These are turbulent times for the public sector in the UK. And whilst that turbulence is significant throughout the four home nations, it is particularly severe in those countries like Wales where the public sector accounts for a significantly greater proportion of total economic activity. The squeeze on public sector spending that was introduced by the UK’s Coalition government following the last General Election, and which translates to the Welsh Government’s budget through the complexities of the Barnett Formula (http://en.wikipedia.org/wiki/Barnett_formula), is having an increasing impact on the ability of public services in Wales to meet their statutory obligations. Consequently, there has been a steady stream of news stories focusing on plans to re-organise health services, local authorities, and education provision, all with the aim of reducing costs.
Earlier this week, the Williams Commission presented its recommendations on the future for local government in Wales, recommending a reduction in the number of unitary authorities from the current total of 22 to something nearer eleven (http://www.bbc.co.uk/news/uk-wales-politics-25776603). The (at least superficially appealing) logic is that fewer, larger organisations will be more efficient to run, and that consequent savings can be used to sustain or even develop and improve essential services. This report comes hard on the heels of reports reaching similar conclusions (although for slightly different reasons) around the organisation of health services in Wales. In the case of the NHS, the proposals are to concentrate specialist services into fewer centres to ensure that there is a sufficient volume of cases in each location to support appropriate levels of staff training and expertise. The driver for the NHS changes is less around funding, and is more a response to the concerns being raised by the relevant Royal Colleges of medicine, surgery and other specialties, that spreading service provision very thinly across different hospitals is unsafe in and of itself, and fails to provide an acceptable level of experience for medical trainees developing specialist skills in preparation for Consultant level posts. Interestingly, the debate on health has moved on recently, with the Welsh Health Minister pointing out that there is robust evidence supporting the view that something in the order of 20% of NHS spending is currently committed to things that we know do not work (http://www.bbc.co.uk/news/uk-wales-25753591).
That public service delivery in Wales needs to change in order to respond to the new reality of reduced public spending and increasing demand, is unarguable. The status quo is not an option. What is disappointing about the current way in which the debate is progressing though, is the lack of a radical, visionary alternative to the current arrangements. The Welsh Government has previously prided itself on its aim of developing policies and approaches to public service delivery in Wales that were demonstrably different to those in the rest of the UK. Rhodri Morgan’s reference to ‘clear red water’ in the early days of the Assembly is the most striking example, but is by no means the only one (http://news.bbc.co.uk/1/hi/wales/2565859.stm). It is regrettable therefore, that the proposals for the NHS and local government now seem both timid and focused on structure, rather than offering bold and alternative approaches focused primarily on the needs of service users and communities.
As an example, the Williams Commission appears to have been limited in its review of local authorities by a desire to establish and/or maintain shared boundaries with police force, health board and EU financial aid areas. This seems like a classic case of two wrongs not making a right. To take policing as an example, it is very unclear that there is any real case for suggesting that Wales needs four police forces (with four Commissioners and commensurate duplication of support functions and overheads), when Scotland appears to be managing quite satisfactorily with one (http://www.scotland.police.uk/about-us/). And EU financial aid boundaries were drawn up specifically to match the existing local authority boundaries – the very boundaries that are now deemed to be no longer appropriate (http://wefo.wales.gov.uk/programmes/20002006/objective1/?lang=en).
What might a radically different approach to public service delivery in Wales look like? It could take as its starting point the services themselves and the best way of delivering them to meet the needs of the users. It would challenge the existing assumptions about the value of local accountability and the importance of local political control. It would question whether it is any longer morally or ethically appropriate to justify different charging arrangements for social care services in different parts of Wales; whether the availability of drugs for treating the same conditions should be different in Cardiff than in Merthyr Tydfil or Denbigh; whether refuse collection services required by the people of Torfaen are really so different from those in Conwy or Pembrokeshire; whether the educational needs of seven year olds in the Vale of Glamorgan vary significantly from their playmates in Anglesey or Wrexham. If the answers to all or any of these questions is ‘no’, then the whole rationale for delivering these services through organisations based on geography begins to disintegrate. There may be very good reasons for having different governance arrangements for the police service as compared to social services and refuse collection, but these reasons are service related, not to do with where they are delivered.
A radical approach might see national delivery agencies for health, social care, education, highways and infrastructure etc.., with full executive responsibility for the implementation of national (Welsh Goverment) policy, informed and held to account by local boards representing service users and other stakeholders. ‘Local’ government would exist to facilitate local (and probably non-statutory) service delivery in areas such as leisure services, community facilities, libraries, parks and the like. These authorities could be much smaller than the existing Unitaries, and would be much less expensive to run. There would need to be an increase in the number of Assembly Members to allow that body to properly oversee the delivery of national service agencies, alongside its legislative role, but the additional costs would be minimal compared to the savings against the current overall cost of government at all levels in Wales.
The challenge facing public service delivery in Wales in the next decade is unprecedented in its scale and likely impact. Just doing the same things slightly differently will not cut it in this new reality. New challenges demand a new radicalism.