Not “blood on the streets” but reform and devolution

20 February 2017

Andrew Rawnsley entered the future-gazing business in his column yesterday and he wasn’t messing about. The Observer‘s lead political commentator agreed with a “senior Tory” that there will be “serious public disorder” within the next two years. There will in fact be “blood on the streets” by 19 February 2019 (or at least he felt that it was “not at all unreasonable” to expect that blood will flow).

I’m going to make my own prediction that he is massively over-exaggerating, and then perhaps the blogosphere can hold us both to account.

His main arguments were that “austerity has not gone away”, preventing any possibility of public spending increases; that the NHS is under particular pressure; and that taxes will rise. On the NHS, he gave something of a counsel of despair, asking for extra money and then predicting that it would make little difference:

“It is a fairly safe prediction about the Budget that the chancellor will have to find some extra cash to alleviate the crisis in the health service. I think it another reasonably sure forecast that the additional funding will prove to be insufficient to ease the long-term pressures.”

I agree with the last part of that. As I’ve said before, George Osborne gave the NHS extra money in November 2015 (£3.8 billion) and November 2014 (£1.3 billion in new money). That hasn’t prevented the “NHS crisis” (really overcrowding in hospitals) that has been so widely reported.

The problem with the main thrust of his argument is that it makes no allowance for the ways that services could change and become more efficient in the years to come. That does seem quite an oversight given the rapid advance of technology, clearly now about to change the shape of public services as we know it. At Reform we will hear much about this tomorrow at our conference on big data in government, headlined by John Manzoni, chief executive of the Civil Service. Data analytics should reveal entirely new information about how to organise public services and which citizens will benefit most from them.

We also heard a lot at our annual conference with Ben Gummer ten days ago.The transformation strategy that he launched aims to make the pioneering work of the Government Digital Service business as usual across Whitehall. I just can’t see that there will be rioting in the streets if, for example, we find ourselves booking GP appointments online, or having telephone or video consultations with GPs and other staff.

For the NHS, as Reform’s paper last week showed, the reform embodied in Sustainability and Transformation Plans is only now about to happen.  It needs significant change to the structures of STPs, to give them real teeth, but still these are real initiatives seeking to bridge the divides between health and social care for the first time.

Rather than rioting, a more likely outcome of where we are now is devolution, which was the other big idea that came out of our annual conference. Ben Gummer wanted public services to follow the agile approach of starting with what citizens want. That will mean looking beyond the traditional silos in which public services are placed. The speakers at the conference, in particular those in the Whitehall session, all concluded that stronger devolution is the way to do that. (So did Reform‘s STP paper in fact). (The current debate on business rates is about the devolution of local government finance)

None of this is to dismiss the impact of financial stringency on public services. The opportunity of new technology and the reality of devolution, however, make this phase of austerity very difficult and offer real grounds for hope.

Andrew Haldenby, Director, Reform

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