Fuel and travel costs are pushing prices up again
Thursday 5 November 2026
Inflation has risen to 3.1%, meaning everyday spending is getting more expensive just as household budgets are already under pressure.
Public services aren’t meeting our needs
Long waits, gaps in provision and overstretched services leave people without the care, support and shared infrastructure they need.
In a nutshell
- Public services matter when we need treatment, support at school, help with daily life, justice or reliable local infrastructure. Long waits and gaps in provision can turn manageable problems into crises.
- The services depend on one another. A missing care package can delay a hospital discharge; a shortage of suitable local school places can mean longer journeys and higher transport bills.
- The causes include rising needs, funding pressures, staffing and maintenance problems, and poor coordination. Private provision can add capacity, but weak contracts, limited competition and poorly controlled financial risks can also make services worse.
The basics
A service can exist on paper without being available when someone needs it. Three questions help distinguish a working service from a promise.
Can you get help in time?
A wait is not just inconvenient if it prolongs pain, interrupts a child’s education or leaves someone without essential support. The right timescale depends on the need.
Is the right service available?
An appointment far from home, a service with restrictive eligibility or a system someone cannot navigate may leave a real gap, even if provision exists elsewhere.
Does the whole system work?
People may need several services at once. Referrals, assessments, transport and follow-up must fit together, with someone responsible when a handover fails.
Most examples below concern England, where the evidence cited applies. The court figures cover England and Wales; the productivity measure covers the UK. Health, education and local services differ across the four nations.
How big is the problem?
There is no single public-services score. These dated examples show different kinds of pressure; they are not a ranking of every service.
Long waits in emergency care
In England in 2025–26, 74.9% of A&E attendances ended in admission, transfer or discharge within four hours, against the 95% standard. For major, consultant-led A&Es, it was 60.9%. [1]
This measures the whole visit, not just the wait to first see a clinician.
Delays to support plans
In England, only 46.1% of new education, health and care plans in the 2025 timeliness measure were issued within 20 weeks, excluding cases where exceptions applied. [2]
A plan identifies a child or young person’s needs and the provision required. A late plan is not necessarily evidence that no support was provided meanwhile.
Justice takes too long
The Crown Court in England and Wales had 80,829 open cases at the end of June 2026, the highest in the series. Of these, 23,706 had been open for at least a year. [3]
Delay leaves victims, witnesses and defendants waiting for resolution.
Gaps in NHS dental access
In the two years to March 2024, 40% of adults in England had seen an NHS dentist, down from 49% in the equivalent period before the pandemic, according to the NAO. [4]
This is an attendance measure: it does not mean every other adult needed care and was refused it.
Buildings in need of repair
In January 2025, the NAO estimated a maintenance backlog of at least £49 billion across the government property portfolios it examined, including schools, hospitals and prisons. [5]
Deteriorating buildings can interrupt services and make staff’s work harder. This figure does not include every infrastructure repair in the UK.
Everyday infrastructure deteriorates
The NAO’s 2024 review found England’s local road condition was declining and the repair backlog increasing. It also found that the Department for Transport lacked adequate condition data and evidence of what its funding achieved. [6]
The network includes pavements, bridges and drainage as well as road surfaces.
Example: one missing service affects a whole family
Ruth is ready to leave hospital after an illness, but she needs help washing, dressing and preparing meals. Her daughter, Maya, lives nearby. This is a fictional illustration.
- Without an appropriate care package, Ruth cannot safely return home. She remains in a hospital bed she no longer needs for acute treatment.
- Maya tries to fill the gap, rearranging work and childcare while contacting different teams. Her availability does not remove Ruth’s need for a proper assessment and safe support.
- The hospital has less space for the next patient. Staff must continue looking after Ruth while trying to organise the next stage of care.
The lesson is that a hospital’s capacity depends partly on what happens outside its walls. Delays can also arise inside the hospital; social care is not the explanation for every delayed discharge.
When one service struggles, others feel it
A saving in one budget is not necessarily a saving overall. Sometimes the cost moves to another service; sometimes it falls on the person or their family.
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Care and recovery support → hospital capacity
Where the gap starts
A patient no longer needs acute hospital care but cannot yet get suitable care, rehabilitation or support at home.
Where the pressure goes
The delayed discharge reduces available beds and can slow admissions from A&E. The patient’s recovery and independence matter as well as the bed.
What the evidence shows
The NAO reported delayed discharge in 14.2% of hospital stays in England in 2025–26. It identified both external capacity constraints and internal delays, such as arranging medicines. [1]
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Mental health support → police response
Where the gap starts
A person in crisis needs timely specialist help, but the right professional or a prompt handover is unavailable.
Where the pressure goes
Police may spend time responding to a health need, reducing their availability for other duties and potentially adding distress for the person in crisis.
What the evidence shows
The government’s Right Care, Right Person agreement explicitly recognises these problems. It calls for coordinated health and police responses; it is not evidence that withdrawing police attendance alone resolves the gap. [7]
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Suitable school places → transport and family time
Where the gap starts
A child needs provision that is not available close to home.
Where the pressure goes
They may travel further, need a specialist vehicle or rely on a parent to transport them. Education, transport budgets and parents’ working lives become connected.
What the evidence shows
The NAO’s 2025 review linked growing transport pressures in England to longer journeys to suitable provision, higher operator costs and reduced public transport. It also described effects on attendance and parents’ work when transport support is withdrawn. [8]
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Crisis spending → less room for early help
Where the gap starts
Councils must meet urgent needs while also funding work intended to stop problems escalating.
Where the pressure goes
Immediate costs can squeeze prevention. The risk is a cycle in which responding to today’s crises leaves less capacity to reduce tomorrow’s.
What the evidence shows
In February 2025, the NAO found that immediate financial pressures were limiting English councils’ investment in prevention, while spending on late intervention in children’s social care had grown. [9]
Does prevention really reduce later demand?
Sometimes, and the evidence is strongest when a specific programme has been evaluated. IFS research published in 2025 estimated that Sure Start provision at its peak prevented around 13,150 hospital admissions a year among 11- to 15-year-olds in England. It also found educational benefits. [10]
But effects varied: admissions increased among one-year-olds, and the research found no reduction in the number of children looked after by the social care system. Benefits emerged over years. This supports carefully evaluated early help, not a promise that every preventative service immediately pays for itself. [10]
How did we get here?
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Needs and costs grew faster than capacity
What happened
Population change, more complex needs and higher delivery costs can increase the work required even when a budget rises.
Why it matters
More pounds do not necessarily buy more support per person. Demand also depends on what people need, not just how many people there are.
What the evidence shows
The NAO found that English local government funding rose 4% in real terms from 2015–16 to 2023–24, but did not keep pace with demand and complexity. Funding per person fell 1%. [9]
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More funding has not always produced better outcomes
What happened
Some services have received substantial increases while still struggling with how support is organised and delivered.
Why it matters
Counting money allocated or plans issued cannot tell us whether people actually get the help they need.
What the evidence shows
In 2024, the NAO reported a 58% rise in England’s high-needs education funding in real terms over the preceding decade, alongside rising identified need, but no improvement in overall outcomes for children and young people. [11]
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Staffing problems are also skills and retention problems
What happened
A service needs the right mix of experienced staff, with manageable work and time to train others. Recruitment alone does not settle that.
Why it matters
An extra post helps only if it can be filled and supported. Turnover and missing specialist skills can disrupt continuity.
What the evidence shows
The NAO identifies skills shortages, high turnover and limited workforce planning as recurring barriers to performance across public services. [12]
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Maintenance and organisation were allowed to lag
What happened
Repairs can be postponed and systems patched while immediate pressures take priority. Separate organisations may optimise their own work without fixing handovers.
Why it matters
Equipment failures, unsuitable premises and repeated administration use time that could support service users.
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The pandemic left a difficult recovery
What happened
Public services experienced major disruption, with recovery differing between services. Some weaknesses and missed standards predated the pandemic.
Why it matters
Additional resources can be absorbed by backlogs and recovery before users notice a better service.
What the evidence shows
ONS estimates published in August 2026 put UK public-service productivity in 2025 at 2.5% below 2019, despite improving during 2025. These estimates are provisional and do not identify a single cause. [14]
Productivity means the service delivered relative to the resources used. It is not a measure of how hard individual staff work. Recent ONS estimates are still being developed and do not yet include updated quality adjustments for the latest years. [14]
What role does privatisation play?
It can contribute to problems, but “privatisation” covers arrangements with quite different consequences. Who pays, who owns the assets and who delivers the service are separate questions.
Selling public assets
Ownership moves to private organisations. The water industry in England and Wales was privatised in 1989; household customers generally cannot switch between its regional monopolies. [15]
Contracting out a service
A public body pays an outside organisation to deliver work. The provider may be a business or a charity. Government’s Sourcing Playbook compares this with in-house and mixed delivery. [16]
Using private finance
Under PFI, a private company financed construction and the public body paid over a long contract for the asset and associated services. This created commitments lasting decades. [17]
An NHS-funded treatment delivered by an independent provider is still publicly funded care. Paying privately because an NHS service is unavailable is a different change: the cost has moved to the patient.
What the evidence shows in practice
Children’s care: weak markets can be costly
The CMA’s 2022 study of England, Scotland and Wales found too few appropriate placements and prices and profits among large providers above what it expected in a well-functioning market. [18]
But it did not find that in-house residential care was automatically cheaper. Comparisons were difficult because needs, staffing and costs differed. The findings support scrutiny of market design and returns, not a blanket verdict on every private home. [18]
Probation: a failed contracting model
In its 2019 review of Transforming Rehabilitation in England and Wales, the NAO found rushed implementation, underinvestment by contracted providers, friction between organisations and poor value for money. [19]
This was a failure of commissioning and commercial design as well as provider performance. It shows how splitting a connected service can create costly gaps.
PFI: maintenance benefits, financing costs
The NAO’s 2018 review identified higher financing costs and inflexible long contracts. It also found evidence of stronger maintenance protection: upkeep was harder to cut when contractually required. [17]
The review highlighted limited evidence on overall benefits. Maintenance commitments can also be made without private finance, so they must be weighed against the extra costs.
Water: ownership needs effective oversight
In April 2025, the NAO found that government and regulators had failed to drive necessary investment and manage risks in the water sector. It reported weak progress on key performance measures and deteriorating financial resilience. [20]
This is evidence of serious failings in the regulated private model examined. It does not, by itself, establish what every alternative ownership model would have delivered.
When can private provision help?
Outside providers can offer specialist expertise, facilities and delivery capacity. The test is whether these improve the whole service at a reasonable cost. A low initial bid means little if quality falls, the contract needs expensive changes or government must rescue delivery.
The Sourcing Playbook therefore calls for comparing delivery models, assessing the supplier market and considering whole-life costs and risks. Public provision should face the same tests of quality, accountability and effective use of resources. [16]
The useful questions are: is there genuine competition, can quality be measured, who carries the financial risk, and can the service keep running if the provider fails? Where users cannot shop around or walk away, providers can have market power, making public oversight especially important.
Who is affected most?
People with few alternatives
Paying for a private appointment, a taxi or extra childcare may solve a problem for one household but be impossible for another.
People who need several services
Disabled people, people with long-term conditions and families with complex needs can be particularly exposed to failed handovers and repeated assessments.
Unpaid carers and families
When formal provision is missing, relatives may absorb the work, expense and stress. That does not make the unmet need disappear.
Why is it hard to fix?
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The service paying is not always the service benefiting
The problem
A council may fund support that helps a hospital, while the financial benefit appears in a different budget. No single manager controls the whole chain.
A possible fix
Agree shared outcomes and responsibilities, and assess costs across services. Joint working needs clear accountability as well as meetings.
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Tomorrow’s capacity competes with today’s crisis
The problem
Services cannot simply stop urgent work while training staff, repairing buildings or expanding early help.
A possible fix
Fund the transition explicitly, protect essential maintenance and evaluate prevention over a realistic period. Savings may arrive later, or take the form of better lives rather than smaller budgets.
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A target can miss the real experience
The problem
A shorter queue is not enough if people are excluded, passed elsewhere or receive care that does not meet their needs.
A possible fix
Track outcomes, quality, access and user experience alongside waiting times and cost. Check who is still missing out.
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Changing ownership does not instantly create capacity
The problem
Bringing a service in-house requires staff, systems, assets and transition planning. Keeping it contracted out still requires skilled commissioning and oversight.
A possible fix
Compare workable options service by service, including transition costs and continuity. Use evidence about performance rather than assuming either ownership model guarantees success.
Where people disagree
The debate is partly about the balance between funding and reform, and partly about what level of service society should guarantee.
The case for greater public investment
- Long waits, gaps in support and deteriorating assets point to needs that current provision is not meeting.
- Workforce development, repairs and prevention require investment before their benefits appear.
- Costs already fall on families and other services when the initial service is unavailable.
- Some services need public or regulated provision because users have little meaningful choice.
Why funding alone is not enough
- Extra spending has not always improved outcomes; the organisation of support matters too.
- Poor coordination, weak contracts and unsuitable incentives can absorb additional resources.
- Private or charitable providers may contribute useful capacity, while public ownership also needs scrutiny.
- Resources are limited. Priorities should consider effectiveness, fairness and what else the same money could achieve.
On balance
A public service succeeds when people can get appropriate help at the right time, and when the infrastructure they rely on works. Budgets, activity counts and promises are only part of that test.
The evidence supports both investment and better delivery. It also shows why decisions must account for effects on other services: reducing one organisation’s spending can leave a bigger problem elsewhere.
Privatisation is one part of the explanation, with outcomes shaped by competition, contracts, finance and accountability. For the options, see Invest in what people need.
Sources and further reading
Sources checked on 4 October 2026. Dates and geographical coverage are given because these services and measures differ. Historical evaluations explain particular failures or successes; they are not presented as measurements of every service today. The sources do not all endorse the same policies.
- National Audit Office: NHS A&E performance improvements are smaller and slower than hoped for (September 2026) — England: four-hour performance in 2025–26, delayed discharge and pressures on hospital flow.
- Department for Education: Education, health and care plans, reporting year 2026 (June 2026) — England: timeliness of plans in calendar year 2025, excluding cases with permitted exceptions. See the timeliness section for the full denominator and exclusions.
- Ministry of Justice: Criminal court statistics quarterly, April to June 2026 (September 2026) — England and Wales: open Crown Court cases and cases open for at least a year. An open caseload is not a count of people or only of trials awaiting a hearing.
- National Audit Office: Dental recovery plan unlikely to deliver target of 1.5m additional treatments (November 2024) — England: adult NHS dental attendance to March 2024, spending and contract incentives. The attendance measure is not a direct estimate of unmet need.
- National Audit Office: Government building maintenance backlog is at least £49 billion (January 2025) — The central government property portfolios examined, including NHS buildings, schools, prisons and defence. This is not a total for all UK infrastructure.
- National Audit Office: The condition and maintenance of local roads in England (2024) — Deteriorating road condition, the repair backlog, weaknesses in condition data and funding allocation.
- Home Office and Department of Health and Social Care: National Partnership Agreement, Right Care, Right Person (2023; updated 2024) — The rationale for coordinating police and health responses in England. This is a policy agreement, not an independent evaluation of the programme’s results.
- National Audit Office: SEND reforms need to address home to school transport pressures (2025) — England: longer journeys to suitable schools, transport market pressures, reduced bus services and effects on families.
- National Audit Office: Whole government response essential to local authorities’ financial sustainability (February 2025) — England: funding relative to demand, reduced prevention spending and growing late-intervention pressures. Historical findings are not presented as a forecast for 2026.
- Institute for Fiscal Studies: Sure Start’s wide-ranging and long-lasting benefits (May 2025) — Evaluation of early access to Sure Start in England, including later hospital admissions and education, mixed effects and long-run estimated benefits.
- National Audit Office: Support for children and young people with special educational needs (October 2024) — England: growth in identified need, high-needs funding and the lack of improvement in outcomes.
- National Audit Office: Delivering more productive public services — Audit-based synthesis of demographic and cost pressures, skills shortages, turnover, technology and organisational barriers.
- National Audit Office: Smarter delivery — improving operational capability to provide better public services (June 2025) — The importance of managing demand, using information and improving services across organisational boundaries.
- Office for National Statistics: Public service productivity, quarterly, UK, January to March 2026 (August 2026) — Annualised estimates for 2025 and comparison with 2019. These are statistics in development; recent estimates lack updated quality adjustments and can be revised.
- House of Commons Library: Economic regulation of the water industry (updated October 2026) — Ownership and regional monopolies in England and Wales, and the role of regulation.
- Cabinet Office: The Sourcing Playbook — Comparing in-house, contracted and mixed delivery; whole-life costs, market health, risk and supplier failure. This is procurement guidance, not proof that one model always works best.
- National Audit Office: PFI and PF2 (January 2018, PDF) — Overview and Part One: long contracts, higher financing costs, maintenance incentives, inflexibility and limitations of the benefits evidence.
- Competition and Markets Authority: Children’s social care market study, final report (March 2022) — England, Scotland and Wales: placement shortages, large-provider profits and limits on public/private cost comparisons. See the summary and the prices, profits and costs sections.
- National Audit Office: Transforming Rehabilitation: progress review (March 2019) — England and Wales: rushed implementation, underinvestment, organisational friction and poor value for money under the former CRC contracts.
- National Audit Office: Regulators have failed to deliver a trusted and resilient water sector (April 2025) — Findings on Defra and the water regulators, investment, company finances, infrastructure and performance.
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