In the late 1980s, legislators in the American state of Oregon were focusing on healthcare. Sure, other local issues continued to resonate strongly but policymakers in Salem’s state capitol came together to create the state’s Health Services Commission. Its role? To prioritise a list of healthcare services for their citizens.
With funds tight, the commission – which was made up of public servants and medical professionals – created a list of 17 priorities chosen on the basis of need. This was a major step forward in creating a process and a plan for policy prioritisation within the state.
However, the success was short-lived. The list was immediately challenged by lawyers acting for the federal government. They argued that a methodology of prioritisation was against specific requirements contained in the Americans with Disabilities Act, (ADA), itself a ground-breaking piece of legislation which “guarantees that people with disabilities have the same opportunities as everyone else to participate in the mainstream of American life”. In light of this intervention, the commission then had to re-examine its methodology in order to comply with the ADA.
Oregon’s experience helps demonstrate that prioritising policies is rarely a straightforward process – but that doesn’t make it any less important. While a government’s time is finite, its problems are infinite. Without the will to prioritise, governments across the world run the risk of trying to do everything and achieving very little.
The use of prioritisation as a method for allocating resources against desired outcomes is not a new concept, however. Historical and religious texts are littered with examples of leaders focusing limited resources on creating secure defences or prioritising agricultural projects. However, as society has become more complex and more interconnected, the use of prioritisation as a method of ensuring delivery of certain objectives has itself become more complex, more difficult and certainly more contested.
With citizens demanding 24/7 services and value for money, rare is the leader who admits that only a small number of areas will gain his or her focus. However, prioritisation is often the only solution to these twin challenges. In theory, it enables public servants to focus their resources on key areas to ensure on-time and in-scope delivery. In reality, it requires equal measures of bravery and political capital, tacitly acknowledging that some things are more important than others and, in the process, potentially alienating certain groups of people whose issues are not seen as a priority.
Following the financial crises of 2009, the Irish government came under increasing pressure to reduce public spending and reform the way public services were delivered. These twin pressures have brought about a culture change within public services in Ireland, culminating in the publication of six national priorities to be delivered by 2016.
And former UK prime minister Tony Blair was the first to create a specific civil service delivery unit to ensure that government priorities were acted on, with someone or some group of people focused on each issue 24/7, 365 days a year. The power of a consistent focus on specific priorities cannot be underestimated, as it allowed the government to illustrate its own priorities and its goals to citizens. This clear alignment of priorities, outcomes and delivery led to tangible outputs. In essence, citizens could see progress.
One of the major threats facing governments across the globe is the erosion of trust between citizens and government. People are facing a crisis of confidence and there is a feeling that public servants can no longer to be counted on to deliver what they say they are going to. Former US treasury secretary Larry Summers provides an example of this in the failure of government to deliver key infrastructure projects on time, which leaves the citizen annoyed and bewildered by the lack of progress. Sumner recounts that it took US forces under General Patton one day to build a bridge over the River Rhine during the Second World War, yet it took local authorities several years to conduct works to the bridge over the Charles River, which connects Boston and Cambridge. His argument is that if government cannot deliver at a micro-level, the citizen will have no trust in the macro-level delivery.
It may seem simple, but prioritising a limited number of tasks allows for a concerted effort towards delivery and in turn a clear outcome for people to observe. It is incumbent on public servants to deliver what has been promised and prioritisation gives them a better chance of doing this.
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