At the heart of the Fitzwilliam Museum in Cambridge lies the grand Founder's Entrance. Gazing at the columns and paintings, too few people look down to see the stunning floor mosaic. That image sprung to mind recently as I tried to think positively about the Government's often opaque and confusing approach to public service reform.
The absence from this Government of an all-encompassing strategy for public service reform is perhaps unsurprising. It is well known that Keir Starmer's Downing Street tends to avoid big abstract ideas and focus on crisis management rather than transformative visions. This is a contrast with the Blair years, in which the ideas of new public management (NPM) were the driving force. That meant internal markets, a focus on financial incentives, encouragement of partnerships with the private sector, and the target-driven approach to delivery extolled and practiced by Michael Barber.
The strength of those years was ambition, coherence and relative consistency. The problem was that in England, as in most other parts of the world, NPM failed to live up to its promise. Simply bolting on competitive mechanisms to public services while still being committed to equity, universalism and tight central accountability was unlikely to be plain sailing.
As often happens with policy fashions, NPM has had its day while leaving traces that continue to be influential – including among health secretary Wes Streeting's advisors – and will no doubt become popular again. The historian of public service reform Christopher Hood points out that the first arguments to commercialise the civil service were voiced in the 19th century before the modern welfare state even existed.
Making a mosaic is not simply about throwing pieces of pottery on the ground and seeing how they land. There is a direction to the public service reform agenda, one that could build momentum over the life of this Parliament, but the absence of a clearly articulated strategy leaves the question of the centre's role unanswered.
Nothing has fully filled the gap left by NPM, but a recurrent theme in public service reform research and advocacy has been the need to reshape services around the changing nature of society and citizens.
The core question is how central administrations with their tendency towards bureaucratic inertia and siloed working respond, on the one hand, to the complexity and pace of change in society and, on the other, to the complexity of individual needs. Around 70% of demand in the NHS now comes from patients with multiple long-term conditions, yet the health service continues to think about body parts rather than whole people.
Haphazard and faltering it may often seem, but the Government is developing an implicit strategy in response. Taken individually, Government policies on devolution, Pride in Place, and neighbourhood healthcare may seem distinct. Yet they are all pointing in a similar direction: localised decision making better able to respond to citizens' needs.
Greater variation in initiatives and policies is a natural consequence of this shift. Different decisionmakers responding to local needs and wants will pursue different policies.
Devolution is probably the most well-known aspect of the Government's agenda here and typifies this change. Each strategic authority has its own footprint, stakeholders and, for most, a mayor with their own priorities. Additionally, maturity varies significantly across systems. By the time Cumbria elects its mayor in 2027, Greater Manchester will have had one for a decade.
This is where the mosaic metaphor comes into play. The individual pieces are not uniform – they vary in shape, size and colour – yet, taken together, they form a pattern.
Making a mosaic is not simply about throwing pieces of pottery on the ground and seeing how they land. There is a direction to the public service reform agenda, one that could build momentum over the life of this Parliament, but the absence of a clearly articulated strategy leaves the question of the centre's role unanswered.
We need a centre that moves from either ignoring or controlling to engaging and enabling. The centre should offer consistent guiding principles, usable insights and useful capabilities, guard rails and intervention powers so that risk can be managed. But the best way of all for the centre to think about how it enables change is to ask the people and places that directly serve the public.
That may be the greatest challenge for central government proponents of public service reform: taking the time to look down.
Matthew Taylor is chief executive of the NHS Confederation
