Gus O’Donnell, a former Cabinet Secretary, has proposed key reforms that he believes would lead to better government in an article in the Political Quarterly.
On the social side, he recognises problem of a rapidly ageing population, with increasing pressure on health and social care budgets. He notes the rising trend in obesity, the growth of dementia and Alzheimer’s and mental health issues in general, making it hard to see how the state can afford to help all who need it.
In his solutions, he proposes policy changes for enhancing wellbeing, and constitutional changes would deliver such policies. He asserts a fairly broad consensus on the following:
- our planning laws are too rigid and slow;
- our infrastructure is outdated and in need of urgent attention;
- our education system is not producing the skills that our businesses need;
- our health system is expensive and inefficient, with too little spent on prevention and mental health resulting in too much being needed for drugs and hospitals.
He questions whether money spent wisely, with UK public spending (Total Managed Expenditure) accounting for round 45 per cent of GDP. The implication is that is unwise and he postulates three reasons for poor levels of public sector productivity: policy hysteresis, short-termism and vested interests.
On politicians and policy, he has lots to say, which includes a desire for pre-qualification criteria for candidates. He questions the sense of free travel for Londoners over 60, free prescriptions and “winter fuel allowances to millionaire pensioners on the Costa Brava”. He sees it as “all part of the ludicrous bias whereby the old are subsidised by the young. It is bad economics and bad social policy.” Which politicians would wish to reverse these policies?
On short-termism, he sees the overwhelming priority in health is to focus more on prevention and to rebalance resources in favour of mental health. He would like to use wellbeing as a success measure. “All hospital staff from the cleaners to the consultants should be absolutely clear that their objective is to improve the wellbeing of patients. Subject to that, they may well have intermediate targets, like reducing waiting times and cleaner wards, but the main goal should be clear.”
On public sector Governance, he suggests a body with strong professional integrity. An Office for Taxpayer Responsibility (OTR) with its own professional staff. Yet he proposes staffing that would only seem to continue organisational hysteresis: “secondments from the Big 4 accountancy firms, some former civil servants, particularly those with Treasury experience, some ex-ministers and private sector members, particularly those with experience of working with the public sector.” Each of these are at risk of having vested interests.
His conclusion is:
Unfortunately, we suffer from strong policy and constitutional hysteresis. We are in a bad place, but it is a stable bad place.