Rethinking public services

When we look at public services in the UK, despite the massive technological and other changes that have taken place in modern times, it is difficult to see any matching pattern of improvement over the years. If anything, essential services, such as street cleaning, road repairs and rubbish collection, seem to have deteriorated in quality, with less well maintained roads and pavements, fewer collections and more demands made on householders. Utilities are still subject to failure and breakdown and massively increased in cost. Public transport, such as local bus, coach and train services, while sometimes more truly public services in the sense of being more accessible to disabled people, are much reduced in scale, reach and flexibility. They are generally much more expensive than their European counterparts, particularly rail, in spite of continuing large-scale public subsidy. These shortcomings continue despite massive improvements in transport reliability, efficiency, speed and environmental impact. In rural areas, for example, many older people are under enormous pressure to drive, despite increasing frailty, for rear of having their mobility and lives drastically restricted.

The one service where people can point to dramatic improvements (despite all its other organisational and funding difficulties) is the National Health Service. Here radically improved treatments, interventions, drugs and procedures, have played a revolutionary part in improving all our lives, particularly those of people with chronic conditions, reducing mortality and morbidity rates, as well as making possible survival from previously life-threatening and life-limiting illnesses and conditions.