Cross service analysis

Summarising the landscape of lack of funding, rising costs and workforce pressures across public services.

Most public services are performing worse now than on the eve of the pandemic

A lack of adequate funding, historic underinvestment in capital infrastructure and an underpaid striking workforce has resulted in eight out of nine public services performing worse in 2023 than on the eve of the pandemic. Criminal courts and hospitals are in serious trouble, and by 2025, the performance of most of these services will be worse than a decade earlier. An incoming government faces a daunting task, but improvement is possible with a number of significant changes.

Across the nine services analysed – hospitals, general practice, adult social care, children’s social care, neighbourhood services, schools, police, criminal courts and prisons – none were performing better than in 2019/20. Just one, children’s social care, was performing at the same level.

However, for criminal courts and hospitals, the situation is stark. By June 2023, the backlog in Crown courts hit a record high, increasing from 40,826 in 2020 to 64,709. On all major performance metrics, hospitals are substantially worse than in 2019/20, while the elective waiting list has grown to 7.7 million cases, 3.1 million more than pre-pandemic.

In general practice, despite a rise in productivity, GP numbers are declining. With demand outstripping supply, patients are finding it harder to get appointments. Those who need adult social care are also struggling to access services, with staffing and capacity problems much worse than in 2019/20.

Virtually all local authority neighbourhood services have declined. Rough sleeping has seen a steep increase and roads have deteriorated. In schools, there has been a decline in maths and reading skills at Key Stage 2, and the gap in attainment between more affluent and less well-off pupils has grown. In the police, the number of charges fell by 13.5% between 2019/20 and 2021/22, despite a huge increase in police numbers. Overcrowding and less experienced staff have resulted in prisoners spending much longer in their cells, significantly reducing rehabilitation and educational programmes.

Many of these performance problems are systemic, and the interrelation between services means an issue with one ultimately bleeds into others. This is particularly evident in health and care, criminal justice and local government.

Most services have not had adequate funding to return to pre-pandemic levels by 2025. Higher than expected inflation and pay increases have taken a large chunk out of funding top-ups. Services have been weakened by long-term underinvestment in capital infrastructure. The total maintenance backlog across hospitals, schools, criminal courts, prisons and roads stands at £47bn. A critical shortage in equipment means public services are getting less out of staff and partially explains why extra funding has not had the desired impact on activity.

Uncompetitive salaries, overwork and stress has led to a high staff turnover, resulting in numbers of less experienced workers and a reliance on temporary and overseas staff. Widespread strikes and the government’s ineffective strategy for dealing with them has led to more than two million working days lost between August 2022 and July 2023.

From April 2025, the funding situation for public services looks even more difficult, with the next spending review set to be the tightest since 2015. An incoming government will face a daunting task and be required to make a change in approach. It needs to do much more to retain high-performing, experienced staff and should consider the impact of its policy decisions on workloads.

The cycle of “crisis-cash-repeat” funding needs to be broken and replaced by long-term settlements. The civil service should be put on a new statutory footing to maintain a long-term perspective on policy, ensuring the government has the capacity to deliver. Capital investment needs to be boosted, and the balance between spending on acute and preventative services improved. One route may be further devolution of public service budgets to local or regional levels.