A flurry of speeches addressing public service reform have come out in November 2024 as new ministers get their feet properly under the table.
A speech from West Streeting to the NHS Providers annual conference was called out by some as a return to name and shame - a throwback to the darkest days of the mythical reign of ‘targets and terror’ in Blair’s first term.
Home Secretary Yvette Cooper’s speech was badged as the most fundamental reforms to policing for 50 years but seemed much better received by the great and good of policing.
And the positive tone of Secretary of State for Education Bridget Phillipson’s speech to the Confederation of School Trusts was such that some saw it seen as the antithesis of the ‘unadulterated barberism’ of Wes Streeting.
Is there a schism in the Government’s approach to public service reform? Are we returning to a punitive performance regime that is straight out of the early days of New Labour?
A return to the naming and shaming of public service managers?
Health Secretary Wes Streeting’s speech to the NHS Providers annual conference in November addressed how best the government can make the performance and organisational health of providers and integrated care boards [ICB’s] transparent and support their leaders to drive improvement. He also outlined the role of government as the intervenor of last resort when all other measures fail to result in improvement.
We’ll assess [ICB’s and providers] against a set of criteria and publish the results, starting from next year.
Those ICBs that perform best - particularly in developing neighbourhood health services - should also enjoy greater freedom and flexibility.
We want to move to a system where freedom is the norm and central grip is the exception to challenge poor performance.
If performance dips, I reserve the right to take those freedoms away. For those judged to be persistently failing, we will act.
Turnaround teams will be sent in to diagnose the problem and help fix the problem, financial controls will be imposed if necessary and where leadership is found lacking, they will be removed [Wes Streeting, speech transcript 13-11-2024 ]
Such themes were a gift for headline writers
NHS hospitals that underperform to be outed in league tables…[FT 13-11-2024]
Wes Streeting plans to name England’s failing trusts and sack poor bosses in bid to raise performance [FT 13-11-2024]
AI image generated by Adobe Express 24-11-2024
In response some practitioners were incredulous, exhibiting perhaps a form of PTSD from the high point of the Department of Health and NHS’s uniquely aggressive and directive approach to the measures and targetry of the Blair governments in the noughties.
…the big NHS plan is to be… naming and shaming? Complete with inflammatory language that’s designed to scapegoat staff, such as the bad managers you’ve branded the NHS’s guilty secret? Do you genuinely think this is constructive? …Worse, league tables are a very blunt and very public form of ritual humiliation – precisely the kind of punitive exercise that has demonstrably negative effects in healthcare. In fact, a a no blame culture in medicine has been shown to improve safety by fostering openness, discussion and learning from mistakes – yet Streeting wants blame itself to be embedded in the heart of his reforms. [Rachel Clarke, Palliative Care doctor and author in Guardian 13-11-2024]
More measured reactions made the point that these historic anxieties will be mitigated or not by how the department goes about this in practice:
There’s a difference between the intent and the way they do it and going back, there is a risk that this will demoralise staff and you will see that in poorly performing areas. [Dr Adrian Boyle, President of the Royal College of Emergency Medicine in FT 13-11-2024].
Whilst relatively rare, the political appeal of naming and shaming comes at the cost of long-lasting resentment and distrust within the sector. One of the worst examples was Ed Ball’s highly political naming, shaming and sacking of Haringey’s Director of Children’s Services in the light of the inquiry into the death of Baby P. It may have played well on the front page of the Sun but remains notorious within the sector almost 15 years later. And the court of appeal subsequently ruled she was "unfairly and unlawfully" sacked [independent 28-5-2011]. As the Director herself reflected:
"My sorrow about the death of Peter Connelly in Haringey when I was director is something which will stay with me for the rest of my life. But as the judges have said, making a 'public sacrifice' of an individual will not prevent further tragedies."
Streeting deflated the headline writers’ outrage by promising not to engage in manager bashing “I could be no more popular that announce the sackings of lots of managers, but that would not be the right thing to do… I am prepared to make the unpopular argument about the value of good leaders.’ He is right to make that promise. He went further to challenge the way the NHS operates:
“I’ve regularly heard the criticism of the top-down nature of the NHS. It can be a difficult criticism for those at the top to hear, but for the last 4 months I’ve found myself at the top of the system - at the peak of the mountain of accountability - and I not only recognise the criticism, I agree with it. The NHS in 2024 is more hierarchical than almost any other organisation I can think of.
Whilst most of the press and social media reactions focused on league tables and rankings (neither of which feature in the speech) and ‘sackings’ they fail to address the totality of the speech which was actually quite an enlightened if inevitably high-level take on how best to enable localities and institutions to improve health, wellbeing and services. He outlines a role for government as a steward of the health system, rather than the top-down controller of health institutions. This role entails devolving policy making, prioritisation, commissioning and resources to local Integrated Care Boards. The approach faces some entrenched barriers within government and the civil service which will need to be confronted if these reforms are not to run into the same buffers as previous efforts.
Within press headlines and social media reactions there is as ever something formulaic and theological about the ahistorical rage at the evils of the Blairite regime. Such narratives fail to recognise that the noughties were in fact a decade of experimentation, learning and substantial evolution in how best government uses priorities and elements of performance management to steer public services, improve public services and ensure value for taxpayers’ money.
However, one thing that changed little during that decade was the toolkit of intervention in poor performing institutions offered to Ministers’ by their advisers. We now have two decades of evidence that you don’t improve performance by punishing people or telling them they are poor performers. For persistent poor performers, it is clear those intervention did not work. For example, Birmingham City Council has become a byword for failed political leadership and mismanagement. Despite two decades of interventions, special measures, inspections and commissioner’s etc it remains mired in poor performance and financial crises: unable to retain a chief executive for more than a couple of years – the sustained failure of local politics is depressing. Government must develop more viable and effective options for its unavoidable role as intervenor of last resort for serious failures and crises in local public services. The balance of effort needs to shift towards supporting capability building, learning and improvement.
The new government’s approach to public service reform
Back in the main body of Streeting’s speech there is much more about the compelling if lightly drawn strategic drivers of the 10 year plan for health that is under development:
· from hospital to community;
· from analogue to digital; and,
· from prevention to health.
He makes the case for moving power from the centre to local integrated care boards, providers and patients. Critically he argues that resources should accompany this flow of power from the centre, with fewer targets supporting the national priorities. The outline performance regime is familiar: best performing boards and providers to be given greater freedom and flexibility to innovate, run community services and manage their own house to meet the needs of patients - regardless of whether they are a foundation trust or not. And he put a strong emphasis on valuing and supporting leaders – clinical and executive. He has commissioned work to address the substantial workforce and talent challenges that will face the 10 year plan.
The main themes in Streeting’s speech reflect many of the most important insights from the Blair/Brown period of performance measures, accountability and service improvement.
There are echoes of Streeting’s approach to performance transparency and accountability in Home Secretary Yvette Cooper’s substantial policing reforms which were also announced in November. Amongst other measures aimed to create new national capabilities she is creating a new Police Performance Unit to track national data on local performance and drive-up standards. A flashback to the undervalued Citizens Charter reform of John Major in the 90’s is provided in the form of a Neighbourhood Policy Guarantee. The guarantee is one of a number of measures that seek to rebuild trust between the policy and the communities they serve. She promises a ‘more active role from the home office in working with police leaders to drive improvements and ensure policy is set up to succeed’. So far, her reforms have been more positively received by the policing sector that Streeting’s changes in Health.
Ed Dorrell of Public First hypothesised that recent reform speeches expose quite opposing approaches to public service reform within the new government.
the Department of Education… is slowly but surely reforming schools and colleges in ways designed to lessen the impact of competition in the system, soften the harder edges of accountability and increase collaboration. The department is implicitly rejecting the ideas of Michael Barber’s New Public Management theory… Improvement in schools will come… if we can get heads and school leaders to work together and share best practice without the threat of a punitive system looming large, driving pressure. These ideas are squarely located in emergent ideas of “social value”, which is very much a counterpunch to NPM.
He contrasts this with Wes Streeting’ speech, which he somewhat misrepresents as
‘pure, unadulterated Barber-ism. a speech outlining an NHS reform agenda that felt straight out of 1999. League tables between hospital trusts are to be introduced, he explained. Hospital managers that underperformed would be eased out; those that were delivering would have “earned autonomy”.
In fact the speech delivered by Streeting is at not at all odds with the implications of ‘public value paradigms’ of public management which led directly to the notion of government as system steward that was embraced by Brown’s government in the late noughties.
But the traction of the ‘schism’ view emphasises the need for Starmer’s new public service reform team to establish a clear narrative about the common threads that will drive public service reform in the new government. There is too much scar tissue in the local public services sector from the past excesses of inspection, audit and intervention to assume people will think the best - or engage positively with reform efforts. Trust will have to be earned, and as ever would be quickly lost by a bit of off the cuff naming and shaming.
A decade of learning: from top down targets to ‘total place’
During the noughties the government’s approach to performance management changed hugely. There was a sustained effort by the treasury to soften the ‘top down targets’ regime through local area agreements and local area PSAs. By 2007 PSAs focused on cross-cutting outcomes rather than narrow inputs and outputs, reflected extensive consultation across sectors, and led to a big reduction in the number of with targets imposed on local public services.
In 2002 the PSA regime was joined by the innovative approach of the Prime Minister’s Delivery Unit (PMDU). PMDU was much more nuanced and collaborative than the lazy ‘barberism’ label. At its best it was about an adult supportive collaboration with those accountable for delivery of the PM’s top priorities. It provided challenge to the quality of policy thinking as much as it questioned and supported planning and implementation (see case study on PSAs and PMDU, Panchamia and Thomas 2014).
The culture of the unit under Barber was that of a critical friend – who would roll their sleeves up and help the accountable department to succeed at same time as enabling the personal accountability of the responsible ministers and senior officials to the Prime Minister. Above all the unit proved to be a capability building factory: equipping many thousands of civil servants and plenty of ministers with performance management and delivery problem solving methods.
The PMDU approach had its limitations – most notably when faced with cross cutting outcomes, and when its scope was expanded beyond the small number of the Prime Minister’s top priorities it was designed for.
In parallel to this evolution of prioritisation, planning and performance management a radical change in the view of how governments should work was fuelled by five years of work in the Blair government’s Strategy Unit (SU), itself inspired by earlier academic work on public value (Moore, 2001). This work reflected the emergence of ‘whole of government’ reforms throughout the Blair governments (Christensen & Lægreid, 2016)and academically was best articulated in the twin paradigms of networked governance (Osborne, 2006) and public value management (PVM) (Stoker, 2006).
In the PVM framework the role of the state is to ‘steer society’ through dialogue and exchange with a wider range of participants in a complex and uncertain world. Rules and incentives are insufficient - new ways to collaborate and legitimise decision making are needed. The implications for political and managerial leaders are profound: success depends on the building of successful relationships through networks and partnerships… ‘efficiency is not achieved by handing over the job to bureaucrats or managers… the key is learning exchange and mutual search for solutions.’… ‘no one is in charge but leaders at various levels play a role. It is not a linear relationship between a principal and agent.’ (Stoker, 2006). The thinking and implications for government are clearly set out in the Cabinet Office’s pamphlet on public service reform (Kelly, Gavin et al., 2002) and Brown’s Smarter Government (CM 7753, 2009).
Exhibit 1. The roles and way of working of government as a system steward
Source: Strategy Unit 2002
The system steward role demands a quite different way of thinking and working from ministers and especially from senior officials.
A test case for some of these system stewardship roles came in the form of the remarkable if short-lived Total Place reform. The programme was launched in the budget in 2009 and was designed to be ‘a fundamentally different approach to public service reform, putting local authorities and their partners at the forefront of a drive to look at all local public service spending: uncovering waste and duplication and freeing up resources to refocus on what people actually want and need’. (HM Treasury & DCLG, 2010).
In practice it became a bold effort to pioneer open policy making through a process of supported co-creation. It established a local process of exploration of assets and opportunities in order to prioritise deeper dives into issue with sufficient local ownership and energy to mobilise the key local players. After exploration through these deep dives the local programmes co-created policies and plans to tackle their issue.
The promised incentive for local public agencies was to be an increase in local freedoms to operate and a progressive removal of the ring fencing of central government resources.
The process was beginning to show a way for local and national policy makers and deliverers to take a strategic look at their assets and existing policies – and driven by the timescales of the programme, make choices about where there was sufficient imperative and common ground to act on specific clients and issues. It was a practical model for many of the key roles of a government acting as a system steward.
A first version of my case study on Total Place will be published here in December 2024. A second iteration will draw on upcoming primary research with active players in the reform, and is due to be published by the Summer of 2025.
Some fundamental barriers to total place
But after just 12 months of the total place pilot phase there were signs the programme was bumping up against two systemic barriers to open policy making and the devolution of both resources and decision making.
1. Resources and accountability
The hard wiring and accountability of Whitehall is a huge barrier to more meaningful devolution of control and policy making – regardless of any evidence that such an approach is more likely to deliver on national priorities.
A central finding of the Total Place pilots was that Whitehall departments would have to devolve significant decision making power relating to ‘their’ services to the local level for this radical approach to work (Hambleton & Howard, 2013). This was something they were not poised to do as at the end of the programme in 2010.
The system of ministerial accountability for spending is flagged as the key factor in this blockage. The long serving principal private secretary to Cabinet Secretary Gus O’Donnell, Ciaran Martin, who lived through the most sustained push to create a sense of collective leadership of the civil service offers a blunt warning:
I’m consistently astonished by the endless attempts to reform British Government in the absence of any consideration of why the departmental structure is so embedded & why so called ‘silos’ exist… For ministers, statutory powers are vested in the concept of a secretary of state, ie the ministerial head of a department. Not a mission board. Not a cabinet committee. Not a working group… They overwhelmingly drive the day-to-day incentives of ministers and senior officials… And they always will unless they are fundamentally changed… any serious change would be a huge and difficult job involving very difficult trade-offs. [Martin, BlueSky 8-2024]
This barrier was not addressed by the programme design of total place. It has proved a step too far for even the most reformist ministers.
I remember a conversation around 2005 with Matthew Taylor, the Prime Minister’s Chief Adviser on Strategy in no10, about the challenges of joined up working. He was pondering whether it was inevitable that the only solution to the struggle on cross cutting priorities would be to take main programme resources and decision making on policy out of departments and put them under a new outcome focused vehicle with Ministerial leadership. Given the continued failure of soft measures such as committees with no meaningful accountability or control it is hard to avoid the conclusion that hard measures will be necessary for some government missions and priorities. But they will likely be strongly resisted by permanent secretaries and the Treasury.
2. Power, control and identity
Perhaps the most serious barrier to meaningful public service reform is how politicians and senior civil servants see their roles and identity, and the centrality of power and control to both.
I think as much as anything Whitehall killed [total place] because this was a threat to the way that Whitehall operated. You could only make this work if you gave people at local level permission to spend the money differently. Denham 31-1-2024 in https://www.newlocal.org.uk/articles/total-place-2-0-video-john-denham/
Academic literature on co-creation of the type analogous to total place notes the threat that such an approach poses to the fundamental roles and identity of both ministers and senior officials.
For those policy domains where devolution and collaborative policy making are most relevant (health education, local government, housing, benefits administration, employment etc) senior officials would no longer be the principal policy adviser, and instead would require system stewardship capabilities that their careers rarely equip them with.
Secretary of State John Denham who led on total place during its short life is clear that rethinking these roles demands a profound cultural change in Whitehall:
I’ve been there, it’s very tempting, you get into your department, you think there are levers you can pull, you can change everything from Cornwall to Coventry to Cumbria, you can’t, it doesn’t work like that, and so I think we need ministers coming in who actually know that in order to deliver the ambitions they have, they’re going to need to send to Whitehall the signals that a culture change in Whitehall is essential. Denham 31-1-2024 in https://www.newlocal.org.uk/articles/total-place-2-0-video-john-denham/
He also reflects that it is officials who will find this a tougher challenge to their roles than ministers, a finding echoed in the IfG’s report on system stewardship.
“it’s having the leadership and the confidence to lead forward a system you don’t control – and that feels very uncomfortable for politicians, and feels even more uncomfortable for civil servants” Senior Official 2010 in (hallsworth, 2011)
Conclusions
There is much that is encouraging about the early outlines of the new government’s approach to public service reform. They seem to be drawing on many of the lessons from the intense period of reforms during the 90’s and noughties.
But they must also pause to reflect on what hampered or frustrated those reforms. Those barriers to reform add up to substantial unfinished business which needs the attention of the strategists at the heart of government, the public service reform team in the cabinet office, and those departments working with local public services:
1. Work out what works in supporting improvement, capability building and innovation in the local public service sector. There are plenty of pockets of good civil service practice, sector led and international examples– but government has lacked a coherent view on how best to support or enable this in public services.
2. Tackle the profound barriers to cross cutting working and devolution. The new government needs to address the fundamental barriers in central government that prevent further delegation of decision making, policy making and devolution of ringfenced resources from main programme). The principal barriers are the system of accountability and the mindset of Minister’s and especially senior officials. As in the noughties the Treasury would need to be an active and positive leader of such changes. They have run elements of spending reviews in the past as thematic outcome focused reviews, and will need to do so again.
3. Establish a coherent vision for the changing role of government. Both of these issues demand serious attention to what it means in practice to govern as a system steward in respect to local public services. Much of the ground work and thinking has been done but bold steps and some reformist senior officials will be needed. After a decade of hunkering down it is not clear they are well set to provide this.
In 2016 one of the finest public administration scholars (Pollitt, 2016) looked back on the evolution of public management research in what became his valedictory article. He observed that successive models of reform in the UK since the 1960’s hold ‘the underlying belief that it is managers who are the key to a transformed public sector... they are the focal point not politicians or frontline staff... managers make things tick.’
He rejects this belief and his conclusion is striking: ‘managerialism is not enough, managers cannot restore fiscal balance, cannot save the welfare state and are certainly not the primary guardians of democracy.’
Public service reform will be necessary but far from sufficient.
Instead, the missions and biggest priorities of the government demand courageous political leadership: bold vision, tough prioritisation, determined action, and innovative policy making. They will need to be supported by a new forward looking Cabinet Secretary and senior officials who are up for the major changes that will be required to support their political choices.
References
Christensen, T., & Lægreid, P. (2016). Transcending new public management: The transformation of public sector reforms. Routledge.
CM 7753. (2009, December). Putting the frontline first: Smarter government. HM Government.
hallsworth, michael. (2011, April). System Stewardship. The future of policy making? Institute for Government.
Hambleton, R., & Howard, J. (2013). Place-Based Leadership and Public Service Innovation. Local Government Studies, 39(1), 47–70. https://doi.org/10.1080/03003930.2012.693076
HM Treasury, & DCLG. (2010, March). Total place: A whole area approach to public services. HMSO.
Kelly, Gavin, Mulgan, Geoff, & Muers, Stephen. (2002). Creating public value: An analytical framework for public service reform. Cabinet Office Strategy Unit.
Leadership centre for local government. (2010). Places, people and politics: Learning to do things differently. Leadership centre for local government.
McNeil, Clare. (2012). The politics of disadvantage: New Labour, social exclusion and post-crash Britain. IPPR, Lankelly Chase.
Moore, M. H. (2001). Creating public value: Strategic management in government (6. print). Harvard Univ. Press.
Osborne, S. P. (2006). The New Public Governance? 1. Public Management Review, 8(3), 377–387. https://doi.org/10.1080/14719030600853022
Pollitt, C. (2016). Managerialism Redux? Financial Accountability & Management, 32(4), 429–447. https://doi.org/10.1111/faam.12094
Pollitt, C. (2017). Public management reform: A comparative analysis - into the age of austerity (Fourth edition). Oxford University Press.
Sørensen, E., Bryson, J., & Crosby, B. (2021). How public leaders can promote public value through co-creation. Policy & Politics, 49(2), 267–286. https://doi.org/10.1332/030557321X16119271739728
Stoker, G. (2006). Public Value Management: A New Narrative for Networked Governance? The American Review of Public Administration, 36(1), 41–57. https://doi.org/10.1177/0275074005282583
コメント