By Karen Taylor, Director, Deloitte Centre for Health Solutions
This week, Deloitte together with Reform published their ninth annual report on the ‘State of the State: Government in the pandemic and beyond’, reflecting on the insights provided by extensive new research into the issues facing government and public services across the UK.1 This year, the focus is on the impact of the coronavirus pandemic on both the public sector and its citizens. At the heart of the research is an exclusive public survey conducted between August and September 2020, which offers insights into perceptions of public services and public spending during and beyond COVID-19, as well as a public perspective on the government’s ‘levelling up’ agenda. To mark the publication of this seminal research, this blog provides a deep dive into the findings relevant to health and social care.
To understand public attitudes, Deloitte and Reform commissioned Ipsos MORI to survey some 5,574 people (aged 16-75) on their views of government and public services; and interviewed more than 40 public sector leaders including permanent secretaries and other senior civil servants, chief constables, council chief executives, NHS leaders, education professionals and elected representatives. Together, this blend of quantitative and qualitative research provides a view of the state through the eyes of those who depend on it and who run it.
In general, the public wants action on jobs and a green recovery but investment priorities vary by region. The biggest source of dissatisfaction concerns jobs, with more than half of the public (58 per cent) believing opportunities for young people will be worse as a result of coronavirus. When asked to make local investment choices, the public’s top five priorities were health, social care, crime, housing and job opportunities Satisfaction with public services also varied with hospitals and healthcare the second top rated local service (Figure 1).
Figure 1. Satisfaction in relation too public services is highest for hospitals and healthcare but social care is just above job opportunities in terms of satisfaction
Satisfaction is high for local services — especially among people who use them
Some of the more specific responses to health and social care included:
- Country differences in levels of satisfaction with hospitals and healthcare with lower levels in Northern Ireland (47 per cent), Wales (50 per cent) and Scotland (53 per cent).
- In Scotland, only 18 per cent were satisfied with social services, 18 per cent in Wales, 13 per cent in Northern Ireland and 15 per cent in England. Regional differences in England showed East Midlands, North West and West Midlands rating satisfaction at 10 per cent. It’s important to recognise that satisfaction levels are driven by experience, and not everyone uses social care services.
- Just under a third (32 per cent) think their local hospital/healthcare service is better in their area compared to others in the UK, 21 per cent of people think social and care services for older and vulnerable people are better in their area.
- The South East and North East of England believe their social and care services are better than other UK areas.
The survey asked people to allocate how they would spend extra public money (based on dividing up 100 points between local services, infrastructure and facilities). Healthcare and hospitals were the top priority for public spending (average of 14 points), followed by social and care services (9 points) highlighting the growing public concerns about care.
Figure 2. How would the public manage local public spending? Health, social care and crime are priorities followed by jobs and housing.
Macro views on the public sector and in particular the NHS and social care
In the interviews conducted for the report, public sector leaders highlighted the agility demonstrated at the outset of the pandemic, such as relaxing bureaucracy and making faster decisions, something they are keen to retain. But many are concerned at the gravitational pull-back to normality unless its leaders intervene. Many talked about the potential for more remote working, enabling them access to wider pools of talent as well as streamlining their estate needs. A number reported that they are reviewing lessons learned in a bid to lock-in new ways of working. Leaders also expressed concerns about the future funding for their organisations given the new pressure on the public finances. They see the future as data-driven, but consider that the government needs to build consent and capability, as well as data literacy among officials.
Figure 3. Public sector leaders want to retain the agility they found as the pandemic began. Many sense a gravitational pull back to normality although decisions on estates are pending.
The report acknowledges that the NHS response to the COVID-19 pandemic was extraordinary and rightly celebrated across the UK. NHS leaders highlighted the incredible work in their trusts and agencies to build capacity and cope with demand, including accelerating progress on adoption of digital technology. Some NHS interviewees mentioned concerns around the suspension of substantial amounts of healthcare services to adjust capacity for COVID-19 while others argued that this has been overstated. Looking beyond the pandemic, health leaders were keen to remind us that the UK’s health and care system remains unsustainable and political leadership is needed to make some major choices.
Figure 4. Macro choices for the NHS and social care still lie ahead.
People hold different views on how much information, including health records, should be shared with government and, while acknowledging the benefits, worry that data sharing will be a risk to their privacy and security. When COVID-19 was declared a global pandemic, the UK government eased regulations around data sharing across the public sector, as part of its emergency response. The survey found that the public are split on whether data should be shared freely within government, with some 36 per cent saying that it should and 37 per cent arguing that it should not, although attitudes have moved towards favouring data sharing in recent years. Older people are more comfortable with data sharing (40 per cent of the over 55s believe data should be shared for its benefits compared to 34 per cent in other age groups).
On health data, over half (56 per cent) said they would be comfortable with the government and other public services using their health data to make decisions about public services. Moreover, they rated the NHS as the most trusted part of the public sector by some margin; with trust in sharing NHS data having improved by six percentage points since the questions was asked six years ago. These findings on sharing and the use of health data resonate with our finding in our reports Digital transformation: Shaping the future of European healthcare (September 2020) and Realising digital-first primary care (February 2020).
While the NHS frontline has rightly been recognised for the daily heroism of its medical staff, the State of the State report also acknowledges the incredible efforts from the police, the army, from teachers, from local government, from the Civil Service and from every part of government and public services in responding to the dreadful pandemic. Nevertheless, the pandemic has left people worried for the next generation but hopeful for our community spirit.
As we found with our work on the digital transformation of healthcare in Europe (which included the UK)2 the research for the State of the State found an acceleration of digital transformation and shown what is possible. The authors suggest that public bodies should build on the momentum for change and continue to pursue digital transformation across their operating models, ways of working and citizen interactions.
A notable theme in the State of the State is on ‘levelling up’, with public sector leaders believing it is the correct diagnosis for the UK. However, many questioned whether it has been adequately defined and some were pessimistic about its chances of success unless its delivery is driven by joined-up regional plans that are owned by leaders in both public and private sectors. This is a subject we will return to in relation to health and social care in a future blog.