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Suppose we got rid of the management pretence that public services can be run by trusts? What would that save?


As the FT notes this morning:

The British government could save at least £20bn a year by modernising IT systems, tackling fraud and getting a grip on failing mega-projects such as the HS2 rail line, according to the head of the UK government’s independent spending watchdog.

To be candid, I really do not doubt it.

But imagine how much more it could save if it stopped pretending that so much of the public sector was made up of independent organisations competing with each other rather than cooperating to provide integrated services.

Take this on the NHS. There are:

  • 42 integrated care boards, which each have an integrated care partnerships
  • 229 total number of trusts, including 154 foundation trusts
  • 50 mental health trusts
  • 10 ambulance trusts
  • 124 acute trusts

Each of these will spend its life:

  • Creating duplicated policy
  • Accounting furiously to each other, billing like crazy and employing an army of accountants to reconcile the results
  • Have its own PR and comms teams
  • Spend a fortune on websites, glossy annual reports and more
  • Duplicate management structures

And all for no gain and a lot of cost. Regional strategic health authorities could solve that.

And then there is education, where in 2022 (I struggled to find more up-to-date information quickly), there were 2,539 multi-academy trusts operating in England, made up of nearly 10,000 schools. That still left 17,500 outside trusts, rather surprisingly, but all these trusts suffer all the problems noted above, and destroy the chance of integrated education provision in any area, which should be the goal.

What if we got rid of all this nonsense? What would that save?




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