KPMG Healthcare and Public Sector Senior Adviser Stephen Dorrell explores the implications of creating more joined up public services
In mid-2015, KPMG hosted a discussion about the implications for housing professionals of the current drive to create more joined up public services. This theme is important in every community in Britain; indeed my role in KPMG takes me to other countries as well, and the drive to create more integrated public services is reflected in every country in the world.
But, although the theme is universal, it was particularly appropriate that the meeting should take place in Manchester because – not for the first time in its history – Manchester is setting a pace in changing the shape of local public services. It is being closely watched by all those who are interested in the development of good public policy.
This provides the context for the question about the scope and pace of the development of devolution policy in Greater Manchester.
The case for the policy is simply made – local commissioners are better placed than more remote national bodies to create integrated local services. They can look across the silos created by national structures and focus on the needs of individuals and communities. The objective is services that provide both better quality and better value.
It is the opportunity of better quality and better value that dictates the answer to questions about scope and timetable. It is hard to see how demand for existing services, never mind the aspiration for improved services, can be met in Greater Manchester without the ability to break away from national formulae and create more flexible local services which are designed to meet local needs.
Any attempt to reduce the scope or slow the pace would simply undermine this process – with the result that service improvements would be threatened and resource constraints would become more pressing.
Re-empowering local government will take time and careful preparation, but as the process gathers pace I believe the drum beat for change will become more insistent and attempts to defend the status quo will sound increasingly perverse.
It is also the answer to questions from providers about prices. There will always be a healthy tension between commissioners and providers over fair reward, but commissioners need to ensure that their minds remain open to new ideas and new solutions. The commissioner’s task is not to reduce the cost of current services; it is to promote the development of new services which are better attuned to the needs of those who use them.
That requires the commissioner to be independent and locally focussed.
We so often hear about people who need help to allow them to continue to live at home. It is shaming how often different agencies allow their conflicts to hurt individual vulnerable citizens; local government, acting as the commissioner, should call such providers to account both by demanding restitution for those who are hurt, and by demanding improved performance in future.
It is not the commissioners’ job to manage service delivery; it most certainly is their job to see public services from the standpoint of those who rely on them and demand – on their behalf – “action this day”. This is also the answer to those who worry about achieving the necessary pace of change.
It is certainly true that citizens are wary of experts who tell them that institutions they trust need to change. It is not difficult to see why this wariness arises. Too often citizens are asked to endorse changes without anyone taking the trouble to analyse and explain why change is necessary.
Democracy has been described as “government by explanation”. It is possible to win the case for change, but it can’t be done without engaging in the argument.
It is why local government is so important in this process. At both local and national level there is an urgent requirement to make the case that public services need to change if they are to meet the combination of quality and value challenges they currently face.
Local government in Greater Manchester is preparing to make that case and carry through an ambitious programme of change. It is a process of fundamental importance to the citizens of Greater Manchester, but the precedent it creates will reverberate in many other cities across the globe.
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