association of Chief Police Officers]
Category: Law and Order
Summary: “I predict that the service will still be routinely unarmed, and based on consent to such an extent that it will be 128,000 (or so) police officers delivering policing on behalf of 60 million and rising”

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Title: Nothing stops a bullet like a job
Author: Rob Owen   [Chief Executive, St Giles Trust]
Category: Law and Order
Summary: “Crime affects everyone, and, if we fail to stop this intergenerational cycle, it will mean more victims, greater criminal justice costs and a host of other problems for society”

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Title: The trade equation
Author: Ali Parsa   [Managing Partner, Circle]
Category: Growth
Summary: “The good news is that British professionals are well respected in the developing world, particularly on matters of healthcare and education”

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Title: PFI 2.0
Author: Anthony Rabin   [Group Deputy Chief Executive, Balfour Beatty plc]
Category: Growth
Summary: “Unless we measure PFI’s outputs against properly constructed benchmarks, we will, to the taxpayer’s disadvantage, continue having the same simplistic debates in years to come”

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Title: A real strategy for the criminal justice system
Author: David Ramsbotham   [Former HM Chief Inspector of Prisons]
Category: Law and Order
Summary: “To ensure consistency, named individuals should be made responsible and accountable for each type of prison and prisoner”

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Title: Seismic shifts in politics and policy
Author: Ruth Richardson   [Former Finance Minister, New Zealand]
Category: Government
Summary: “The real reform of the public sector is only going to come when governments knuckle down to the real task of defining first what the state should (and should not) do, before embarking on the crusade for a smarter state. No point in the state doing dumb things in a smarter way”

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Title: Making Parliament fit for purpose
Author: Greg Rosen   [Consultant Director, Reform]
Category: Government
Summary: “As a first step, the Commons, as well as the Lords, should have a Committee able to examine the merits of Statutory Instruments, and the power to require government to schedule time, without the current 90-minute guillotine, on the Floor of the House to debate them”

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Title: Swedish lessons
Author: Björn Savén   [Executive Chairman, IK Investment Partners Ltd]
Category: Growth
Summary: “Last year, in the aftermath of the 2008 global banking crisis, Sweden’s economy expanded 5.7 per cent, the most in the European Union, as exports, which account for about half of its output, recovered and consumers kept up spending following four years of income-tax cuts”

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Title: Profit with Purpose
Author: Pascale Scheurer   [Founder and Director, Intelligent Futures Ltd]
Category: Education
Summary: “In this year of the London Olympics and the UN International Year of Cooperatives, the spirit of both is transforming a sector not formerly associated with ‘fair play’: the profit-making business”

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Title: Time for a healthcare reformation
Author: Mark Simmonds   [PPS to the Secretary of State for Environment, Food and Rural Affairs]
Category: Health
Summary: “There must be changes internally to alter attitudes and to facilitate and encourage innovation, calculated risk-taking and integrating care, none of which have been historically good in the NHS”

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Title: From league tables to pattern recognition
Author: Mike Standing   [Head of Europe, Monitor Group]
Category: Government
Summary: “A new approach for improving performance in public service delivery is emerging. The approach is based on identifying and managing patterns of activities, costs and outcomes”

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Title: Living to be 500, death by asteroid, and the inevitability of NHS reform
Author: Simon Stevens   [President, Global Health, UnitedHealth Group]
Category: Health
Summary: “Since Britain has not in fact eliminated economic boom and bust (just as ‘history’ did not in fact ‘end’ with the collapse of the Berlin Wall), the NHS now faces its deepest and most sustained budget crunch since 1948”

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Title: Improving the underlying competitiveness of the economy
Author: Will Straw   [Associate Director, Institute for Public Policy Research]
Category: Growth
Summary: “Rather than looking for quick fixes, that will be about as effective as a placebo, the UK needs to improve the underlying competitiveness of the economy”

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Title: The jigsaw of public service reform
Author: Matthew Swindells   [Senior Vice President and Managing Director of Global Consulting, Cerner]
Category: Health
Summary: “Politicians who want to sell change find themselves having to describe improvement to an already ‘great’ service. This is bound to lead to suspicion amongst the public and ultimate disappointment”

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Title: Closing the social aspiration gap
Author: Matthew Taylor   [Chief Executive, Royal Society of the Arts]
Category: Government
Summary: “Arguably fiscal deficits are, in part, a reflection of the difficulty modern politicians have with telling us we can’t have our cake and eat it too”

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Title: From guarantor to enabler-the future of the state
Author: Otto Thoresen   [Director General, ABI]
Category: Growth
Summary: “We have to increasingly move to the role of the state as an enabler of individual prosperity rather than a guarantor of individual prosperity”

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Title: A new paradigm for policing and the community
Author: Sara Thornton   [Chief Constable, Thames Valley Police]
Category: Health
Summary: “I think that all would agree that austerity should be seen as an opportunity to develop new ways of delivering policing services that are equally as effective but cost less”

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Title: A class act
Author: Elizabeth Truss
Category: Education
Summary: “For those in doubt, the current eurozone crisis has made it clear where the balance of economic power in the world now lies. We see the East ascendant with China now involved in bailing out the eurozone”

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Title: Rehabilitation starts in prison
Author: Janet Wallsgrove   [Director, HMP YOI Parc Prison]
Category: Law and Order
Summary: “Too often ‘prison industries’ – a misnomer if ever there was one – are little more than a means of keeping prisoners occupied rather than providing them with the means to acquire skills, or real experience of working”

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Title: Will a new Beveridge emerge
Author: Norman Warner   [Former Health Minister]
Category: Government
Summary: “Although Beveridge’s welfare state has served us well, it was designed for a different time and a set of social, economic and political assumptions that no longer holds good”

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Title: Free schools and the Big Society
Author: Toby Young   [Chair of Governors, West London Free School]
Category: Education
Summary: “My reluctant conclusion is that proponents of the Big Society can draw little succour from the success of this [free schools] programme”

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