By Aiden Hannah, Research Analyst, and Karen Taylor, Director, Deloitte Centre for Health Solutions
In November 2021, Deloitte’s public sector team together with the think tank Reform published their tenth annual report ‘The State of the State 2021-22: Towards a new public sector normal’. The report recognises that, since March 2020, the UK governments and public services have led radical, exhaustive, and dynamic responses to the COVID-19 pandemic. During this past year, they have had to deal with both the pandemic and its wider repercussions in seeking to establish a ‘new normal’. Unsurprisingly, health and social care feature throughout the commentary. Our blog this week provides our take on the report’s key findings on the NHS and social care, supplemented where relevant with observations from our own research.
The COVID-19 legacy emerges
After more than 20 months of extensive economic interventions from national and local governments, the State of the State (SotS) report identifies growing concerns about tax and public spending. Where six out of 10 of the public have backed the need for higher public spending for most of the past decade, this year’s survey finds support for higher spending is finely balanced, as fears over the economy and the cost of the pandemic alter public mood. However, when it comes to health and care, the public continue to believe that increased spending should be a top priority.
The report also found significant variations in public confidence and trust between the different layers of government and public services, albeit trust in local services is relatively buoyant. Some of the more positive legacies because of the pandemic that interviewees identified include organisations being more in tune with their people’s wellbeing, policy makers more focused on inequalities, and local services forging partnerships to deliver more connected preventative measures.
Notably, the public continue to have the highest levels of trust in the NHS compared to other public services. The NHS scored highest across all nine criteria, with the highest scores given for being trusted to do the right thing for society, treating citizens with respect and making decisions informed by evidence. However, NHS leaders fear that staff resilience and public trust will wane in the years ahead, due to the relentless demand on staff and patients frustrated by waiting lists caused by the pandemic (see quotes below).
Public sector leaders reveal the legacy of the pandemic.
Building back better together and levelling up
During the pandemic public sector services worked together in new ways and the public sector worked in partnership with the private sector to deliver solutions such as the vaccination and testing programmes. Leaders from both businesses and the public sector consider that partnership working should be maintained and continue to drive social value beyond the pandemic as part of building back better.
A crucial priority for government is ‘levelling up’ and tackling the inequalities seen across the UK. We also demonstrate this in our current future of public health report series, which identifies the inextricable link between health and the economy, and the fact that the UK is an unequal society with numerous social and economic factors (exacerbated by the pandemic) driving health inequalities.1 However, given this link between health and the economy, levelling up will need to include levelling up health, and a relentless focus on reducing the widening health inequalities gap exacerbated by the pandemic. Furthermore, as the largest employer in the UK, the NHS has an important and broader role to play in the levelling up agenda.
The year ahead
The SotS research suggests that the coming months could define the future of government for years to come. Crucially, health and social care dominate the public’s views on the areas of public spending that should be prioritised, with NHS spending by far the top priority (see Figure 1). Social services are the second and third highest spending priorities followed by housing (a key social determinant of health). The next highest priority area is linked to public interest and expectation on the transition to net zero in the years ahead, which is also an important area of transformation for the NHS.2
Figure 1. Areas for public spending that survey respondents believe should be prioritised.
In autumn 2021, the UK Government announced a Health and Social Care levy, seen as a major step towards a transformation of social care in England. While leaders were generally supportive of the levy, seeing it as a step towards the major transformation of social care in England, some public sector leaders worry whether the ever-increasing funding required by health will affect the levels of investment needed to meet the ambitions of levelling up and net zero.
The SotS public survey explored the factors that the public wanted the social care reforms to focus on. The most important factor identified is for care to be personalised to an individual’s needs followed by the need for the people giving care to have the right training and qualifications. Affordability was the third highest priority for all respondents (both those with experience of care and those without), followed by ensuring that the people giving care have sufficient time to do a good job (see Figure 2).
Figure 2. Public opinions revealed which areas are most important for the social care reform to focus on.
A further crucial area highlighted in the SotS 2021 report, that will affect the year ahead, is that the surge in public sector digital transformation sparked by the pandemic will end. Public sector leaders have identified a focus on addressing legacy IT issues before adopting leading edge technologies. Senior health interviewees acknowledged that digital transformation is fundamentally challenging because the NHS is not a single entity, but a federated, local system supported by a collection of central bodies. Interviewees in both local and central organisations agreed that citizen-facing health technology is the area most ripe for development. However, leaders were concerned that NHS organisations would transform the citizen experience in different ways and paces, so they favoured a more system-wide approach.
NHS leaders highlighted their concerns that despite an acceleration in the adoption of digital technologies during the pandemic, there remains a broad spectrum of digital maturity across the health and social care system, and that the scale and structure of the NHS can make it challenging to address this (see quotes below).
NHS leaders’ views on the current state of digital transformation across healthcare.
These findings reflect the findings in our reports Shaping the future of UK healthcare: Closing the digital gap (November 2019) and Realising digital-first primary care (February 2020), which found that despite numerous strategies, programmes, and national reviews, there was a wide gap in digital maturity within and across the different sectors of care. During the pandemic we have followed-up with a number of the case study organisations in our reports and found that while there had been some improvements, these are often in the more mature organisations and the gap remains.
This tenth annual State of the State report has found NHS and social care services are having to deal with both the short and long term legacies of the pandemic, but are managing to retain public confidence and trust. Moreover, it has found that health, social care for older people and social services for vulnerable adults are the public’s top choices for prioritising future public spending. Nevertheless, the public want social care to be reformed and to focus more on personalisation, professionalism, and affordability.
As part of the recovery, levelling up is a crucial priority area for all public services. As the sector continues to face challenging times ahead, areas where we anticipate transformation to be focused include the digital transformation of health and social care delivery. Furthermore, the government faces tough funding decisions in the years ahead. As part of establishing a ‘new normal’, policy makers and taxpayers are likely to want to see a tangible return on their investment, including on health and social care spending.
The State of the State report once again blends a citizen survey of 5,792 adults, conducted between 9 and 14 September 2021, and commentary based on interviews with 50 of the most senior figures in government and public services (conducted between July and October 2021). For the first time the research also included interviews with business leaders on their experience of working with the public sector. This quantitative and qualitative research approach provides a rich view of the evolution of the priorities and choices made by the UK public sector.