Too often, public service reform is treated as being synonymous with public sector reform. The focus turns to structures, governance, and organisational redesign. These all matter, but if tweaking structures could transform lives, it would have happened by now. If public services are to be designed around people, prevention and relationships, then structural change is a necessary, but insufficient, condition. Radical improvement requires leaders in all sectors to change how power, accountability and partnership work in practice. The real challenge is not how we organise public bodies, but how we organise public services around people.
We can’t assume that the foundations are basically sound and that a few fine-tunings will get everything right. That ‘one last heave’ approach is a triumph of hope over experience. The great societal problems – poverty, worklessness, sharply diverging health outcomes between rich and poor – cannot be solved by the state alone. After all, it has been trying for over a hundred years. The operating models underpinning public services must meet the scale, complexity and urgency of the social challenges facing this age. As such, we need a new accommodation and understanding between the voluntary and public sectors.
The relationship between state and civil society is always in flux. A hundred and fifty years ago, the great Victorian charities strove to better societal conditions in the face of state disinterest. The welfare state and post-war settlement shifted the scales towards state-first intervention. The state did more and more and more. In recent decades, the public sector has increasingly commissioned the voluntary sector to deliver work on its behalf. Of course, even this phrase, “on its behalf”, reveals a misplaced belief about on whose behalf such services operate, which explains the tension that often exists in this relationship. Too often, there are clashes around power and money, and a mistaken belief that charities are cheap subcontractors for the state. We urgently need a fourth wave in this state-society relationship: a move towards the voluntary sector and public sector being strategic partners in change. For this, three things are important.
Identifying outcomes
First, we require a relentless focus on identifying the outcomes we want to see. In working together, what problems are we trying to solve? In many places, the voluntary sector is still thought of as a delivery agent for models designed elsewhere. If charities are only invited in once the decisions have been made, that is not partnership; it is outsourcing.
Often, it is outsourcing too late, to respond to systemic failure or crisis. Time and again, opportunities for early prevention go by because the computer says no. The voluntary sector, pulsating with creative energy, excels at prevention. It is hard to pin down the reasons, but trust must surely play a role. Communities often trust, and relate to, charities in a way not afforded to the public sector. From my own area of children’s palliative care, there is solid academic research to show that the involvement of the voluntary sector helps prevent conflict between healthcare professionals and worried parents. People usually know the answers to the problems in their own lives, if only we are prepared to hear them, and the voluntary sector has remarkably good ears.
Successful public service reform must therefore be characterised by shared accountability and genuine strategic partnership. The sectors must plan together, work together, make decisions together, share risk together, and hold each other mutually accountable.
Charities must demonstrate reliability, credibility, evidence, and impact; we cannot be strategic partners while behaving only as campaigners or contractors.
This means the voluntary sector needs to be bolder. For too long charities have often undersold their value, speaking about partnership while hesitating to articulate where they add something genuinely different. Communities trust charities in ways they do not always trust public bodies; charities are often closer to people’s lives, quicker to spot emerging problems and more willing to experiment with solutions.
We should not be embarrassed to say so, but boldness also brings responsibility. It is not enough to say we want influence, there must also be clarity. What decision are we trying to shape? What outcome are we seeking? What are we uniquely able to contribute? Mature partnerships require both confidence and curiosity; the confidence to communicate our own needs clearly, and the curiosity to listen properly to the needs of others. By the same token, public services must create space for earlier involvement, shared decision-making and a more balanced distribution of power and resources to facilitate this wholly.
Shifting behaviours
Second, we need to practice leadership behaviours that drive change.
Leaders must recognise the hierarchies and power dynamics that sour relationships between sectors, moving beyond transactional relationships defined by contracts and funding rounds which can drive unhelpful organisational self-protection. Bluntly, shared outcomes require shared power.
Leadership must be generous, boundaryless, starting from the assumption that partnership working is the norm. That spirit shot to the surface during covid, but has not been sustained. I do not know why. Success will depend as much on trust, humility and compassionate leadership as it does on policy. Done right, leadership bridges the inevitable gap between policy and practice. Leaders must practise radical self-awareness, being honest about where their organisation adds value, where it needs to change, and where it may need to step back so something better can emerge.
Too often, conversations across sectors start and end with money. Of course resources matter; no one can deliver long-term outcomes on fragile funding. But if every conversation begins with what one organisation needs from another rather than what outcomes we are trying to create together, we should not be surprised when relationships become transactional, and get stuck.
At CHAS, we have spent the last six years shifting from being an arm’s-length voluntary sector organisation to being as a core part of Scotland’s health and care system. As Scotland’s single national provider of specialist children’s hospice care, we now deliver more palliative care outside our two hospices – in family homes, hospitals and communities – than within hospice walls. We pool and share specialist resource with NHS partners through joint CHAS/NHS teams in hospitals, and host Scotland’s specialist paediatric palliative clinical advisory service, which is available 24/7 for children approaching the end of life.
That has only happened because of genuine partnership working. Children’s palliative care is a powerful example of the wider public service reform challenge; no single organisation can meet the needs of a child with a life-shortening condition and their family on its own.
The system only works when the relationships work. Public service reform is, at heart, about behavioural change, not structures. Moreover, if we do not name the long-standing culture of competition for funding, influence, and recognition and control, we will struggle to build the very collaboration reform needs.
Understanding each other
This requires the third change: for the sectors need to understand each other’s worlds. I am struck by how little pollination there is between the public, private and voluntary sectors. Bluntly, too few leaders in one sector have real, deep exposure to another. It is a loss. Diversity of thought amongst executive teams is closely correlated with success, and a key driver of good partnership working.
Yes, organisational and psychological contexts differ. Public bodies are rightly shaped by scrutiny, accountability, consistency and risk. Charities are closer to people and more relational in approach; and better able to respond flexibly to individual need. The private sector has a sharp understanding of customer wishes.
No one is better than another, but if we do not build bridges, we will all continue to live on the other side of the river.
We must intentionally cultivate more opportunities for leaders to understand each other’s worlds, with a shared approach to risk, accountability and improvement. At CHAS, our executive team is strengthened enormously by colleagues who have direct experience of working at senior level in the NHS and integration authorities. I have worked at executive level in two sectors, but this is rare. CHAS would be less successful, less rounded, and less relevant without this cross-sector experience.
So where is the cause for optimism? Ultimately, public service reform will not be measured by the number of strategies published or structures reviewed. The sole test is whether people experience good services that feel joined up and centred on what matters to them. Scotland must be brave enough to transform the relationships and behaviours that shape how people experience public services. Our current approaches are informed by ideas which are 100 years old. We need to tilt our collective gaze, and look forward with confidence and vision to a future where the public and voluntary sectors work differently. That is our best chance to solve great social issues that bedevil our country and vex those charged with making it better.
Rami Okasha is Chief Executive of CHAS