A recent report by The King's Fund, titled 'Doing With: Reinventing Public Services In A Time Of Crisis', suggests a fundamental overhaul of how public services are delivered across the UK. The influential health think tank argues that traditional models, often characterised by 'doing to' or 'doing for' citizens, are no longer adequate to address the complex and interconnected challenges facing the nation, including persistent health inequalities, economic instability, and the ongoing cost of living crisis.
The report advocates for a paradigm shift towards 'doing with' – an approach that prioritises co-production, collaboration, and shared responsibility between public services and the communities they serve. This involves actively involving citizens in the design, delivery, and evaluation of services, rather than simply being recipients. The King's Fund believes that this collaborative model can foster greater trust, empower individuals, and ultimately lead to more effective and sustainable outcomes.
The publication highlights that the current pressures on public services, particularly the NHS, are immense. Waiting lists remain high, with over 7.6 million people waiting for routine hospital treatment in England as of December 2023, according to NHS England data. The report posits that by empowering communities and leveraging local assets, some of these pressures could be alleviated, and health and social outcomes improved without necessarily requiring significant new financial investment.
Practical implications of this 'doing with' approach could include increased community-led health initiatives, more personalised social care plans developed in partnership with individuals and their families, and local authorities working directly with residents to shape urban planning and environmental projects. The King's Fund draws on examples from across the UK where this collaborative model has already demonstrated success, showcasing how shared decision-making can lead to more tailored and impactful interventions.
The report also touches on the need for cultural change within public sector organisations. It suggests that leaders must be willing to cede some control, share power, and invest in building the capabilities of both staff and citizens to engage effectively in co-production. This shift requires a move away from purely transactional relationships towards genuine partnerships, recognising the valuable insights and resources that communities themselves possess.
In the context of the NHS, this could mean a greater emphasis on integrated care systems truly working with local populations to identify and address health needs, rather than a top-down allocation of resources. It aligns with the broader move towards prevention and early intervention, where community involvement is crucial for long-term health improvements. Patients should always consult their GP or call NHS 111 for medical advice.
Source: The King's Fund