Can the public sector changeI went to an event very recently where a number of public sector and not for profit organisations were shouting very loudly about the joined up way in which they were working together and the great benefits that were being delivered to their customers.

On the face of it, this was exciting news but was everything as it seems? I can hear readers now thinking ‘he is going to have a go at the NHS’. Well in a way you would be right and in a way wrong. It is brilliant that service deliverers can improve and extend the range of services and observe genuine results.

So where is the problem? Well, the biggest one comes when someone reminds us that ultimately these organisations are spending our money. One of the people present who commissions services provided compelling evidence that these services were being effective. Commissioners have predictions for future service demand. This helps to ensure the amount and type of services required are actually there. The commissioner stated that demand was increasing much less than predicted which implies that prevention is working.

Well, that’s that then? Not quite. A gentleman asks politely but in a very ‘civil servant’ type of manner, what evidence he can put on the table at a meeting he is going to attend the next day. He wants facts (and lots of them) as do his colleagues (anyone with the word ‘Manager’ in their job title). We have a whole raft of people whose job it is to justify and account for spending.

The organisations are delivering new or altered services (great) but underneath they are fundamentally the same. This is a little like saying that a supermarket chain is changing and supporting the environment whilst all it is doing is stocking some local potatoes and getting rid of some plastic packaging.

We should remove whole swathes of middle management. We could then fund many more services if we could only change the way in which these organisations work. The public only turn their attention to accountability when the services they seek are not there. When GP visits are easy to make, when libraries are still there and functioning well, when refuse collections do not result in piles of waste on the street, we are all happy.

For a small example of how this can work see my article Ban The Boss – see the BBC’s Business Doctor at work. Its an hour long programme but well worth it.

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