This week, Deloitte and the think tank Reform published The State of the State 2017-18, our annual report on the UK’s public sector, based on fresh research that includes a citizen survey of 1,000 members of the public and in-depth interviews with 45 public sector leaders, including leaders from both health and social care. Having read The State of the State from a healthcare perspective, three issues caught my attention relating to data, austerity and demand.

First, the NHS should be encouraged by our findings on public attitudes on data. As John Manzoni, the head of the civil service said earlier this year, data-driven public services are widely regarded as the next stage in the sector’s development. John went on to say that government needs to secure public trust in order to make that happen– and our citizen survey offers some reassuring findings. Some 56 per cent of the public say that they trust public bodies with their data compared to 31 per cent who trust companies. Better still, 77 per cent say they support the NHS using personal health data to improve its services and treatments.

Our survey went on to explore the factors that drive public trust and mistrust in how data is used. We found that people generally trust the public sector more with data because they believe public bodies use it for the good of society and will not use it for marketing. The results also suggest that government can build further on that trust by explaining why it is using data and how the public benefits.

The second issue relating to healthcare that struck me from The State of the State is that public attitudes towards austerity have hardened – especially where the NHS is concerned. Overall, our survey found that public support for spending cuts has halved since austerity began. Just 22 per cent of the public said that they support spending cuts to restore the public finances compared to 54 per cent in 2010. And when we asked which areas of spending they would like to see protected from cuts, 80 per cent said the NHS. That makes the health service by far the public’s biggest spending priority.

However, while austerity has been a huge challenge across many parts of the UK public sector, The State of the State found that demand has become as big an issue. Our interviewees included NHS chief executives, council chief executives and chief constables, and many told us that austerity – while tough on their organisations – has driven innovation and constructive change. Looking ahead, their greater concern was demand.

NHS funding has of course been ring-fenced throughout the UK’s austerity years, but our interviewees were clear that funding has not kept pace with demand. One NHS chief executive told us that he was “seeing demand growth outstripping growth in resources and outstripping the ability of business-as-usual savings to bridge the gap”.

Statistics on demand are of course stark. According to the NHS Confederation, in 2015-16 there were 40 per cent more operations ('procedures and interventions') completed by the NHS compared to 2005-06, with an increase from 7.2 million to 10.1 million; and 16.3 million total hospital admissions, 28 per cent more than a decade earlier (12.7 million). The total annual attendances at Accident & Emergency departments was 23.4 million in 2016-17, 23.5 per cent higher than a decade earlier. Importantly, by the end of April 2017, there were 3.783 million patients on the waiting list for treatment; 382,618 (10.1 per cent) had been waiting for longer than 18 weeks, compared to 302,901 (8.4 per cent) at the same point in 2016.2 If left unchecked, demand will continue to rise – especially given that the number of 85 year olds is set to double over the next 20 years.

As a result, many of the public officials we interviewed thought that increased budgets or substantial one-off injections of funding would only alleviate demand pressures in the short term. Most wanted to see more strategic and sustainable policymaking, better public engagement to encourage greater self-care and more system-wide thinking on prevention.

There is no doubt that The State of the State 2017-18 finds the UK public sector at a time of immediate challenge as the public services address ongoing austerity and rising demand. However, it also shows that the UK’s healthcare system attracts enormous goodwill that could help the NHS – along with other public bodies – harness their data to drive decision-making and deliver more citizen-centric services.

This article also appeared on LinkedIN -


Sara Siegel - Partner, UK Healthcare Strategy and Consulting

Sara is a Partner in the Healthcare Strategy practice at Deloitte. She has worked with the National Health Service (NHS) and the Department of Health (DM) for the last 11 years on major policy implementations. She also works with private sector health companies on growth strategy and policy impact and leads our analytics work for healthcare.

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1 Big data in government: the challenges and opportunities, John Manzoni, Feb 2017.
2 NHS Statistics facts and figures. NHS Confederation July 2017. See also:


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