When transformation isn’t transformation
Transformation (noun). A marked change in form, nature, or appearance.
Public services need transformation. That is the message from recent government policies. This year the Government announced a Transformation Strategy. The NHS and police have dedicated transformation funds – worth billions of pounds. The Home Office’s £175 million Transformation Fund invests in new approaches to “transform policing for the future”, according to Home Secretary Amber Rudd.
This is only right. Policing and the NHS can better prevent crime and ill-health, use digital technology to work smarter, and diversify staff to more efficiently meet demand. (Reformresearch on how workforces in the NHS and police should be organised to achieve this change is forthcoming.)
Yet, the multi-billion-pound funds in these services are not being spent in transformative ways.
In the NHS, transformation funding pays for normal service. The NHS’s Sustainability and Transformation Fund is the clearest example. This is designed to provide financial backing to “support the implementation of the Five Year Forward View vision of better health, better patient care and improved NHS efficiency”. The vision, the FYFV makes clear, is a shift to prevention and public health, with more care being delivered outside of hospitals. Yet, the National Audit Office finds that 84 per cent of the £2.14 billion fund is for hospital financial sustainability – that is, delivering reactive care, in hospitals.
A story of missed chances to invest in transformation can also be told in policing. The 2016-17 Police Transformation Fund commits £2 million to collaborative procurement led by the Met, £1.5 million to shared services for the South East led by Hampshire, £2.5 million over two years to a resource-planning programme led by Cambridgeshire and £500,000 over two years to the College of Policing to build a website detailing the skills required for each policing role. These are hardly transformational.
These funds are misspending money while ignoring lessons of genuine transformation across public services. In London, the NHS is piloting an AI triage system in place of NHS 111; Twitter is being used in the capital for people to report incidents. Lakeside Healthcare is delivering extra services in general practice, to over 100,000 people in Northamptonshire. The fire service’s emphasis on prevention has helped halve the number of fires as a decade ago.
These show what is to play for in public services. Investing in similar services would deliver the transformation public services need.