Every year the Institute for Government and the Chartered Institute of Public Finance and Accountancy (CIPFA) publish Performance Tracker, a review of the state of our public services. It is the work of very experienced civil servants, accountants and experts in public finance. None of these are people noted for overdramatising issues, but their conclusions are devastating.
To sum up
They summarise their findings:
Public services are in a fragile state. Some are in crisis. Patients are waiting half a day in A&E, weeks for GP appointments and a year or more for elective treatments. Few crimes result in charges, criminal courts are gummed up, and many prisoners are still stuck in their cells under more restrictive regimes without adequate access to training or education. Pupils have lost months of learning, with little prospect of catching up, social care providers are going out of business or handing back contracts, and neighbourhood amenities have been hollowed out.
No prospect of returning to normal
The report examines nine public services in detail. These are general practice, hospitals, adult social care, children’s social care, neighbourhood services, schools, police, criminal courts and prisons. In every case the problems are substantial and the prospects for returning to “normal”, even in the medium term, look poor.
The report is absolutely clear that “efficiency savings” will make little or no contribution to the problem: “there is no meaningful fat to trim”.
Crises on top of long-standing problems
The report concludes that the problems are not new. After a decade of austerity things were already bad. Government had prioritised efficiency over resilience, without achieving either. Cutting out things which looked like “waste” left us unprepared when Covid struck. Now it would cost billions even to get back to the low levels of service we had two years ago. Improvements will cost much more.
All services will struggle with the impact of inflation, pay awards and energy prices. Planned increases in spending will not be nearly enough to recover lost learning for school children, to unwind the waiting lists accumulated by Covid in hospitals, or to reduce the huge backlogs in the courts and prison systems. The local government funding settlement will mean further cuts in social care, and neighbourhood services. Of the nine services examined, only the police will have enough to return to 2019 levels, which were already well below 2010 levels.
Backlogs are now extreme. At 7 million patients, the NHS queues for elective treatments are higher than ever before. The number of Crown Court cases waiting for trial has risen from 33,000 in 2019 to 59,700 today, the highest total since 2000. These figures underestimate the real scale of the problems. People who defer going to the doctor, for fear of infection or overloading the NHS still further, are building up more serious cases for the future. When people know that cases may take years to come to court, they, and perhaps the police, lose confidence in the system. Victims fail to report, and the police may be tempted not to pursue offenders. Laws which are not enforced, are not really laws at all.
Not enough people
Most of the problems cannot be solved by injections of money. In many cases there simply are not enough people. In some of these services there have been major staff shortages for a long time. They have been amplified by Covid, and Brexit. Shortages make the work more demanding for those who remain, who are then more vulnerable to illness and burnout, exacerbating the problems.
Although pay awards are putting great pressure on budgets, they are not keeping pace with inflation. The clapping for key workers during Covid did not result in better pay. It is hard to blame public service workers who are tempted to leave for better paid, less demanding work in the private sector. But filling the gaps cannot be done quickly: judges, doctors and social workers take years to train, and the government badly needs a long-term strategy for the public sector workforce.
The report has four recommendations. They say that government should:
- publish regular reports on workforce shortages
- publish plans on backlogs with milestones for the workforce and estate
- work across departments to align spending with policy priorities and break down “policy silos”
- improve the range and quality of data on service, and especially on adult social care
These are not people inclined to cry wolf
Civil servants and accountants are two professions famous for caution. But the picture they paint is devastating. The public services on which we all depend have been running down for more than a decade. The result is that when a crisis hits, they have no spare capacity to respond. Brexit, Covid, and now inflation (driven partly by war in Europe) have tipped them all into crisis.
The challenge facing government now is extraordinary. Taxes and borrowing are already high, but the services which hold the fabric of our society together are failing. Without more money, things will get worse.
Will the Sunak government rise to the challenge?
About the authors
The Institute of Government is an independent think tank, staffed mainly by former senior civil servants. They study, consult and report on the way government is run.
The Chartered Institute of Public Finance is an international accountancy body concerned with the efficient and effective management of public finances. It sets standards, trains staff, awards qualifications and provides information, advice and consultancy to public bodies.