Skip to main content

Markets for good: the next generation of public service reform

This report is about reform of ‘human’ public services only: health and education, and poverty-fighting services such as addiction support, social work, prisoner rehabilitation, skills training and so on. It is not intended to cover all of government activity.

The challenge: our failing human public services Without reform, Britain’s human public services are facing crisis. Budgets are falling, but demand is rising, driven by globalisation and ageing. Schools fail far too many pupils, the vocational system is more geared to producing nail technicians than nano-technicians, and the NHS is cracking under the strain of coping with, in particular, increasing levels of chronic conditions and ageing. The situation in services that receive less media attention is arguably even worse. There are tragic shortcomings in our mental health, addiction and prison rehabilitation services. Experts agree that more local, open, collaborative services are the answer, but even intermittent experiments in this direction often meet heavy opposition.

These challenges cannot be dealt with simply by spending more money. There isn’t any. Nor is it sufficient to follow business-as-usual attempts to reach slightly better value for money. We need a quantum leap in value for money and that means fundamental public service reform. Unfortunately, the country is having totally the wrong sort of debate to deliver such a quantum leap. Public service reform, when actually discussed, is done so within a narrow framework of each particular service. It rarely arrives at the crucial topic of how these services fit together.