Public performance and delivery

What Works?  Local Government is Finding Out

/ jlowther2015 / Leave a comment

Jason Lowther

At last month’s Smith Square debate, we had an interesting discussion (among other themes) on how innovation spreads.  I mentioned that I was frustrated at the lack of traction that many evaluation reports seem to get, and that so many basically say “we don’t know so probably do more research”.  However, over the last 18 months, government has released a wave of evaluation evidence across multiple themes that are priorities for local government.  Partly in answer to my challenge, over the next few weeks we’ll be looking at what each of these can tell us about “what works” in their area: homelessness and rough sleeping, local growth and skills programmes, democratic engagement, the Community Ownership Fund (COF), and others.

This week, I’ll have a go at seeing the story the collection as a whole might be telling us about the pressures, strengths and future direction of local government systems. They reveal a landscape where councils are doing a great deal right, but also where structural conditions, funding models and capacity constraints limit what even the best local practice is able to achieve.

A shared diagnosis: rising demand, systemic pressure and fragmented delivery

Most of the recently published evaluations echo the same system‑level diagnosis: demand is rising faster than capacity. In homelessness, systems‑wide analysis shows local authorities facing increasing crisis presentations driven by housing shortages, welfare constraints and cost‑of‑living pressures. In UKSPF and Multiply, compressed timeframes and short‑term funding cycles created operational strain and restrict innovation.  The Community Ownership Fund interim evaluation suggests that without the fund many pubs, community centres, sports facilities and heritage buildings would likely have been lost from community use, but also highlights long lead‑in times, complex project management demands, and volunteer burnout as recurring challenges.

Prevention consistently outperforms crisis response, but funding architectures still favour the latter

Across homelessness evaluations, the conclusion is clear: prevention is more humane, more effective and delivers better value for money than crisis response. Yet central‑local funding arrangements often reward short‑term, visible ‘rescue’ rather than long‑term preventative investment. Skills and economic development evaluations show similar dynamics. Multiply deep dives find that providers would benefit from multi‑year cycles that allow them to embed contextualised numeracy provision and build trusted relationships. Instead, annualised funding introduces uncertainty and forces a focus on quick (rather than effective) delivery.

The COF evaluation also surfaces a version of this problem. It shows that community ownership has deep preventative value, protecting assets before they disappear, strengthening social infrastructure, and avoiding long‑term local decline. But early rounds of COF were more accessible to groups with high pre‑existing capability, meaning communities most at risk were sometimes least able to prevent asset loss. Later rounds have improved this, lowering match‑funding requirements, widening eligibility, and offering stronger pre‑application support to disadvantaged communities. The lesson resonates across sectors: preventative systems require accessible, stable and equitable funding frameworks.


Local flexibility and community empowerment are major drivers of success

One of the clearest conclusions across the recent evaluations is that local flexibility works. UKSPF’s devolved decision‑making has been widely praised for enabling councils to design interventions aligned to local priorities. Multiply’s flexible design allowed councils to embed numeracy learning in real‑world contexts that resonated with learners.  The COF interim report finds that COF has been “uniquely positioned” to meet community needs, enabling groups to save valued assets and renew pride in place. Communities report increased participation, stronger local identity and early signs of improved social cohesion following COF‑supported interventions.

Workforce, capacity and governance: the quiet constraints shaping outcomes

A recurring thread across the evaluations is the impact of workforce shortages and operational capacity. Staff churn, fragile volunteer bases, rising caseloads and short‑term contracts constrain delivery, limit innovation and prevent organisations from embedding learning. Investing in capacity (skills, governance, leadership and organisational resilience) is critical for successful place‑based policy.

Partnerships make the biggest difference, but they need careful stewardship

From rough sleeping multi‑disciplinary teams to UKSPF delivery partnerships with VCSE organisations, strong collaboration emerges as one of the most important influences on success. Evaluations show that where councils act as effective system convenors (aligning partners, coordinating case management, sharing data and creating shared goals), outcomes improve.

What does all this mean for local government?

Three big implications stand out across the evaluations.

First, councils are increasingly system‑shapers, not simply programme‑managers.  The evaluations underline that successful outcomes depend on how councils orchestrate local systems (such as housing, economic development, VCSE partners and community groups) rather than on the quality of any single programme.

Second, stable, long‑term funding is essential for prevention, equity and innovation.  Short‑term cycles undermine prevention, limit strategic planning and exhaust delivery partners. The COF findings show how programme design changes can increase equity, but also how instability can disadvantage the communities most in need.

Finally, capacity‑building is central to reducing inequality, even when the policy focus is capital investment.  Across the board, councils, community groups and VCSE partners need investment in skills, leadership and organisational resilience. It’s essential that as a sector we develop systematic and accredited processes to deliver the necessary education and training.

The emerging picture is of local government doing extraordinary work under extraordinary pressure. But the future of place‑based policy will depend on giving councils and communities the tools, stability and capacity to shape local systems, rather than firefighting the consequences of systemic constraints.

Next time I will be diving in more detail into what the evaluations tell us about “what works” in tackling homelessness and rough sleeping.

Intervention 3.0: Designing a Responsive Model for Local Government Support in England

/ jlowther2015 / Leave a comment

Jason Lowther / Paul Joyce / Philip Whiteman

The arrival of the new UK government looks set to result in a new policy on central government’s intervention powers in local authorities, the third generation of such policies this century.  This article suggests some key lessons from earlier models. 

Intervention 1.0 was facilitated by Best Value legislation that an “authority must make arrangements to secure continuous improvement in the way in which its functions are exercised, having regard to a combination of economy, efficiency and effectiveness” (Local Government Act 1999).  This remains the basis of statutory interventions today.  But the context could not be more different. 

The Blair government commissioned an extensive set of national performance indicators, developed independently by the Audit Commission with a common definition and quality assured through local audits.  The “District Auditor” role maintained in depth contextualised knowledge of each local council, and could identify and flag significant governance or performance issues at an early stage.  As well as diagnosing problems, the Audit Commission’s national studies provided evidence-based recommendations to help improve local services’ economy, efficiency and effectiveness.

The strengths of this model were the comprehensive nature of the evaluation, its collective and mutually supportive use of expert agencies to provide an evidence base, and the sanctions that went with it including transparent public reporting.  Inlogov produced a series of reports diagnosing and explaining the causes of poor performance, analysing recovery planning and strategies for organisational recovery, evaluating various policy instruments for recovery (such as lead officials) and identifying the key developmental mechanisms for recovery. 

Our reports clearly demonstrated that the context for poor performance determines effective mechanisms for recovery: one size definitely does not fit all.  The causes of failure are varied, such as ineffective leadership arrangements and inadequacies in the operating culture. 

Improvement mechanisms need to address issues of cognition, capability and capacity.  Cognition is the council’s awareness and understanding of their performance trajectory, which is often resilient to changes in political control.  Capability concerns the construction and institutionalisation of a change-oriented vision by council leaders.  Finally, capacity is the ability to deliver the required vision and change. The required change mechanisms are both internal (such as leadership change) and external (for example, peer mentors, expert advisors, and funding). 

Intervention 2.0

The arrival of the Coalition government in 2010 brought rapid changes to intervention.  The Audit Commission was summarily discarded, publicly justified by claimed savings of £50m.  In reality, recent research by the Audit Reform Lab at the University of Sheffield suggests that English audits have higher costs and greater delays than in Wales or Scotland (where centralised oversight arrangements were maintained). 

From 2010 to 2020, central government intervention was relatively rare with formal interventions in only four councils.  However, from 2021 this situation changed substantially with interventions in eight councils in three years (none of these councils were controlled by the ruling national party).  In the same three years, there were statutory best value notices in a further nine councils.

It’s fair to describe this phase of intervention as less structured and evidence-based, without robust national data or independent routine inspection of councils.    

There has been limited evaluation of Intervention 2.0 to date.  Our early research findings based on three case studies suggest a five-stage model of intervention: (i) crisis revelation, (ii) delegitimisation, (iii) imposed reforms, (iv) capacity building, (v) restoration or reorganisation.  We conclude that under localism interventions were not merely administrative responses to failure but were deeply political acts that reshaped the legitimacy and capacity of local governance. The Commissioners, acting as technocratic agents of central government, connected central and local government, and had the effect of buffering the political tensions of intervention, while leading a process in which managerial competence rather than local democracy steered intervention.

Where next for intervention?

The raft of interventions related to section 114 notices, the establishment of the new Local Government Outcomes Framework and local audit reform including the Local Audit Office indicate a new phase of intervention and open opportunities to develop a more systematic and evidence-based approach.  More thought is needed on how this should work in future, including the role of peer reviews and inter-council support arrangements.  The centralisation of intervention power and the dominance of technocratic intervention needs to evolve to suit devolution and to provide greater support for local democracy. This could build on the new audit arrangements through a “district auditor” type overview of governance.

The acid test of reforms should be that while central government would still be able to intervene when councils were failing, the intervention process would minimise the suspension of local democracy, do as little damage as possible to the public’s trust in their local council, and foster good local democratic political leadership.

This article first appeared in the Municipal Journal on 16 October 2025 titled “How not to damage democracy”. It is available here: https://www.themj.co.uk/damage-democracy

Dr Jason Lowther is director of INLOGOV (the Institute of Local Government Studies) at the University of Birmingham.  Prof Paul Joyce is an Associate at INLOGOV.  Dr Philip Whiteman is a lecturer on public policy and administration at INLOGOV.

The Treasury’s Long Shadow: Why Local Government Needs Its Own Barber

/ jlowther2015 / Leave a comment

Philip Swann

The extent to which the Blair government’s delivery unit became the focus of tension between No 10 and the Treasury is a key theme in Michelle Clement’s fascinating history[1] of the unit. It was a product of Tony Blair’s ambition to reform public services and was seen by Gordon Brown as a threat to his dominance of domestic policies generally and his planning mechanism, public service agreements, specifically.

There are striking similarities between the Treasury’s “not invented here” attempted dismissal of the Prime Minister’s Delivery Unit (PMDU) and the treatment of the government’s missions in the recent spending review.

Prime Minister Kier Starmer announced in February 2023 that five missions would form the “backbone” of Labour’s election manifesto. In October 2024 the Cabinet Office announced the establishment of a “mission board” for each mission chaired by the relevant secretary of state.  In December 2025 the government complicated things slightly when it published its Plan for Change: Milestones for Mission-led Government. It set out six targets which, “guided by our missions” would “set clear milestones[2]” to track the government’s progress.

The milestones were: raising living standards in every part of the UK; rebuilding Britain with 1.5m homes in England and fast-tracking planning decisions; ending hospital backlogs; putting police back on the beat; giving children the best start in life; and securing home-grown energy.

The missions were largely ignored in the spending review. Only one of the missions was referred to in Rachel Reeves’ speech and there were only 14 cursory references to missions in the core spending review document. This must mean that the missions were not central to the discussions about the government’s public expenditure priorities. This is so far removed from the way in which missions have been deployed elsewhere, such as by Camden Council. There missions were central to the council’s strategic planning and were used to engage partner organisations and the community in a concerted drive to address the challenges facing the borough.

It is clear from Clement’s book that the first head of the PMDU, Michael Barber, managed to keep the Treasury on board. His unpublished diaries are a key sources for the book, and Clement argues convincingly that, as one of the few senior figures who were respected by both Blair and Brown, he was instrumental in keeping the No 10-led show on the road.

In retrospect it is clear to me that local government suffered as a result of the differences of approach to delivery advanced by No 10 and Treasury. At the time the LGA, where I was director of strategy and communications, made a series of attempts to secure a more collaborative approach with government to the challenges then facing the country.

Local public service agreements (the name gives the game away) and their successors, local area agreements, became entangled in the Treasury’s target-laden bureaucracy and did not benefit from Barber’s more thoughtful “deliverology” which Clement refers to as an art rather than a science. Similarly the LGA’s “shared priorities, an earlier version of missions, got little traction beyond the Office of the Deputy Prime Minister and the then Audit Commission.

I do not recall any significant engagement with Barber, but I am not sure we would have made much progress. Clement refers to local delivery but not to local government and all the evidence suggests that Barber would have shared David Blunkett’s antipathy to the perceived lack of ambition of local education authorities (Barber worked with Blunkett in Blair’s first term).

It is not clear whether the absence of any significant reference to missions in the spending review was an oversight or a reflection of a bigger split between the Treasury and the Cabinet Office. If there is a serious divide we do not know where the Prime Minister stands. What we do know is that local government faces an urgent task in getting the Treasury to give more energy and political capital to the fundamental reform of local government finance. It is also fair to argue that, if taken seriously, the missions provide a good basis for a discussion why that should be a priority for central as well as local government.

One clear message from Clement’s book is that people matter. Local government needs to find its Barber.

[1] Clement, M. 2025 The Art of Delivery. Biteback Publishing

 

Phil Swann is studying for a PhD on central-local government relations at INLOGOV.

The abolition of NHS England 

/ jlowther2015 / Leave a comment

Councillor Dr Ketan Sheth,

We all recognise that the current government inherited a deeply entrenched crisis in our NHS. Years of austerity, coupled with the immense strain of the Covid pandemic, have left our health service at breaking point. Across the country, patients are facing unacceptable delays — whether in A&E, for a GP appointment, or for much-needed elective procedures. The Health Secretary, Wes Streeting, has not shied away from the truth, acknowledging that the NHS is ‘broken’. But with this recognition comes a clear responsibility to act. The commitment to investment and reform was at the very heart of the Labour government’s manifesto, and it is now our duty to ensure these promises become reality.

The three fundamental shifts outlined by Wes — focusing on prevention rather than cure, strengthening community-based care over hospital reliance, and embracing digital innovation — are undeniably the right priorities. 

These are not new challenges; they are the very issues that those of us in local government and health services have been highlighting for years. With Tom Kibasi now leading the development of the NHS’s Ten-Year Plan, there is a real opportunity to turn ambition into action. But make no mistake — this will require more than just vision. It demands political will, cross-sector collaboration, and real investment to drive lasting change.

As a councillor with deep experience in health and social care, and as Chair of a London joint health scrutiny committee, I firmly believe that elected representatives — both national and local — must have clear oversight of how the NHS delivers for our residents. The NHS is funded by the taxpayer, and accountability for its spending —amounting to hundreds of billions —must be transparent. Striking the right balance between strategic oversight and operational efficiency is key. Reducing duplication and inefficiencies between national bodies is a sensible goal, but only if it genuinely results in better care, not just headline-grabbing restructuring.

Earlier this month, the government announced that, in order to focus resources on the frontline, NHS England would be abolished and funding to Integrated Care Boards (ICBs) would be cut by half. There is a logical argument for streamlining management functions where the Department of Health and NHS England overlap. Equally, we cannot ignore the vast NHS deficits that must be tackled if we are to clear the backlog left by the previous government. Cutting costs without compromising frontline care is an extraordinarily difficult balancing act, and success will hinge on empowering local decision-making rather than imposing one-size-fits-all solutions from Whitehall.

But now we must address both the handling and the substance of these decisions.

First, the handling. The people working in NHS England and ICBs are dedicated professionals, many of whom have spent their careers serving our health service. These are individuals with expertise, commitment, and families to support — not faceless bureaucrats. It is entirely possible to debate the structure of public services without resorting to derogatory language, labelling roles as ‘flabby’ or dismissing people as ‘blockers and checkers’. That is why it was reassuring to see Wes take to the airwaves to make a crucial clarification: the target is excessive bureaucracy, not the people who keep our NHS running.

On substance, the proposal to merge the functions of NHS England with the Department of Health is a bold and potentially transformative step — but only if executed properly. Addressing duplication in management is a legitimate goal, yet we must not underestimate the sheer complexity of NHS operations. The government must ensure that what replaces NHS England’s oversight role does not become another layer of top-down control. If local government is to have greater freedoms to shape healthcare services, these must be real and meaningful, not simply a rebranding exercise where old centralised structures persist under new names.

We must also keep our focus on tackling the stark health inequalities that persist in our communities. This means:

• Reducing waiting times for GP appointments and elective procedures.

• Strengthening hospital discharge pathways to ensure patients receive the care they need at home.

• Investing in public health initiatives to drive prevention and early intervention.

• Engaging meaningfully with local communities, in line with the NHS’s statutory duty to involve them.

• Managing winter pressures effectively and ensuring higher vaccination uptake.

While we await the publication of the Ten-Year Plan, which we hope will provide clarity on these pressing issues, one thing is certain: this government must not just explain why these changes are necessary, but prove to the public how they will lead to tangible improvements in their daily lives. The NHS is more than an institution; it is a national treasure, built on the principle that healthcare should be available to all, free at the point of use.

This moment is an opportunity — a chance to build an NHS that is fit for the future. It will take determination, investment, and an unwavering commitment to those who rely on it every day. Let’s not waste it.

Cllr Ketan Sheth chairs the North West London Joint Health Scrutiny Committee

Transforming Maternity Services in Brent

/ inlogov / Leave a comment

Councillor Dr Ketan Sheth

Each year here in Brent, we welcome almost 4,000 newborns into the world at Northwick Park Hospital’s maternity department. Each birth is the start of an exciting journey for new parents and families, who should all have confidence that they will receive safe, effective, compassionate maternity care that focuses on their individual needs.

Sadly, across the country, this has not always been the case. A quick online news search reveals that NHS maternity services have not always performed to an acceptable standard, with disparities in care especially for women from Black, Asian, and minority ethnic groups. The hard truth is that poor quality maternity care puts the safety and well-being of women and babies at risk.

An inspection by the Care Quality Commission in 2021 raised concerns about the quality and safety of maternity services at Northwick Park Hospital. I am delighted to say that in the years that have followed that inspection, Brent’s local government scrutiny committee has been working with the NHS leadership to ensure the service improves and staff have been working tirelessly with the National Maternity Safety Programme to turn things around for the 3,700 births there each year.

The maternity department recently celebrated opening its newly refurbished triage and birthing centres. Whilst this investment in new modern facilities is welcome, it is positive cultural change that is by far the biggest ingredient in the service transformation. There is a new senior management team and a commitment to listening to local women through the Northwick Park Maternity and Neonatal Voices Partnership, which is chaired by local mothers.

This has resulted in a raft of changes, including a special area for women who need to have an induced labour and a specialist midwife to support them. Obstetric nurses are on-hand to help women who have caesarean birth to recover quicker, and seven community midwifery teams have been set-up, three of which are in Brent. A new LifeStart trolley has also been introduced to look after newborn babies who need extra support, while keeping them close to their mothers. Antenatal care for women at risk of gestational diabetes has improved too.  

These substantial improvements, and many others besides, have led to the maternity team being taken off NHS England’s special measures. Indeed, the maternity service at Northwick Park Hospital was deemed the most improved of all trusts in a recent National Maternity Patient Survey

Transformation like this does not come about easily; it requires passion and the commitment from the local government and NHS working in partnership to continually deliver the best care possible for women, babies, and families. 

Tomorrow and every day, around ten babies will be born at Northwick Park, and each mother will have different needs. I wish them all the very best, safe in the knowledge they can expect personalised, safe, and compassionate care.  

Cllr Ketan Sheth chairs the North West London Joint Health Scrutiny Committee

REASONS TO BE HOPEFUL – HOW THE GAP IN LIFE EXPECTANCY BETWEEN ENGLISH REGIONS WAS NARROWED

/ jlowther2015 / Leave a comment

Nicholas Hicks and Jon Bright

In this blog, we discuss a major success in health policy that’s been largely forgotten.

What happened?
During the 2000s, a government strategy to tackle health inequalities in England led to a reduction in geographical differences in life expectancy. Furthermore, this success reversed a trend that had been increasing. It was achieved by reducing death rates caused by coronary heart disease.


The chart below shows an overall reduction in coronary heart disease mortality and a reduction of nearly 20% (19.07%) in the gap between the national average and the poorest areas. [Barr et al 2017]


This is the only period in the last 50 years when inequalities in death rates between rich and poor have narrowed. It was a considerable achievement and an historic result.

What was the impact in terms of lives extended?
This policy meant that many millions of people lived longer and healthier lives. Much of the benefit was probably due to reductions in smoking and managing risks such as high blood pressure and cholesterol. In 2000, 38% of the adult population smoked and smoking was twice as common amongst those on low incomes. Today, only about 13% of the adult population smoke, the lowest since records began.

But this achievement was not down to health policy alone. Importantly, it was also due to coordinated action across Government to tackle inequalities more generally. This is because many of the factors that affect health lie outside the health sector.

What were the policy drivers?
This work started in 2000 with the NHS Plan (that committed Government to publishing inequality targets), and the Department of Health’s National Service Framework for Coronary Heart Disease, and continued over several years.

These policies led to a national commitment to reduce inequalities. In the wake of the NHS Plan, the Government set Inequalities targets and incorporated them into national Public Service Agreements (PSAs). These Agreements required central government Departments to do better in those parts of the country where outcomes were poorest. This applied not only to health but also to low income, family functioning, education, employment, and crime. These wider issues are major influences on people’s health and targeted action on these made it more likely that health-specific interventions would succeed.

PSAs defined the goals of the 2002 and 2004 Comprehensive Spending Review. Departmental budgets were only agreed once each Department produced credible plans showing how they would contribute to the inequality targets.

What did all this mean in practice for people living in poorer regions?
Health-specific interventions included smoking cessation clinics; improving the distribution of GPs – many disadvantaged areas had no GP service; more resources for disadvantaged areas; national guidance on best practice; and improved access to mental health services. Action to tackle the wider causes of poor health included improving housing (the Decent Homes Standard); increasing household income (the Minimum Wage, Tax Credits); investment in education and skills; reducing the number of young people not in education, employment and training; teenage pregnancy prevention; and investment in early years (Sure Start and family support).

This approach is consistent with Prof Michael Marmot’s conclusions in his 2010 report, ‘Fair Society, Healthy Lives‘ .


What did evaluators find?
Evaluators found that regional inequalities decreased for all-cause mortality and that the strategy was broadly successful in meeting its ambitious targets. Writing in 2017, Barr et al they concluded that ‘future approaches should learn from this experience”. They noted that current policies were probably reversing this achievement of the previous decade. See also Holroyd et al’s systematic review.

In our main paper REASONS TO BE HOPEFUL we discuss the evaluations in more detail.


Health inequalities-narrowing the gapOct2023FinalDownload

What lessons should we draw?
There are five main lessons to draw from this evidence:

  1. When Government takes a coordinated approach to a problem – and sticks with it over time – the results can be impressive, even with problems thought to be intractable.
  2. Health is a good proxy for Levelling Up. Narrowing the health gap between regions is a good proxy for ‘levelling up’ more widely. Health inequalities are in large part due to poverty, poor education, and poor housing. Regional inequalities in educational attainment and crime also narrowed.
  3. Leadership and persistence are essential. A ‘whole of government’ approach requires good cross departmental working, full engagement with local government, and leadership from the Prime Minister.
  4. Tackling the nation’s problems needs longer term policy making so successful approaches don’t fizzle out whenever there’s a change of Government. As we’ve seen, benefits achieved up to 2010 may have been lost by 2017. Maintaining progress requires cross-party, long-term collaboration.
  5. This approach worked by influencing mainstream budgets via better targeting and evidence-based interventions, rather than relying only special ring-fenced funding

Today, the big health challenges today are obesity, diabetes and related conditions. Again, poorer populations are much more affected. Will today’s politicians rise to the occasion?

Dr Nicholas Hicks BM BCh FRCP FRCGP FFPH is an Honorary Senior Research Fellow, Nuffield Department of Primary Health Care Sciences at the University of Oxford and a Senior Strategy Advisor, Department of Health and Social Care. He is also an Associate Fellow, Green Templeton College, University of Oxford. He was seconded to the Department of Health Strategy Unit and helped draft the inequalities chapter of the NHS Plan in July 2000 ([email protected]).

Jon Bright is a former civil servant who worked in the Cabinet Office and Department of Communities and Local Government between 1998 and 2014.

References

  1. Meadows D. Leverage points: places to intervene in a system.
  2. NHS Plan. A plan for investment; a plan for reform. Department of Health (2000): 106-7
  3. Health inequalities – national targets on infant mortality and life expectancy – technical briefing . Department of Health March 2002
  4. Spending Review 2002: Public Service Agreements, HM Treasury 2002 para 1.12
  5. Holdroyd I, Vodden A, Srinivasan A, Kuhn I, Bambra C, Ford JA. Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010. BMJ Open. 2022 Sep 9;12(9):e063137. doi: 10.1136/bmjopen-2022-063137. PMID: 36134765; PMCID: PMC9472114.