The thoughts that count - the best of global thought leadership (July 2021)

What will the public services we use look like in the future? The Serco Institute’s monthly digest – The Thoughts That Count – pulls together some of the best thinking on public services policy from across the world.

Health & social care

Understanding integration: how to listen to and learn from people and communities – The King’s Fund (UK)

The move towards integrated care has been the defining policy in health and care over the past decade in the UK and will continue to gather pace with the development of integrated care systems (ICSs). The aim of ICSs is to improve people’s outcomes and experiences of care by bringing services together around people and communities. This report is a practical guide for partners working in these systems, with ideas on how they can optimise integrated delivery of healthcare in England.

A wait on your mind? Policy Exchange (UK)

The waiting list for elective treatment in the NHS in England has reached an unprecedented level. This Policy Exchange report sets out a number of recommendations seeking to address the backlog, including: showing patients how clinical prioritisation methodologies are being applied to them, embracing new ways of working brought about by the pandemic, and focussing on ensuring that unknown clinical risks are accounted for by prioritising patients who currently lack a diagnosis.

Market-driven Medicare would set US health care on a better course – American Enterprise Institute

Medicare’s payment regulations heavily influence how hospitals, physician groups, and other providers organize themselves to maximize profits while delivering medical services to their patients, according to this paper. It tries to offer an “alternative” view on how to structure the system from the perspective of a “market advocate” building on the program’s existing “consumer-oriented features”. It recommends reforms that emphasize strengthened price competition, informed and structured coverage options, and better financial incentives for migration toward low-cost, high-value care.

Filling the Medicaid Gap with a Public Option – Urban Institute (US)

As of July 2021, 12 US States have not expanded Medicaid as permitted by the Affordable Care Act, contributing to 5.8 million people with incomes below the federal poverty level being without coverage. This paper examines the possibility of introducing a “public option plan” – a government sponsored plan paying Medicare rates to providers. Through their research the Urban Institute conclude that a public option that typically pays Medicare rates would considerably reduce the cost of increasing coverage in the “Medicaid gap.”

Public-Private Partnerships for Urban Health: A Primer of the Benefits, Challenges, and Opportunities – Urban Institute (US)

This paper explores how Public-Private Partnerships (PPPs) can help governments leverage the financial and technical capabilities of private sector partners to deliver better health outcomes, with a focus on “developing countries”.

Lessons from the 2000s: the ambition to reduce waits must be matched with patience and realism – The King’s Fund  (UK)

The NHS had a problem with rising waiting times for elective care before the arrival of Covid-19. In the main though, the declines in performance were fairly slow with the exception of repeated winter crises in A&E. Promises of additional staff and money from the government during the 2019 general election also held the prospect of stopping and then reversing the decline. This ‘long read’ focuses on core waiting times for elective care rather than waiting in A&E or for other specific services such as cancer or mental health

Covid-19, vaccines & lockdowns

Tackling Covid-19 over the long-term: How to strengthen international efforts to end the pandemicInstitute for Government & Wellcome Trust (UK)

This paper is the product of bringing together leading scientists and policy makers to discuss how the pandemic could develop and the policies needed to end it.

State Revival: The role of the states in Australia’s COVID-19 response and beyond – The Australia Institute

Australia’s states and territories have taken the lead in addressing the Covid-19 pandemic, supported by constitutional powers and popular mandates. This report claims that with the states now emboldened by their role in managing the pandemic, further action on climate change, changes to federal-state financial arrangements, and reform of National Cabinet could all be on the agenda.

The Missing Link: How Pharmacies Can Accelerate Australia's Vaccine Roll-out – The McKell Institute (Australia)

Australia has had a stuttering vaccine roll-out programme. This report explores how enabling more community pharmacies to deliver the vaccine will help accelerate the program once more supply is received.

The Case for a National Scheme for Paid Vaccination Leave – The McKell Institute (Australia)

To help speed up the Australian vaccine roll-out, this paper argues for paid vaccination leave. It claims that the cost of paid vaccination leave would be lower than the cost of further delays to the vaccine rollout.

The gap between doses matters! – McGuiness Institute (New Zealand)

This short paper argues that the New Zealand vaccine roll-out should mimic the UK’s approach of increasing the gap between doses. Having a 12-week space between injections would not only make it possible for New Zealand to rollout the vaccination to more people, but most importantly, would deliver more durable long-term protection, this paper says.

Leveraging Community Expertise to Advance Health Equity – Urban Institute (US)

The Covid-19 pandemic’s disproportionate effects on people of color and increased attention to racial justice have given rise to new or expanded efforts to address health inequities, this Urban Institute paper says. In this brief, the researchers examine how governments and organizations adopt community engagement approaches to “collaborate and share power with communities that experience health inequities.”

Three Areas in Which Pandemic Management Could Have Been Better – Public Policy Forum (Canada)

This paper reviews Canada’s response to the pandemic and identifies three areas in which they could have done better including: keeping schools open, using technology to combat the pandemic, and prioritizing vaccine targeting.

Governance & policy

Smarter Government: Assessing the Commission for Smart Government’s ‘four steps’ for reformInstitute for Government (UK)

The authors note how war and crises have inspired reform in the past in “part from a search for fresh beginnings but also because moments of extreme tension show what works and what needs to change in a country’s major institutions”. The Covid-19 aftermath, they say, is such a moment. With this in mind the authors assess the UK Government’s Commission for Smart Government’s ‘four steps’ for reform.

Gridlock: removing barriers to policy reform Grattan Institute (Australia)

Concerns about popularity, tribalism, and vested interests “stand in the way of the public interest” in Australia according to this report. The country could break the “gridlock in policy reform” by increasing the expertise and independence of the public service, reducing the number of ministerial advisers closely tied to political parties and making them more accountable, tightening controls over political donations, stricter campaign finance, lobbying regulations, and managing post-politics careers, and setting up a federal anti-corruption commission with teeth to ensure that the rules of the system are followed.

The Social State: From Transactional to Relational Public Services – Demos (UK)

This new piece of research finds that as the UK comes out of the crisis mode of the pandemic, the British public could be finding it harder to make new connections and not easier. This report calls for a system of relational public services that can bring together local communities and make it easier for people to build relationships with other users, the community at large and people who provide the services. 

Defence & security

What is the Role of the Royal Navy?Royal United Services Institute (UK)

The author notes how the UK Government’s Integrated Review and Defence Command Paper has shed light on the missions and roles of the Royal Navy, but “there exists a conceptual gap between discussions of geopolitical ambitions and capabilities which the government and the Royal Navy will need to cover”. The commentary articulates the gaps between ambitions and capabilities, whilst providing recommendations on what is – and what is not – possible for the Royal Navy in light of international threats.

European SovereigntyEuropean Union Institute for Security Studies  

Given rapidly shifting global geopolitical and technology trends, and the seeming fragmentation of the multilateral order, the EU is being forced to confront its own position in international affairs. This paper zooms in on each of these elements of the debate about European sovereignty with case studies on semiconductors, the Iran nuclear deal and EU security and defence partnerships with the US and the UK.

Cost imposition in the contact layer: Special operations forces and great-power rivalry American Enterprise Institute

Cost imposition – using the targeted investment to disproportionately drive up the costs an opponent must pay to maintain its strategic position – is central to the foreign policy of large nations such as the US. This paper looks at this concept in relation to Special Operations Forces. It argues that, for now, cost imposition will typically not involve kinetic action – physical conflict – but will highlight SOF’s “softer skills” – such as intelligence gathering.

Understanding the Value of Defence: Towards a Defence Value Proposition for the UK – RAND Corporation (UK)

Commissioned by the Ministry of Defence, this report examines how the UK defence sector offers benefits “to both the economy and society in times of peace as well as conflict.” It seeks to explore “the 'value proposition' of UK defence, to provide a better understanding of why defence exists and explore how the value it brings to the nation can be better articulated across government, to partners and to the wider public.”

Understanding the Ministry of Defence's Wider Contribution to UK Prosperity – RAND Corporation (UK)

Linked to the wider study commissioned by the UK’s Ministry of Defence outlined above, this report seeks to inform a better understanding of different “methodologies” that could help the Ministry of Defence to quantify the value that defence brings to the nation. The researchers develop five different “methodologies” to explore how to measure the defence sector’s contribution to the UK outside of conflicts.

Employment & skills

Education, Employment and Housing: A CSJ submission to the Government’s National Strategy for Disabled People – Centre for Social Justice (UK)

In this briefing paper, the CSJ has focussed on areas of policy – education, employment, and housing – are critical to the outcomes of disabled people in the UK. For each category of policy, the CJS provides recommendations on how they can be optimised to support disabled people.

A renewed EU approach for Jobs and Skills – Centre for European Policy Studies

Covid-19, digitalisation and the European Green Deal are all cited as factors which are changing the landscape for the European labour force in this report. The ‘task force’ behind this paper make recommendations which seek to ensure the industrial transition to a green and digital economy more socially acceptable, and enhancing its potential in terms of competitiveness.


Reducing Probation Revocations in Pima County, Arizona – Urban Institute (US)

This technical paper explores the issue of “probation revocation” – what happens when a person on probation is arrested for a new crime or is in violation of their conditions. Partnering with the Adult Probation Services Division of the Arizona Administrative Office of the Courts and the Pima County Adult Probation Department, the Urban Institute seek to “shed light on the revocation pathways in Pima County and to identify policy solutions to address them.” 

Breaking the Homelessness-Jail Cycle through a Housing First Approach – Urban Institute (US)

This study brings together the results from Denver’s Five-Year Supportive Housing Program. It finds that Denver Supportive Housing Social Impact Bond Initiative is beginning to “pay off” for the city of Denver, its homeless residents, and a group of investors banking on social impact.

State Juvenile Justice Reforms Can Boost Opportunity, Particularly for Communities of Color – Center on Budget and Policy Priorities (US)

This paper argues that US States can expand opportunity and build stronger, more prosperous, and inclusive communities by reducing the incarceration of children and young adults and increasing the use of sensible alternatives that advance equitable outcomes.


E Pluribus Unum: Findings from the Cato Institute 2021 Immigration and Identity National Survey – Cato Institute (US)

This survey of 2,600 U.S. adults seeks to examine why Americans support or oppose a more open immigration regime. It finds that finds that nearly three-quarters (72%) of Americans believe immigrants come to the United States to “find jobs and improve their lives” while 27% think immigrants come to obtain government services and welfare.

Environment & climate change

Fairness and Opportunity – Institute for Public Policy Research (UK)

This landmark Environmental Justice Commission final report is a “fully realised blueprint for a transition to net zero grounded in fairness and public engagement”. The conclusion is that governments, businesses and communities should reduce emissions in ways that protect and repair nature, lock in fairness and offer a “people’s dividend”.

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