Interesting report on barriers to change at the top of government in UK by Reform  a public services think tank.

Summary

There is remarkable consensus – including among many working within the civil service – on the key flaws in the Whitehall machine. Yet, while successive administrations have attempted to modernise the civil service and improve the structures of Whitehall, the same problems continue to recur. 

At a time when the nation is facing era-defining and systemic changes, the nucleus of government – Whitehall – must be operationally brilliant. Addressing shortcomings is not only key to better government, but to Britain’s future prosperity. Mapping the barriers to reforming Whitehall is the crucial first step to developing a plan which can overcome those deep-rooted flaws.

'Breaking down the barriers' is based on interviews with 27 senior leaders – former ministers, cabinet secretaries, permanent secretaries, other senior civil servants, and government advisers – with direct experience of reform programmes. Their candid reflections, across different decades, departments and governments, form the basis for this paper.

Together, the insights from this paper offer a striking insider view of why Whitehall is so difficult to change, and hint at what future reform programmes must do differently to actually succeed. 

The key barriers identified in the paper are:

A lack of clarity about who is responsible for instigating change 

Ministerial uninterest 

A poorly defined and weak executive centre
 
A bias for policy and ministerial handling skills over corporate and organisational capabilities in promotion

Departmental fiefdoms 

A leadership cadre with limited external experience and a status quo bias
 
Insufficient investment in change management and poor communication of the tangible value for reform 

Limited attempts to build enthusiasts for reform throughout the civil service 

Limited exposure at all levels to alternative organisational models and ways for working 

The absence of a self-reforming, or stewardship, mentality

Full report at https://reform.uk/wp-content/uploads/2023/07/Barriers.pdf

The question for PFM Boarders:

Is it the same elsewhere?

Message from Abdelhak S. Senhadji Deputy Director Fiscal Affairs Department International Monetary Fund which may be of interested to members not linked into the IMF

The IMF launched an innovative online tool in April to assist policymakers in designing financing strategies for achieving the Sustainable Development Goals (SDGs). The tool, SDG-FiT, allows users to evaluate policy choices that can raise long-term economic growth, mobilize government revenue, and attract private investment for development. SDG-FiT is based on the IMF Staff Discussion Note “A Post-Pandemic Assessment of the Sustainable Development Goals,”  which lays out a macroeconomic framework for assessing the post-COVID-19 financing needs in five sectors of the SDGs: electricity, water and sanitation, roads, health, and education. SDG-FiT has transformed this framework into an online tool that can be used to assess SDG financing gaps and evaluate policy options to close them with macroeconomic consistency.

SDG-FiT is flexible and user-friendly thanks to its powerful visual storytelling features, making a complex framework accessible to a general audience. Users can experiment with policy scenarios building on a baseline (current policy) scenario whose underlying data are pre-populated using estimates and projections by the IMF and the United Nations. In particular, the costing of SDGs in each of the five sectors is based on detailed estimates for 107 countries undertaken by IMF staff and the baseline macroeconomic projections are sourced from the World Economic Outlook. SDG-FiT computes financing gaps in the baseline by comparing the SDG costing estimates for reaching the SDGs by 2030 and the current levels of spending on these SDGs. The tool then allows users to specify financing channels to close or reduce the financing gaps in policy scenarios. These channels cover policy changes that alter: (i) revenue, including tax and non-tax revenues; (ii) government borrowing and deficit; (iii) allocation of existing resources to SDGs; and (iv) private financing.

SDG-FiT is online to try it out. Should there be any questions or encounter any difficulties in using it, please contact the IMF's designated team for help (SDG-FiT SDG-FiT-Support@imf.org).  Feed back is welcomed.

SDG web page
https://sdgfit.imf.org/sdginfopages/index.html

Since 2018, this Lancet Commission has sought to understand how to maximise synergies between the global health agendas of universal health coverage, health security, and health promotion, and what drives dis-synergies. By synergies the Commission is referring to an intervention, institutional capacity, or policy, that positively and substantially contributes to the achievement of two or more of these agendas in the areas where they intersect. We gathered data through desk reviews; case studies at the subnational, national, and global levels; consultation with two subregional bodies; and periodic Commissioner meetings both face to face and online to review, analyse, and synthesise data. Several key findings and implications for action arise from the analysis and the gathered data, particularly the in-depth country case studies, which provided several examples of these issues in action.


Full report  can be downloaded https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01930-4/fulltext?dgcid=raven_jbs_etoc_email

Worth revisiting, in light of COVID, this quite perceptive article in the Lancet in 2015. Was anyone listening and are they now?

https://pfmboard.com/index.php?topic=7825.msg24925#
Ten essential reforms before the next pandemic. Re: Will Ebola change the game?
The  Lancet Vol.386 | Number 10009 | Nov 28, 2015

Interesting report linking health spending (or lack of it) to outcomes related to employment, inequality and GDP.

https://www.ippr.org/research/publications/health-and-prosperity

https://www.ippr.org/files/2022-04/health-and-prosperity-april22.pdf

Summary
The hidden personal cost of UK long-term sickness that cries out for a new national health mission
•   New health conditions cost people up to £2,200 on average from annual earnings – others in household also badly affected
•   Sickness is a key factor in around half of people leaving work
•   Better health would benefit economic prospects for all, but could boost women’s earnings twice as much as men’s
•   UK should aim to become the healthiest country in the world within 30 years, says IPPR Commission on Health and Prosperity
The UK’s poor record on health is taking a huge toll on people’s personal finances and job prospects, a landmark report of the IPPR Commission on Health and Prosperity exposes today.
The onset of illness costs people up to £2,200 of their annual earnings, according to an IPPR study of the most recent seven years of panel data from the UK Household Longitudinal Study. The data span five years before the pandemic broke out, and the first two since it began in early 2020. Researchers found that:
•   Someone with a new physical illness experienced on average a fall of around £1,800 in their annual earnings, before the pandemic. 
•   In the same period, those with a new mental illness faced an average fall in annual earnings of around £2,200.
•   Since 2020, someone with a new chronic physical illness experienced on average a £1,400 annual earnings fall, while the onset of a mental illness has meant an average annual earnings fall of around £1,700.
They also found that the onset of chronic illness since 2020 has also had an impact on others living in the same household as the newly unwell person, with their annual earnings falling by around £1,200 on average.
The study of the cost of poor health on employment and earnings is among the most ambitious ever undertaken.
It found that loss of earnings following sickness was driven by factors including people leaving their job, working fewer hours, or not returning to work when they might have done so if in better health. These are additional to other costs of sickness, such as paying for healthcare, increased energy usage, or the cost of travel to appointments.
For many, these costs prove life changing. Among those diagnosed with a long-term illness since the pandemic, two in five lost 10 per cent or more of their earnings. Chronic physical conditions are estimated to have driven 700,000 people to leave employment in the same period, forgoing all their earned income.
Job loss was the biggest driver of lost earnings. The report found that poor health was a factor for more than half those who left their jobs (56 per cent) before the pandemic, with a larger impact since. Among older adults, poor health often led to early retirement.
The report also found that people with lower incomes are likely to be worse affected by becoming ill. Following the onset of a chronic illness, around one in six of those already in the lowest income quartile left employment during the pandemic, compared to around one in 20 of those in the highest quartile.
This unequal impact is compounded by the fact that people on low incomes are more likely to experience sickness, and less likely to get the best possible care.
It found that the impact of lost income is also unequal by gender, region and ethnicity in the UK. According to a new analysis applied by IPPR, improvements in people’s health would have different impacts on the earnings of different groups. It found that:
•   Better health would improve the incomes of all women as a group at twice the rate of men
•   Levelling-up on health gaps would increase regional earnings most in Wales, the West Midlands and the North East
•   Workers from Bangladeshi or Pakistani backgrounds would benefit financially the most from better health
Much sickness in the UK is preventable – through better housing, better jobs, action on public health challenges like obesity, or access to the best treatments and social care. Yet UK governments have systematically failed to pull the right levers over the last three decades, the report says.
The IPPR Commission on Health and Prosperity – with commissioners including Lord Ara Darzi, Dame Sally Davies, Mayor Andy Burnham, Sir Oliver Letwin and Dr Halima Begum - challenges the government to do better on raising overall national health, and as a result to reap the wide economic benefits.
It calls for a new Health and Prosperity Act, modelled on the 2008 Climate Change Act. This would hardwire two ambitious new missions in law:
•   To make the UK the healthiest country in the world within 30 years;
•   To increase healthy life expectancy to beyond the state retirement age across every region.
Taken together, the report says, these could serve as a health equivalent of ‘net zero’.
As it stands, the UK has both a lower healthy life expectancy and a lower rate of improvement in healthy life expectancy than other high-income countries.

One final post to close this diary. The signed book draw took place this week. The winner was a graduate student at Georgia State University and the book is already on its way.

Thanks to Mauro for the opportunity to write this diary. And thanks to you for reading it.

Best wishes,
Gary