News and Comment

25th anniversary guest blog series: The challenges and opportunities facing public services

Thursday 25 September 2014


Public services are undeniably facing a period of intense, unrelenting challenge. This is the reality felt by the front line and those who use services every day. The challenges are significant, but they are not without hope and opportunity, where there is political will to make things work.

The challenges are not simple, and they are not isolated. In many ways, we are now dealing with the consequences of success – more than 13,000 people celebrated their 100th birthdays in 2013 – a rise of more than 70 per cent in just a decade. Those individual people have done well to reach the milestone, but individuals do not do this alone – they did it with a century’s worth of treatment, care and health advice.

Caring for millions of older people is indeed a challenge – but if we are prepared to value care, and design services with the intention of maximising health as well as dealing with the consequences of illness, there are opportunities here to keep people well and independent. To take those opportunities, the system needs to work together, and it needs to be refocused. We need to have a sophisticated understanding of costs and benefits, and the RCN is working with OPM to ensure that the costs and benefits of nursing are fully understood. That way, decisions can be taken on the basis of long term health gain, not short term cash savings.

In other ways, we are dealing with the consequences of failure – of health inequalities which mean that young people in some communities have health not much better than when their ancestors worked in heavy industry and could expect to die in middle age. These problems go far wider than health – there are spirals of deprivation which mean that generations are afflicted by low pay, poor diet, and low aspirations which rob people of the motivation to live better lives.

In both cases, the expertise and opportunity exists to make public services better using the skills of professionals such as nurses. Meeting the needs of the older generation is complex and requires skill – but the skill does exist if we are willing to invest the resources. And we know how to help people to lead healthier and more productive lives – but again, we have to be willing to grasp the opportunity, and take the time to help.

With the political will to make it work, the public sector has many things going for it – professionals who spend their lifetimes working to care for people, and who are committed to finding the best ways to help with the resources available. We know what good interventions look like in the public sector – experts work together without territory, whether it is through education, welfare, child protection or crime prevention.

Many public services have existed for almost a century now, and like the rest of the developed world we have learned a lot. We should be better at learning the lessons of history, and of sharing experiences between sectors, but already the public service ethos is deeply ingrained and it is a great asset.

Nurses, like other professionals who deliver public services, represent excellent value for the work they do – even with the modest pay increase proposed by the independent body but denied by the government. A recent report by the Commonwealth Fund showed that the UK NHS represents the best value in the world.

Health staff have more to offer than just their labour. They have the expertise and commitment to design services to meet future needs, to advocate for the people they care for and to promote better lives to all their patients. This is true whether their patients are from the parts of the country where they can expect to live to 100, or the areas where their life expectancy has not significantly improved for generations.

To do all those things, the NHS does not only need to pay them. It needs to empower them, value them and listen to their experiences. Collectively, the answers to the current challenges are contained within those who have dedicated their lives to making public services better, it just requires a concerted effort to bring it out.

Dr Peter Carter is Chief Executive & General Secretary of the Royal College of Nursing (RCN)


About the series

OPM is celebrating its 25th anniversary this year, and as a public interest organisation, we’ve always contributed to the debate about the future of public services.

With this and the next general election in mind, we’ve asked a number of senior thinkers to give their views on the challenges and opportunities facing public services and society in the near future.

This is one of a series of guest blogs, which we’ll be adding to in the coming weeks and months. To read previous posts in the series, go to our news and comment page.