Over the course of this inquiry the Trust will publish several research projects to inform the work of its Commission on 2020 Public Services. The Commission's final report will be published after the next General Election, with the aim of providing whichever party wins the election with a clear and comprehensive plan for reform.
From Social Security To Social Productivity: a vision for 2020 Public Services
The report calls for a complete reconfiguring of public services around the needs and capabilities of citizens, based on the principle of social productivity. It argues that our public services are increasingly unsustainable. The Commission calls for a new deal between citizens and the state, based on social productivity - greater social responsibility and more intelligent collaboration between citizens and public services.
Payment by Outcome: A Commissioner's Toolkit
by Gary L. Sturgess and Lauren M. Cumming with James Dicker, Alexis Sotiropoulos and Nadiya Sultan
This report is dedicated to understanding how government can use payment-by-outcome to extract better results from public services, promote innovation, increase accountability and encourage co-production from service users. Paying providers for the results they achieve, rather than the effort they put in, is a centrepiece of the Coalition government’s plans to reform public services. Therefore it is essential that politicians, policymakers, commissioners and service providers consider the serious criticism levelled at this policy and understand the implementation challenges they may face. Payment-by-outcome has obvious advantages, so it is worth exploring how to make it work well. This report is a toolkit: through a number of real world case studies, the authors have identified common problems and solutions that have been implemented or attempted. We hope to enable those involved in implementation to learn from experience and share knowledge across sectors in order to improve our public services.
Payment-by-Outcome in Long-Term Condition Management
The Department of Health estimates that treating and caring for people with long-term conditions accounts for 70% of the total health and social care spend in England. Long-term condition management aims to improve the health of sufferers and decrease the cost of their treatment by helping patients better manage their diseases. Important lessons for payment-by-outcome can be learned from the application of performance measurement and payment-by-results in this field.
Payment-by-Outcome in Offender Management
Half of adult prisoners released in England and Wales between January and March 2008 were reconvicted within 12 months of release. This appalling figure is behind the Government’s drive to implement payment-by-outcome in this area. Through analysis of pilots and proposals, this case study explores some of the tools that have been used to overcome the challenges in moving towards paying providers for reductions in re-offending rates.
Payment-by-Outcome in Welfare to Work
Payment-by-outcome has a longer history in welfare to work than many realise. One of the earliest large-scale schemes was implemented in the United States in 1982. A solid understanding of the challenges other countries have faced and how their programmes have evolved will give commissioners a greater appreciation of the diversity of tools at their disposal. This study also highlights, however, the importance of context and the need to adapt tools from other countries to suit particular circumstances.
Pricing Pharmaceuticals by Outcome
The cost-effectiveness of pharmaceutical products is coming under increasing scrutiny from institutional purchasers such as governments and insurers as part of a drive to contain rising health expenditures. In response to this pressure, manufacturers have begun to negotiate innovative pricing schemes for novel and expensive drugs based around health outcomes and patient response. Analysis of models developed over the last 10-20 years reveals general lessons and tools for the application of payment-by-outcome frameworks to public services.
2020 Public Safety: Opportunities for Reform
Our public safety services are overly complicated, inaccessible, and not delivering strong justice outcomes and clear value for money, says a report published today: 2020 Public Safety: Opportunities for Reform. As a new round of reforms begins, it is essential to agree the principles that hold together this vast range of diverse activity.
The Future of Competition and Accountability in Education
by Rebecca Allen and Simon Burgess
In this timely review of the evidence on the impact of competition among schools on educational outcomes, Dr Rebecca Allen and Professor Simon Burgess examine the difficulties of creating the conditions in which education quasi-markets can truly raise attainment.
Shifts in Culture, Power and Finance: A Way Forward for Education?
What do students, parents and professionals want from the education system? Do the Commission's ideas on reforming public services suggest a better way forward? This report sets out the findings from a deliberative event in Peterborough in June 2010. Contributions from Matthew Taylor and Julian Astle reflect on the themes that emerged. They find an overly prescriptive system which undervalues teachers and needs to engage parents more fully.
2020 Welfare: Life, Work , Locality
The current welfare system is based upon a model of individual incentives, sanctions and the strict monitoring of individual compliance. Instead, 2020 Welfare calls for a dynamic, integrated and more transparent approach that considers citizens within the context of their pasts, future aspirations, family relationships and local communities. It also suggests how welfare could be designed to increase personal responsibility and to make greater use of broader social capacity. In fiscally constrained times it is important public services harness this capacity for 'social productivity', but for a truly sustainable, effective welfare system we need to ground our sense of individual entitlement and citizenship within the wider collective.
The Distributional Impact of Public Spending in the UK
Ian Preston and Cormac O’Dea
Cormac O'Dea and Ian Preston here present a review of current literature on the first two of these questions. By exploring what is (and is not) known about the distributional impact of public spending they support 2020 PST's commitment to draw clearer lines of sight between contributions and benefits. As we suggested in November, "Cutting back public spending without understanding the impact of the present system of redistribution is like scrambling in the dark." The scale of recent budget cut announcements gives even greater cause to consider the distributional effects of tax rises and spending cuts in public services and welfare. ‘The Distributional Impact of Public Spending in the UK' is another ray of light on the matter.
Developing a Civic Approach to Public Services; Time to take pluralism seriously
This paper is an attempt to do just that, arguing that our notions of citizenship should not be fixed - neither totally ‘rational', nor inevitably ‘social' - but should instead be based on something more plural, that recognises the ‘existence and interplay of different civic ideals in our culture'. As we move to a political context in which the agency of citizens and communities is being encouraged as part of a ‘big society', these observations are worth paying attention to. If our assumptions about citizen capacity and motivation are myopic, then attempts to engage them in the design and delivery of their public services will fail.
Motivation, Behaviour and the Microfoundations of Public Services
Gerry Stoker and Alice Moseley
At a time when resources are scarce, it is all the more important that public services work ‘with the grain' of citizens' lives and make the most of our human tendency to support our family and local communities. In this paper, Gerry Stoker and Alice Moseley explore the evidence for man as a ‘rational animal'. They, like Bertrand Russell, find there is little to suggest that our behaviours are wholly motivated in this way.
Restoring Social Citizenship in an Age of New Risks
Hartley Dean proposes two ways of restoring social citizenship: the development of local social rights councils to build a bottom-up commitment for social justice; and, a campaign to advance supranational monitoring and enforcement of social rights. The time has come to pool responsibility by reasserting the fact that "citizenship is social"
Improving Health Outcomes - A Guide For Action
Our health and social care system is in flux. The new coalition government is setting out a fresh set of priorities for the NHS, and the fiscal crisis is already forcing difficult choices over the funding and organisation of social care services. Yet without fundamental reform to our health and care systems, short term measures will struggle to cope with the challenge of a changing society and daunting new demands. In this report, the 2020 Commission's health working group sets out how three shifts - in culture, power and finance - could provide the framework for such fundamental reform.
Democracy, Deliberation and Public Service Reform - The case of NICE
Dr Annabelle Lever
The role of public deliberation in government decision-making is at the centre of our current national debate. In the aftermath of the general election, our new coalition government - itself built on negotiation and compromise - wants to involve the public in some of the most difficult spending decisions for decades. In one recent poll, Ipsos MORI found that 66% of the public would ‘prefer a Prime Minister who mainly acts on the views and opinions of the general public to make decisions'. The idea of such a 'big conversation' is nothing new; but we have never quite got it right, and the stakes are now higher than ever.
In this enjoyable and challenging paper, Dr Annabelle Lever reminds us that engaging the public in a meaningful way is neither straightforward nor without its own underlying issues. Her analysis of NICE's experience of lay deliberation over the cost-effectiveness of NHS treatments demonstrates the validity and strength of 'deliberative solutions to seemingly technical problems'. But it also uncovers challenges. Deliberation and consultation are expensive; they are vulnerable to information asymmetries; and an objective presentation of the evidence being considered is difficult to achieve.
The Operation of Choice and Competition in Healthcare
Professor Carol Propper
Extending choice and competition in healthcare has been an explicit goal of successive governments in the UK. Provider competition can drive up productivity; patient choice can improve responsiveness to patients' needs. The potential of extending both is a system that provides better health outcomes at lower cost. As Professor Propper notes, a simple argument underpins this logic: "Competitive pressure helps make private firms more efficient", whilst "giving purchasers or service users the ability to choose applies competitive pressure to health care providers" (who will) "raise their game to attract business".
Yet in a complex and path-dependent system, the extension of competition and choice is neither linear nor inevitable. Nor are its impacts uniform or consistent. In the following paper, Professor Propper subjects the existing evidence to new scrutiny, and asks: do the economic arguments stack up? Does the evidence match the theory? And, given this evidence, what is the likely and desirable direction of travel in future?
Equality, Cohesion and Public Services
Public service policies have never been more focussed on reducing inequality and enhancing cohesion. Yet despite important achievements, services in general have struggled to make substantial progress. This report looks at what's changed and what hasn't. It asks how entrenched inequalities could be tackled differently, as part of wholesale reform of public services based on Commission principles.
The deficit: a longer term view
This presentation shows that while the UK’s budget deficit is a cause for concern, a longer term perspective demonstrates the need to transform our public services. Of a series of projections for public spending, our most likely scenarios (featured here) suggest that tax revenues would have to rise to 52% GDP (by 2030) unless we find new ways to deliver public services for less.
Rather than simply a matter of making cuts in the short run, public services should be redesigned to cope with the cost pressures of our ageing society, climate change, and the need for infrastructure investment. Where cuts have to be made in the short term, two questions need to be kept in mind:
- Impacts on future demand:
- What will be the long term impact of any change in the nature and/or level of welfare provided?
- Will this change make citizens more reliant on public services in the future or enable them to take greater responsibility for themselves and others?
- Distributional impacts
- Who will this cut affect? What will be the consequence?
- Will distributional consequences generate other demands in the long term?
Reflections on Public Service Reform in a Cold Fiscal Climate
Professor Christopher Hood sets out the historical and comparative precedents for significant public-sector reforms under conditions of fiscal stringency. He identifies three main reform strategies for public services in such conditions:
- ‘Resetting recent reforms’ (taking reform themes of the recent past, such as targets and rankings, and reorienting them for an age of fiscal consolidation);
- ‘System redesign’ (involving more radical changes in the ways services are provided or basic incentive structures for public services, for instance over funding mechanisms for devolved governments and local government); and,
- ‘East of Suez moments’ (involving choices about areas of public services to be abandoned to focus resources on existing or new ones).
These three strategies for public service reform are not mutually exclusive, none of them ‘belongs’ to one political party or ideology and all of them have accompanying disadvantages. In terms of the pace of change, Professor Hood suggests that the first and third may be more quickly deployable than the second. One challenge will be how to apply the first anad third strategies in ways that open up space for more transformative measures (the second) in the longer term.
Targets, choice and voice: accountability in public services
Deborah Wilson, Univ. Of Bristol
- Explores top-down and bottom-up accountability mechanisms
- Unpicks problems and benefits of both
- Shows that consistency and and alignment between them are key
Supply side futures for public services
Paul Grout and Pete Alcock, Univs. of Bristol & Birmingham
- Explores potential for more diverse supply side mkts in future
- Looks at opps & challenges for priv, state & 3rd sector providers
- Concludes that fostering a vibrant & diverse supply side will be difficult, but will be key to achieving the 2020 vision…
The future of joined-up public services
Patrick Dunleavy, LSE
- Public services are too fragmented & too complex for citizens
- Asks: how can we join up & meet people's needs more holistically?
- Answer is Digital Era Governance – enhancing potential of technology, and reversing some of the fragmentation pushed since the New Public Management era.
2020 Vision: A far-sighted approach to transforming public services
Public services are a cornerstone of British society and it is vital they be the best that can be offered. Given the scale of the challenges Britain faces, including the current fiscal crisis and the long-term crisis driven by, among other things, an ageing population, if public services are not transformed, there is a danger that they will simply be cut to the point that they can no longer cope with demand. 2020 Vision: A far-sighted approach to transforming public services discusses how best to enable citizen involvement in setting priorities for public action, delivering outcomes from services and holding service providers and government accountable for their performance. The report analyses the barriers to transformation, recommends steps to overcome them, and provides some practical examples of the types of policies that could create the conditions for transformation. At a time when a new coalition government has come to power and will need to deal with the present and long-term crises, 2020 Vision provides a framework for action to ensure public services continue to play a central role in making life better for all.
Citizen engagement: testing policy ideas for public service reform
This qualitative research report by Ipsos MORI gets under the skin of public attitudes to public services. We know from the evidence gathered for us by Ipsos earlier this year, and published in partnership with the RSA, that the public value public services highly and are wary of reform which might threaten their relationship with them. In this, the second phase of the research for the 2020 Public Services Trust (2020PST), we probe the values and judgments underpinning these attitudes, as well as testing responses to specific proposals.
Delivering a Localist Future: a route-map for change
We have got lost on our way to localism. It has been
endlessly debated, important steps have been taken, but we're yet to reach the
destination. We remain one of the most centralised states in the
developed world, and this has been bad for our democratic life and bad for our
ability to create services that engage with and change people's lives. Delivering
a Localist Future: a route-map for change sets out a practical way forward,
arguing that today's fiscal crisis can be a driver of reform, rather than an
additional road block.
There should be negotiations between central government and the large cities and counties that are operating as sub-regions. These will agree ‘more for less single place budgets' securing the devolution of new powers and financial freedoms in return for a flat rate reduction in central funding. Accountability needs to shift accordingly, as argued in a recent IPPR/PWC report. A clearly visible figure - similar to a Mayor, Commissioner, Sheriff or Governor - will be accountable for the single place budget.
The route-map does not simply transfer power from Whitehall to Town Hall. It challenges local government to empower citizens and communities more effectively, extending individual budgets, neighbourhood and community mutuals and commissioning, with a plurality of service providers, including voluntary sector providers. Power must genuinely start to flow up from the citizen, rather than down from the centre.
Online or in-line: the future of information and technology in public services
From Twitter and Second Life, to online banking and blogging, it is no exaggeration to say that technology is transforming the way many of us live our lives. Whilst we can readily order pizza over the internet, buy clothes and even purchase business services online, we are often limited to standing in queues or waiting on hold to speak to public services and government.
Technology opens up the capacity for information and online services to be within easy reach of citizens. It also allows for greater dialogue between service users and providers, enhancing the potential for government to deliver more responsive, accountable and cost- effective public services.
But there are serious concerns that need to be addressed, including privacy, data security and individual consent for data sharing. Questions also arise about the role of central government, private firms and third sector organisations in building capacity for better use of data and information in public services. This report addresses these challenges and sets out a range of policy options that need to be brought into the public debate.
Officials, professionals, geeks, techies, and citizen activists - Online or In-line is for you.
Beyond Beveridge: Principles for 2020 Public Services
'Beyond Beveridge' is the interim report of the Commission on 2020 Public Services. It sets out the urgency for change, the limits of our current public services settlement, and the need for a systematic and long-term approach to reform. The report offers a positive vision for 2020 public services, and three policy building blocks to get us there: a shift in culture, a shift in power, and a shift in finance. The report represents the interim findings of our diverse and experienced commission, and the principles on which it will base its final conclusions in summer 2010.
What do people want, need and expect from public services?
Ultimately, the public will decide the future of public services. What do they want, need and expect from their services? In this authoritative report, prepared by Ipsos MORI, the most up to date quantitative and qualitative data is used to explore the public’s priorities and anxieties. It suggests how the relationship between citizens and their services might change in the future. In particular, it suggests that there may be some appetite for citizens playing a more active role in deciding or reviewing the actions of public services, although the limits of this appetite and the conditions for translating into action need to be clearly understood. Published in partnership with the RSA, with the generous support of the Joseph Rowntree Foundation and the DCLG, the report brings home the need for politicians and policy makers to engage more urgently and honestly about the choices ahead for public sector reform.
Financing the United Kingdom’s Welfare States
Professor Glennerster's paper is timely and prescient. Accusing politicians of having an acute "case of myopia", he asserts that to continue to fund the current range of services, reduce child poverty and help the poorest elderly people pay for the costs of climate change will require an additional 4-6% of our GDP over the next twenty years. Adding these estimates to HM Treasury forecasts increases the share of national income spent by government to over 45% by 2020. Yet public tax receipts have rarely been above 40%. In the face of this, Professor Glennerster advocates thinking strategically about which groups can afford to pay more into the welfare state, using partnership models to share costs between the state and citizens, and thinking creatively about how to get services to do more with fewer resources. But the most striking argument Professor Glennerster makes is that even if all of his perhaps unpalatable recommendations were implemented, by 2028 the Exchequer would still need to raise a sum of 2-4% of GDP through general taxation.
Scoping the Challenges for 2020 Public Services
A Brief History of Public Service Reform
A Brief History of Public Service Reform is the first publication in the Scoping the Challenges for 2020 Public Services series. This series of three publications seek to survey the landscape of issues and questions we need to pose to hold a coherent and comprehensive debate on the future of public services. A Brief History of Public Service Reform is an analysis of UK welfare and public services from before 1945 to the present day. It explores the evolution of the system and when, why and how change took place. This report seeks to answer how we have got here and identify the prospects for radical reform – aiding the national conversation on the future of public services.
The Commission encourages readers to join the debate, by clicking below on ‘Add a Comment’ to have your say.
Scoping the Challenges for 2020 Public Services
Drivers for Change: Citizen Demand in 2020
Drivers for Change: Citizen Demand in 2020 is the second publication in the Scoping the Challenges for 2020 Public Services series. This series of three publications seek to survey the landscape of issues and questions we need to pose to hold a coherent and comprehensive debate on the future of public services. Drivers for Change: Citizen Demand in 2020 examines over 30 social, cultural and technology trends that will have a bearing on the demand for public services, and explores three scenarios which illustrate life as it might be in 2020. Everyone has an interest in the debate on the future of public services; as citizens, as users of public services, and as taxpayers. In creating alternative scenarios and describing their implications for fictional characters, the aim of the report is not to predict the future. Rather, it is to dramatise the debate about the future choices our society will face and provoke new thinking about how policy makers might respond. In doing so, we hope to encourage a variety of voices to join this conversation.
The Commission encourages readers to join the debate, by clicking below on ‘Add a Comment’ to have your say.
To cope with the fiscal challenges the UK faces and still deliver world class public services, government will need to re-think the ways it delivers services at the central and local levels. Government will need to encourage and reward innovation and create powerful incentives to focus providers on the results citizens want from public action. Better Outcomes describes a radically new approach to realising public outcomes. Outcome commissioning involves specifying outcomes to public, private and voluntary sector providers and paying them when results are achieved. Better Outcomes analyses the challenges to implementing this approach, such as extraneous variables and time lags, concluding that there are various ways to resolve these issues, including implementing yardstick competition or using surrogate measures. Outcome commissioning is applicable in many areas, from foster care to waste management to IT systems. We urge politicians, policy makers and service managers to engage with these ideas and issues to improve outcomes for the public.
The Fiscal Landscape: Understanding contributions and benefits
This project is part of the third and final strand of our Scoping the Challenges series. Having identified the case for reform, we now consider how we might finance public services in light of the demand pressures in 2020. The current fiscal situation and impending public spending cuts makes this work even more urgent and important. How, for example, will we meet the costs of an ageing population when there is already a great hole in the social care budget? What of the cost implications of increased longevity on the health service and pensions? In considering what the state should provide and how it can be funded in the future, it is vital that we understand the current pattern of tax and spending in the UK. Only then can we have an informed discussion on what can be cut, and who will feel the pain. ‘The Fiscal Landscape: Understanding the contributions and benefits’ is a first step in our attempt to shed greater light on ‘who gains, who pays, and how much?’ from UK public spending.
Avoiding a repeat of the 1980s
For all the reform strategies and grand narratives emerging from Whitehall, much of the real action will happen at the local level.... read the full article
A new settlement for public services, by Clare Tickell
The state needs to be smaller. This is the conclusion not of the coalition government, but of a cross-party group of politicians and experts on the RSA’s 2020 Public Services Trust, whose final report is out soon.
... read the full article
Meeting the place-based challenge
Bill Cooper of KPMG and Ben Lucas of the 2020 Public Services Trust warn that many councils are not yet fully prepared to take on the new responsibilities of place-based budgeting.... read the full article
The coalition's NHS reforms - far enough or a 'quick fix'?
The NHS was recently ranked as one of the most efficient and effective health systems in the world, so is radical reform an unnecessary risk? Dr Greg Parston looks into the matter.... read the full article