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The Guardian | Wednesday 7 October 2009 1

What we need is honesty, not denial Public spending is going to be squeezed, hard. The questions are when, where and how. The government has taken refuge in stealth; its planned cuts fall hardest on capital spending, and involve the usual salami-slicing of services (disguised as “effi ciency”). The Tories would hide behind a new super quango and attack public services with relish. But honesty, rather than denial, is the best place to start.

There must be a better way that involves setting explicit priorities, decentralising decisions where possible, and ensuring democratic engagement (remarkably, MPs at present play no role in spending choices). Left to itself, the government machine will protect bureaucracy and senior management by sacrifi cing frontline services and modestly-paid staff . A cultural revolu-tion is needed to reverse the top-down approach and protect public services.

Some potentially unpopular or

controversial cuts are inevitable. The Liberal Democrats have identifi ed big defence projects (including Trident), government IT and database contracts, the child trust fund, tax credits for high earners, and future public sec-tor pension and pay arrangements for the burgeoning ranks of highly-paid public sector staff (including MPs). The more credible the choices, the more we ensure that frontline services are indeed protected, and that we are in a position to make future commitments to combat unemployment and invest in education.Vince Cable, Liberal Democrat shadow chancellor of the exchequer

Let’s invest in our young people Over the last fi ve years, there has been big investment in youth services, but, at a time of recession, the writing is defi nitely on the wall and serious cuts in budgets loom for local authorities and third sector organisations .

A generation of disaff ected and dis-

engaged young people, out of work and out of society, seems a real possibility. What do we do? The secret must be in reigniting in communities the desire and the capacity to support their own young people. The state employee needs to work across the generations, getting people talking about what they want for their young people, getting young people to talk about what they want, and then supporting and training people locally to deliver for young people.

This approach, both curative and pre-ven tive, is about long-term in vestment in people and assuming the collective responsibility for each other that fosters belonging and understanding.Fiona Blacke, chief executive, National Youth Agency

First, defi ne the core business of the state Let’s start with the obvious. It may have been a challenge to deliver effi ciency savings in good times, but in hard times it will not be enough. Something more

strategic is needed, defi ning what the core business of the state is and how it can best be delivered. Innovation be-comes imperative, but it now means en-listing the creative energy of staff whose pay is frozen. Simply resisting cuts will not be an adequate (or eff ective) response. Whoever wins the election, managing public services in tougher times will be the name of the game.

Public service reform will intensify, not to improve quality but to get the same for less (or, more likely, less for less). Forget about the kind of choice that costs more , which almost all choice does. The private and third sectors will be looked to for savings, but these may well turn out to be illusory. At risk will be the more promising public service developments of recent times, not least the emphasis on personalisation and the attempt to assemble a set of service entitlements – public service guaran-tees – for users. This promises much and should not be abandoned just because some people are now more interested in cutting the state down to size.Tony Wright MP, chairman, Commons public administration select committee

Ditch plans for national databases If cuts are to be made, do not slash and burn . Aim for constructive continuity , so that frontline workers can focus on helping and protecting children, fami-lies, disabled and older people.

Reduce plans and performance data requirements . And give up on plans for expensive national databases such as ContactPoint, which will hold informa-tion on all children. Let’s not kid our-selves that they are reliable and secure.

Protect funding for programmes such as Sure Start , so that we do not have a new generation of young parents like those whose lives were blighted by the Thatcher years .

Invest in training of frontline workers in social work and social care . Promote often low-budget initiatives that harness the competence within communities, rather than competitive contracting, which enriches big business.Ray Jones, social work professor and former director, Wiltshire social services

SUE CROWE ‘SAVE SURE START’

Sue Crowe, a mother of three , is a passion-ate supporter of the Sure Start facilities that opened in the north Cornwall town of Cam-borne in 2001. Since the Trevu centre was launched in a disused girls’ school, she has been a regular user, attending music and play sessions with her daughters, aged 18 months and three , and her seven-year-old son. The prospect of cuts in public spend-ing that would threaten the centre make her uneasy.

She says: “Our whole town has benefi ted because the centre has pulled together peo-ple from all communities, who might oth-erwise never have met. It’s a very inclusive system. If the service is cut, the town will go back to feeling very ghettoised, with poorer children never mixing with middle-class children. Children across the town will lose out socially and educationally, and their health will suff er.”

When she had her oldest child, she had no access to a Sure Start facility. But life as a parent was transformed when she moved and found the children’s services accessible in the centre of town, a short walk from the area’s more deprived estates and the more expensive areas.

“ I felt totally isolated, but when I started coming here,” she recalls, “I could see parents really benefi ting from the compan-ionship . It catches fi rst-time parents, who often don’t have an idea about what they need to be doing.

“Parents and health professionals agree this is an excellent way of working; it makes it so much easier to access serv-ices. When you’re lugging small children around, you don’t want to drive from one place to another , keeping to set dates and times. If cuts are made and services are spread out, parents will struggle to access them, and the most vulnerable will suff er. The sense of community cohesion will disappear.” Amelia Gentleman

A new public servicesPart two: the responseLast week Guardian writers looked at the future for schools, hospitals and welfare at a time of fi nancial crisis, and invited readers and experts to have their say. Here is a selection of their views, from a chief constable to a frontline social worker, from Vince Cable to an NHS patient. A special four page pullout

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A NEW PUBLIC SERVICES2 The Guardian | Wednesday 7 October 2009

SocietyGuardianNews, views and hundreds of jobs guardian.co.uk/society ≥

COMMENT IS FREE…

The main causes of costs in the public sector result from the factory design of public services (standards, call centres, call handling times, targets, press one for this, two for that, etc). This factory design means that it takes a large number of transactions to deal with each demand for service.

Public sector organisations (for example, council benefi ts services ) don’t realise that, from our point of view, the service is comically terrible because it takes ages to get something very simple resolved. We end up having either to manage the many bits of the service ourselves or we resort to going to the Citizens Advice for help.

If the government worked to understand and remove the causes of cost, they would save millions, and services would improve beyond their wildest dreams. The trouble is, the government are the ones who create and push the factory design (the main cause of cost) – so they don’t want to hear it. Charlotte Pell

Join the debate at guardian.co.uk/commentisfree

Time for long-term, radical thinking Everyone agrees that cuts will be needed, but the question is where? There is a great danger that the pressure on budgets will lead to short-term deci-sion-making where the usual suspects – such as mental health services – get cut, instead of the focus being put on driv ing effi ciencies in the acute and mainstream primary care sector or on reducing social care service bureaucracy.

People may keep their heads in the sand, recommissioning existing ineffi cient services rather than looking to new providers to do things diff er-ently. Commissioners should be making radical decisions, involving local people in designing and delivering the services they use.

Budget cuts shouldn’t end up punish-ing those people already badly hit by the recession. Investing in prevent ive interventions, such as those that tackle unemployment, substance misuse or mental health problems, would short-circuit the intergenerational cycle of deprivation. The New Economics Foundation estimates the net return on full investment in these areas would be £269bn over 10 years.

Investing in personalised social care services for people with a learning dis-ability, for example, cannot continue to be a “nice to have”. I am hopeful that this time, at least, those who hold the purse strings will be able to make a real diff erence.Victor Adebowale, chief executive, Turning Point, a social care provider

Take out waste, bring in innovationThere is a consensus that savings of around 20% will be needed in the NHS in the three years from 2011, and this represents an unprecedented need for change and innovation. At the same time, it is vital to hold on to the gains in quality that have already been made and not indulge in slash-and-burn cuts that are poorly thought-through. The variation in performance in the NHS shows that there is scope for improve-ment, but achieving the best will mean removing waste, duplication, unneces-sary steps, and delay.

Action will be required across the whole system, not just in the back offi ce. Many of the savings available from this remain on paper until they reach a scale where fewer staff , buildings and other fi xed costs are needed. This may mean radical change in the way care is organised, and perhaps some hospital closures. If this is not enough to bridge the gap, then choices about whole lines of service will need to be taken.

It may also be necessary to look at asset sales and staff pay to create some headroom, whic h will be diffi cult as the sort of change that is required needs the full engagement and imagination of NHS staff . Hopefully, the squeeze will produce unprecedented innovation and creativity- it will need to. Nigel Edwards, director of policy, NHS Confederation

A rocket boost for welfare reformVoters, the polls tell us, are most sup-portive of cuts to the welfare bill,

which is the single largest item in the budget. Over the last decade, even left-leaning voters have become increasingly sceptical about the benefi ts of benefi t spending. Despite Tony Blair’s promise to reduce “the bills of social failure”, the social security bill is forecast to be £193bn by 2013. Unless it can be tamed, the pressure on all other departments will be immense. The next government will need to put rocket boosters under welfare reform. Despite public support in principle, in practice it is likely to prove controversial in the extreme.

Even sitting at the centre of the government, you don’t actually know what the opportunities for savings are. You are like the Soviet central planner trying to guess everything. Parties in

opposition, therefore, have very lit-tle chance of realistically being able to spell out exactly where the axe will have to fall. Britain has always imposed cuts from the centre. The lesson from other countries is that the job of fi nding savings is better devolved down to the departments. Neil O’Brien, director, Policy Exchange

Save money - spend wisely on legal aid The debate has got to be about how to overhaul the current system eff ectively, not simply how to make cuts. Since legal aid reforms were introduced in 2007, I have been repeatedly asked to choose between keeping my law centre fi nan-cially sustainable and helping those in most need.

Last week, two colleagues debated whether to accept instructions on a complex race discrimination case involving nine separate claims against nine respondents – for one legal aid fee. They brought it to me as manager, wor-ried that they would not be able to make their targets if they took it on. I said: “What are we here for, if not this?” So they went away to do the case. But they will not meet their targets. The “busi-ness” I am running is not sustainable.

We have a local authority grant to shore us up; that is the only way we can survive under the current system. So what’s the answer? How do you make cuts in a sector already cut to the bone? The answer is to spend more wisely.

The truth is that running a law centre is not terribly expensive. It costs about £350,000 a year. And yet the savings that can be made by a law centre – or other advice service – properly able to help those most in need are signifi cant.

Research show s that each tenant evic-tion avoided by a law centre saves the tax payer an estimated £34,000.

Legal aid could be a powerful

prevent ive force in our society, trans-forming lives and saving the govern-ment a lot of time and money in the process. What we need now is a system that allows it to play that role. Paul im Thurn, manager, Carlisle Law Centre

Early intervention for children at risk Few would question the importance of child protection, and we can hope that the crisis services will remain relatively well-funded. But services that can prevent those crises are another matter. There is no doubt that early interven-tion is the right thing to do for children and young people. The problem is prov-ing that it also saves money . Over the next few months, we must marshal our evidence to prove what we instinctively know to be true.

Better co-operation between agencies will deliver better value for money and results. Retrenchment and isolation of services will not help reduce defi cits, nor maintain the improvements in serv-ices to children and young people, but will only shift the blame within the sys-tem. Let us hope that managers across public services for children are able to see the bigger picture. Kim Bromley-Derry, president, Associ-ation of Directors of Children’s Services

Reform is urgent as our population agesThere is already a real danger that care and support for older people will be hit hard as local authorities make cuts, with more and more needs left unmet. The postcode lottery in care will get worse as eligibility criteria are tightened and charges hiked. Legal challenges may follow.

We can get better value for money for individuals through access to advice and support for carers, and for taxpay-ers by looking at total public spend in every local authority area. This should lead to more eff ective pooled funding, as well as investment in prevention. The fi nancial pressures will make radi-cal reform of care funding by the next government even more urgent as our population ages. Stephen Burke, chief executive, Counsel and Care

Amalgamation will cost the police moreThe options for cutting police spending and driving out further effi ciencies are limited. Collaboration is not always the answer, as it tends to be in specialised fi elds. It will help mitigate some of the eff ects of cuts, but not eliminate them. The service will pursue greater effi cien-cies through technology, but these too will produce only limited benefi ts and require upfront investment. In the short to medium term, wholesale amalgama-tions of forces are likely to cost, not save, money.

If big savings are to be made, and quickly, then there will have to be sub-stantial cuts in police numbers, or pay will have to be pegged to well below infl ation. Neither option looks very safe when it is likely to be the police service that is dealing with many of the nega-tive social consequences that fall out of a prolonged recession. Timothy Brain, chief constable of Gloucestershire

Sustainability is not an optional extraThe public sector so often sees environ-mental sustainability as an additional agenda, the preserve of one person or team, and an optional extra that can be cut in times of hardship. But this is short-sighted.

Sustainable development can poten-tially create value while reducing costs. Look at businesses such as M&S or Wal-Mart, which have very ambitious sus-tainability plans. They’re not doing that for the good of their soul, but because it makes business sense and will create shareholder value. The public sector needs to adopt this way of thinking. This isn’t about asking “What can be cut?”, but “What’s the future that we’re trying to create?”

As many in the private sector have found, once you have a vision of a long-term sustainable future, a more effi cient way of delivering that often follows. Helen Clarkson, deputy director, Forum for the Future

CHRISTINE RANSOME-WALLIS ‘LISTEN TO CARERS’

It’s been hard enough to get proper support and entitlements for the last 12 years, says Christine Ransome-Wallis, so the prospect of cuts to public spend-ing hardly fi lls her with enthusiasm. She’s been the main carer for her 91-year-old mother, Margaret (pictured), for much of that time and it has been, she admits, “an uphill struggle”.

But if a fi nancial crisis forces public services – from the benefi ts system to

the NHS and social services – to become more effi cient , she wonders if some good may come of it. She has little confi -dence, however, that the authorities will fi nd innovative approaches to delivering services. “ If anyone has a new idea, it’s not going to happen overnight.”

Local authorities should hire ex-carers to do some of the jobs cur-rently reserved for professionals, says Birmingham-based Ransome-Wallis,

who worked for the NHS . She believes carers have a key role to play in enabling public services to refi ne effi cient ways of working. They know where the system breaks down, where it creates duplica-tion, and how it can better meet needs.

“They should talk to people who know what they are talking about, rather than people in glass palaces and ivory towers.”Patrick Butler

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A NEW PUBLIC SERVICESThe Guardian | Wednesday 7 October 2009 3

Long-term strategy: to enable people Over the next decade, we need to fi nd brave and clever ways to make tax payers’ money go further. Otherwise, we face a demoralising process of year-on-year penny shaving, a deteriorating public sphere, and worsening social outcomes.

First , focus on effi ciency and eff ec-tiveness. On the one hand, it is about a ruthless determination to drive down the cost of back-offi ce functions. On the other , it is about liberating local authori-ties from central targets and regulation so they can reduce duplication and focus resources on key outcomes.

Second, look at public services’ core objectives. We need a strategic review in education, which could reduce the costs of university education while spending more on under- fi ve and primary provi-sion, or an NHS review that addresses the lack of effi cacy of most medical interventions and instead invests more in services – such as mental health – that are critical to people’s resilience.

The ultimate aim of public policy should be to enable people to be the people they need to be to create the future they want. If our long-term strategy for public service had this starting point, the coming age of auster-ity could also be one of great invention and progress. Matthew Taylor, chief executive, Royal Society for the encouragement of Arts, Manufactures and Commerce (RSA)

Axe poor-quality block contracts Working with some of society’s most vulnerable people on a daily basis, it is hard for me to see where cuts will come from . Cuts may garner votes from people who see a bloated public sector, but frontline services have already been pushed to the limits , with many teams freezing recruitment and leaving vacan-cies empty in an attempt to save money.

We do have the opportunity now to innovate and save at the same time by cutting down on large, poor-quality block contracts in service provision. Clever and creative commissioning might leave room for more chiselled services, and especially more localised services . Individual budgets are also a wonderfully inclusive proposal in theory. But these initiatives must not be overwhelmed by the political pressure to cut costs and limit services . These services do not have to cost more, but they do have to exist.

Similarly, moves away from residen-tial and nursing care towards care in the home cannot be assumed to mean lower costs if quality is to be upheld. It is diffi cult to see how funding can be maintained to provide the necessary quality of care without some kind of means-testing. It is just unlikely that this solution will win votes.Anonymous social worker who blog s at fi ghtingmonsters.wordpress.com

Share power with service users The government could save money, cut the crime rate, and transform public services if it dared to embrace the terri-fying concept of power-sharing.

Power-sharing means policy-makers stop thinking they know what’s best for others. They should stop treating users of public services – people in jail, people with mental health problems, excluded teenagers – as a problem to be solved by people with no real knowledge of what it’s like. When it comes to help, support or rehabilitation services, we should listen to people who have direct involve-ment in those services, such as ex-off enders and recovering addicts. They are ready to bring about change ; it is those with power and responsibility who are reluctant to hand it over to them.

Stop fostering reliance on distant policy-makers and an army of paper-wielding service providers. Instead, invest in giv ing service users a voice. Mark Johnson, rehabilitated off ender and founder of the charity Uservoice

Councils can’t rely on ‘social capital’ The word here in Suff olk is of cuts in spending of up to a third over the next few years. Yes, that’s 33%. Very soon, we’ll be looking at a very diff erent local authority, delivering less – its role no longer about “doing things ” but about making sure they are done.

But just how will this gap between budgets and aspirations be bridged? The buzz-phrase is “social capital” – community self-help, mutual support and voluntarism. This is the headline strategy, and there’s even a new cabinet portfolio in its name .

Sounds great. Yet can we generate enough of this “social capital” in the digital, dissociative 2010s? Nobody truly knows, but a sensible guess is that it will be no magic bullet, especially in areas where people don’t even look at each other in the street, never mind help old ladies across the road.

So, expect tried and tested stuff : a pay and recruitment freeze; a mass sacking of expensive council employees; and outsourcing of traditional local author-ity mainstays such as schools, care management and children’s services.

Enter, the third sector. People, quite rightly, don’t trust the private mega-corps to organise education and care. Their track record is patchy. By con-trast, charities and social businesses are trusted, have the right cost base, and draw in community eff ort. It will all be very brutal, but there might be something better – and more fi nancially sustainable – at the end. Craig Dearden-Phillips , chief executive of Speaking Up, an advocacy charity , and a Liberal Democrat member of Suff olk county council

Whitehall has room for dramatic reform The country is bust, so something has to give. As far as public services are con-cerned, it would not be unreasonable to aim for a standard 30% cut across all government departments . Meeting that scale of challenge is not easy. Are we happy to lay off large numbers of civil servants? Would the education of this country grind to a halt if the Department for Children, Schools and Families was

cut dramatically? If the Tenants Services Authority disappeared, would there be a crisis in social housing? Probably not. There is room for dramatic reform in Whitehall, but we should not rush to frontline services for big savings.

We must spend now to save in the long term . That means investing in prevention rather than cure, and back-ing innovation. Celebrate civic leaders who deliver successful services – don’t bring in armies of consultants. Under-stand how the public use technology and make our information accessible to them. Is the public sector ready to do this? I think they might be. I see govern-ment departments saving small fortunes through good procurement. Big money can be saved, but not if we want to keep doing what we have always done. Zenna Atkins, consultant, Social Solutions

We must save the health visitors When the healthcare cuts come, as come they will, we must save the health visitors. The health-visiting service is underfunded and understaff ed, and has become the Cinderella of the NHS. The role of the health visitor seems simple enough. Keep an eye on newborn babies and young families. Health visitors are better placed than anyone, including GPs and social workers, to detect early signs of post-natal depression and, most important ly, early signs of child abuse.

For reasons that escape me, health visitors have no cachet, no “street cred”, even within the nursing profession.

Meanwhile, they continue to work quietly and autonomously in the com-munity, doing a job that doctors are not equipped to do – a job that saves lives. Expand the health visiting service. By so doing, we may prevent the next Haringey tragedy.‘Dr Crippen’, nhsblogdoc.blogspot.com

Show Ofsted, not senior staff , the door Ed Balls has been a cerebral educa-tion secretary – which makes the ugly ignorance of his mooted plans to save £250 m by sacking over 3,000 senior staff through “federating” schools all the more shocking. Whil e the benefi ts of federation are clear, cutting the jobs of headteachers and deput ies – the major-ity of whom are human dynamos cop ing with intolerable stress, Stakhanovite hours, and are the antithesis of work-life balance – would be foolish indeed. It is their commitment that keeps the whole edifi ce from crumbling .

A substantial contribution to the vast savings government desires could be better achieved by showing Ofsted the door . Their judg ments are whimsical , and their idea of what constitutes good teaching is based on universally held falsehoods . Phil Beadle, English teacher

The market doesn’t own “choice” Hard times like these spawn fi ne-sound-ing buzz phrases: “personalisation”, “individual budgets”, “third-sector involvement”, “cross-institutional col-laboration”, empowerment, recovery-focus, innovation. But false friends are worse than bitter enemies: many users anticipate cuts in provision being implemented under their guise , which aren’t about to somehow make every-thing great, and cheaper to boot. None are of themselves bad notions, but their proper implementation is not guaran-teed in this economic climate .

Tired free-market “solutions” unasked for by users are, as ever, being touted, appropriating this language of change and choice for an atomised con-sumerism that undermines social inclu-sion and the communality that accrues from the shared use of services . Users know social care monies are to meet needs, not wants, yet market-based solutions often try to create demand, promising the earth.

Involving users in service design and delivery gives better, cheaper systems , because users know what’s needed . Responsive and personalised services, yes, but not necessarily if the cost is the loss of much-loved day centres, drop-ins and small providers disproportionately disadvantaged by the crude applica-tion of marketisation . True diversity of providers, and hence real choice, may disappear, with only the big corporates or quasi-corporate “super” charities left. Instead, invest in users not marketisers. Alisdair Cameron, team leader, mental health service users in volvement group Launchpad, Newcastle-upon-Tyne

Recessions come and goThe growing consensus that “there must be cuts” is unfortunate, because it has cut off any real discussion about exactly how big, and how long-term, the crisis in public fi nances is.

Before the crisis hit, it was fairly clear that there was already a relatively small hole in the public fi nances – a “structural defi cit”, in the jargon – as the government was getting less in from taxes than it was spending. The public defi cit was creeping up and was passing Gordon Brown’s 40% of GDP ceiling.

At 40%, however, public sector debt was, historically, at fairly low levels – it has been much higher – and across the developed world this was at the lower end . Even at 60%, it would not be excep-tional. It is now set to rise to 80%-plus.

This sudden jump has been caused mainly by the collapse of tax income, not extra public spending. Taxes will come back, but as yet it is not clear how much, because of the shrinkage in the fi nancial sector. So we don’t know how big the ongoing structural defi cit will be.

Some cuts probably are needed, as well as some tax rises, but consum-ing our public capital to get us out of a mainly short-term public fi nance crisis would be an absurd over-reaction. And ironic, given that, in the current crisis, a remarkable feature of some private sec-tor reaction has been to try to preserve capacity, rather than the “slash and burn” practices in previous recessions.

Capitalists have learn ed tha t reces-sions come and go, and policies should be more long-term. It would be weird if just as they start to learn this, we started dismantling the public domain because of a short-term crisis.Colin Talbot, profesor of public policy, Manchester Business School

TONY RUSSELL ‘PROTECT VITAL NHS SERVICES’

Cuts may be inevitable, says Tony Rus-sell, a user of mental health services and founder of the campaigning group Breakthrough – but the danger is that they will be made in all the wrong places. In the NHS, unfashionable serv-ices such as mental health will be fi rst in the fi ring line, he fears. “I have no problem with cuts, but they should not be at the expense of vital services.

“In times of fi nancial crisis, people get depressed, ill and stressed. Demand

is rising, and mental health services are under pressure. If the nation isn’t healthy, then everything else is irrel-evant,” Russell says.

“Make cuts, but make them in expen-sive IT and communications depart-ments, and stop wasting money on fancy brochures promoting foundation trusts. Why do we pay for these massive quangos that don’t do anything? Let’s cut defence spending, and pull our troops out of Afghanistan.”

Investment has to be focused on the health frontline, Russell argues. He pays tribute to “brilliant” clinicians and dedi-cated local NHS trust chief executives, but is sceptical about the value of the upper tiers of the NHS and civil service.

He says: “I sometimes think we have lions led by donkeys in the NHS – too many decisions made by too many people who know nothing about the reality of mental health.” Patrick Butler

COMMENT IS FREE…

I am a middle-ranking operational police offi cer in the Met. The crudeness of the political debate about police numbers has always really frustrated me. There has been a tangible increase in the number of offi cers but I cannot see a corresponding increase in the service we off er . . . far too many offi cers are sitting in offi ces and doing very little. There is fat to be cut . Unrealneil

We need less local govern-ment, not more. Clear away endless tiers of management [and] the purely political depart ments – eg, equalities ; return to providing the basic services people want and need. Mickyboy

Local government is so much better than it was 12 years ago – unfortunately, the rate of improvement hasn’t kept pace with the increased expectation of a population stuff ed on a diet of negativity, cynicism and adversarial point-scoring politicians. Sssshhhbloggers Join the debate at Guardian.co.uk/commentisfree

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A NEW PUBLIC SERVICES4 The Guardian | Wednesday 7 October 2009

Next week: Politics and public service cutsWe present fi ve ideas for reform to the main parties The Guardian, Wednesday 14 October ≥

Third sector must play a serious rolePublic service reform was too diffi cult to achieve in the good times. In the bad times, it will be too expensive not to. Cuts must lead to real and radical reforms – and we need to get serious about involving the third sector.

For example, we spend £11bn a year on reoff ending, yet the third sector has an excellent track record of results in this area. By scaling up existing pro-grammes, it could save upwards of £2bn.

We also need to get serious about taking a prevent ive approach to many of our problems. Diabetes costs the NHS £9bn a year – 10% of its budget. How-ever, 80% of type 2 diabetes is prevent-able. The 16,000 volunteers working for Diabetes UK alone saved £16m this year.

And we need to get serious about personalising services. Currently, many services go unwanted and unused. By giving individuals choice, there will certainly be effi ciency if not cost savings. Stephen Bubb, chief executive, Association of Chief Executives of Voluntary Organisations

State has to become a smarter shopperThere is a temptation to play safe when money gets tight. In areas such as adult social care, the focus could easily switch to keeping staff in jobs, rather than making sure that people get the services they need.

We must ensure that the momentum that is building behind personalisation isn’t lost. In the short term, individual budgets may well end up costing more. Yet the long-term impact is potentially enormous – both on people’s well being and in fi nancial terms. Instead of point-ing to the occasional seemingly gener-ous individual budget, we should focus on the “failure demand” that exists in the social care system – demand that wouldn’t be there if more people were just given what they want and need fi rst time round.

Procurement is another key area. If the past 12 months have taught us anything, it is that we should challenge economic orthodoxies. One such ortho-doxy – economies of scale – ignores the diseconomies that come from bundling services into massive contracts, which only big businesses, distant from the people who should be served, can win.

Procurement, when it comes down to it, is just the state’s way of shopping – and it’s vital that the state becomes a smarter shopper. Rob Greenland, blogger, thesocialbusiness.co.uk

Push on with personal budgetsEffi ciency is not about cutting or spend-ing; it’s about making the best use of our individual capacities and social capital. Personal budgets are effi cient because they unlock the wasted capacities of cit-izens, their familes, and the community, but the current system pushes resources into fi xed and institutional services that cannot meet needs effi ciently.

Th e extension of personal budgets is leading to dramatic reductions in the use of residential care and day centres.

These budgets are not a panacea for every problem. But, with the right polit-ical leadership, they will lead to radical reform in education, healthcare, social care, and the redesign of the wider tax and benefi t system. Simon Duff y, founder, Centre for Welfare Reform

New housing needs public subsidyWhen it comes to the inevitable rounds of public spending cuts, any chancellor will fi nd it diffi cult to produce greater effi ciency savings from the social hous-ing sector without dramatically slashing the number of new homes being built. Housing associations currently con-tribute £2 from their own resources for every £1 of public money they receive. It would be almost impossible to fi nd any other sector to provide that kind of value to the taxpayer.

Our members also supply specialist housing and support services to some of the most vulnerable people in our neighbourhoods. This work is partly funded by the £1.7bn Supporting People fund, and independent research has found this delivers more than £3bn value to the public purse. It is vital that it is protected. But with less public subsidy, housing associations would be unable to maintain their current levels of investment – and it would be the poor and the vulnerable who would pay the heaviest price as a result. David Orr, chief executive, National Housing Federation

Private lessons on greater effi ciencyThe sooner we start to talk about cut-ting costs without doing irreparable damage to the most important services the better. But this can’t be done with-out pain and without sacrifi cing some services that someone holds dear.

We propose a three-stage plan for reducing public expenditure. First, a rapid, hard-headed review of all un necessary expenditure to save money and to buy time for more radical action.

This should be followed by a compre-hensive review of spending priorities, with the aim of cutting back hard in those areas deemed to be of relatively low priority.

Finally, the way public services are provided must be overhauled, taking a lead from the private sector, where many services have been transformed – for example, through the use of tech-nology, including online interaction with customers and the development of call centres and central distribution hubs. Alan Downey, head of public sector at consultants KPMG

Voters can ensure councils give valueCouncils are seasoned campaigners in the battle to do more with less. While MPs and the media have been debating future spending cuts, town halls have spent the past year coping with a perfect storm of reduced income and increasing demand for services. Thousands of jobs have been lost, and more effi ciencies are being made.

We need a long, hard look at the whole of the public sector to make sure it really works for people in an effi cient and accountable way. Councillors are directly answerable to voters through the ballot box. That is what makes them ideally placed to make sure that we are getting value out of the billions of pounds spent in each area.

Councils are already leading eff orts to slice away duplicated eff ort by looking at all public money spent in each area by dozens of public bodies, making sure there is no wasteful duplication.

All political parties should look to local government to answer the central question of our times: how to deliver better quality public services for less.Margaret Eaton, chairman, Local Government Association

Consultancy costs the NHS too muchThe NHS spends at least £350m a year on management consultants – a fi gure that we suspect could be much higher. If anything pointed out the waste and ineffi ciencies that could be cut from an NHS budget, this was surely it.

Of the huge fi gure spent on these consultants, 78% (or £273m) was spent on projects that did not directly aff ect patient care. These include rebrand-ing trusts, changing logos, or renaming organisations to make them more attrac-tive to potential patients. The RCN has nothing against management consult-ants, but when one considers that the money spent on them could pay for 330 fully-staff ed medical wards, one has to question the virtue of this expenditure.

If the NHS is to look at ways to reduce spending, then we must examine costs such as these. What we mustn’t do is wield the axe on our frontline services and the areas that comfort, cure and care for patients.Peter Carter, general secretary, Royal College of Nursing

Unions know where to eliminate wasteThe level of cuts being bandied about should worry people who care about public services. We do believe that savings can be made, but if you want to deliver quality services, when money is tight, you need to work with staff and unions, who can identify where there is waste and eliminate it. Scrapping ID cards is a start. And how about ditching Trident, and stopping spending billions on consultants, privatisations and the internal markets?

The best way to rebuild the public fi nances is by fair taxation – those who have the most, including the fi nancial institutions that caused this crisis, pay the most – and not by cutting services upon which the majority depend.Dave Prentis, general secretary, public services union Unison

ANDREW WASIKE ‘DON’T SKIMP ON HOUSING’ Andrew Wasike knows better than many the realities of modern – or not so modern – social housing. Through his work with the Leeds Tenant Federation, he goes inside a lot of homes, and is often worried by what he sees.

Wasike claims that the government’s Decent Homes commitment – to ensure that by 2010 all accommodation is warm, weatherproof and has reasonably modern facilities – has turned out to be “merely cosmetic”, with only a handful of homes in each area getting attention. But with a fi nancial squeeze on the horizon, he is adamant that completing the project must be a priority, and that it will end up saving resources elsewhere.

“Some families are living in very poor conditions,” he says. “We’re in the 21st century; we need proper standards. It aff ects people’s health. The cold weather goes straight through the walls. If these were insulated, people would reduce the amount of visits they make to their GP with problems like asthma.”

Having lived in the Netherlands for seven years, Wasike, a former politi-cal detainee who left his native Kenya in 1999, is keen for the government to look to other European countries for solutions.

“In the Netherlands, central govern-ment gives every local authority money that is supposed to maintain houses,” he says. “It has to be used for that work, and any money that is left has to be returned. Councils have an obligation to see that it has improved standards, and if it is judged that it hasn’t then the councils will be held responsible and made to pay back the money.” That incentive, he says, makes all the diff er-ence to delivery .

Wasike is keen for tenants to take a greater stake in the upkeep of their homes. “We should fi nd a way to edu-cate tenants to maintain their homes and keep them in good shape, so it’s not only housing associations or councils who are responsible . Residents need to work as a team with them. Landlords should walk around and see if their houses are well maintained. If they’re not, they should be asking why that is.” Rachel Williams and Shanthy Sooriasegaram P

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