Steadying the swinging pendulum – how might we accommodate competing approaches to public service delivery?

Abstract

This chapter reflects on the challenge of accommodating competing approaches to public service delivery. Discourse around the social determinants of health is skewed towards the parts of the population whose adverse social circumstances harm their health the most. Local authorities are much closer to the complexities of service delivery than central government departments, and thus have an instrumental role to play in efforts to support these groups. They do not play this role alone — it is shared with other local delivery agencies, such as Sustainability and Transformation Partnerships in the National Health Service (NHS), as well as private providers and local community groups. There has always been much debate around what role each of these actors should play, and how they might interact with one another so as to create masterful theatre rather than a depressing farce. This question continues to be the focus of much policymaking, experimentation, and debate. The chapter then considers the West London Zone for Children and Young People, a cross-sector delivery partnership. It also explores some of the intersecting themes across other efforts, drawing on research from the Government Outcomes Lab.