“How to Survive Austerity” was Mike Gill’s field guide for public sector managers who suddenly found the ground shifting under their feet. Written in the aftermath of the 2008 financial crisis, it shot to number one on Amazon in its category for both paperback and Kindle, tapping straight into the anxiety and uncertainty many managers were feeling. At one point, it sat ahead of books by Tony Blair, Boris Johnson and Henry Kissinger on Amazon’s bestseller list – proving that practical advice on surviving budget cuts was more in demand than memoirs and grand strategy.
At Scale will be producing a short series of posts over the coming weeks that revisit and update the book’s core framework for NHS, local government and VCFS leaders navigating the current wave of transformation – neighbourhood health, integrated care, and the relentless pressure to do more with less.
What the Book Is Really About
On the surface, it was a book about managing budget cuts. In reality, it was about survival and influence in what Mike called the “new public sector” – a system that demanded more for less and was far less forgiving of vague value propositions.
The book was written for the managers who sat in the middle of the storm: accountable for performance, squeezed by politicians and finance teams on one side and by staff, unions and service users on the other.
The central argument was simple: if you want your service to survive, you cannot just work harder and hope. You have to present your service so clearly and compellingly that decision-makers, partners and the public understand what you do, what it costs, and why it is worth protecting.
That argument has only become more urgent. Today’s PCN clinical directors, NHS trust leaders, local authority commissioners and VCFS chief executives face the same fundamental challenge – but in a landscape that has grown vastly more complex. Neighbourhood health. Place-based partnerships. Integrated care systems. Multiple commissioners. Continuous CQC scrutiny. The need for clarity has never been greater.
The Seven-Step Survival Framework
At the heart of the book was a practical seven-step framework – summarised by the acronym CHERISH – designed to help managers make their services valued and protected:
1. Get clear on your service – what you do, who you do it for, and what would happen if you stopped.
2. Know your numbers – costs, activity, outcomes and the real value you create, not just the size of your budget.
3. Tell a value story, not a victim story – move from “we are being cut” to “here is the impact we deliver and why it matters.”
4. Map your stakeholders – understand whose support you need in finance, commissioning, partner agencies and the community.
5. Re-shape how you work – look for productivity, partnership and demand-management opportunities rather than salami-slicing.
6. Lead your people through uncertainty – keeping teams focused, informed and hopeful when the backdrop is anything but.
7. Position yourself for what comes next – a landscape that will be leaner, more data-driven and more demanding of leaders at every level.
These steps remain as relevant today as they were in 2016 – perhaps more so. The NHS 10 Year Plan, the shift to neighbourhood health, and the continued squeeze on local government budgets all demand exactly this kind of strategic clarity from service leaders.
Tone: No-Nonsense, But Oddly Optimistic
Although the book dealt with grim realities, it was not a counsel of despair. Mike treated austerity as a brutal but unavoidable context and focused relentlessly on what individual managers could actually control: how they framed their service, how they used evidence, and how they showed up as leaders.
The promise was that by doing this well, you could both protect as much as possible today and position yourself as a leader in whatever system emerged tomorrow.
A recurring thread was what one reviewer called “optimism with teeth.” There was still “so much to cherish and preserve” in public services – but that only happened if managers took a more strategic, outward-facing stance instead of keeping their heads down and hoping the cuts passed them by.
Why It Is Still Relevant Now
Even though it was published in 2016, the book feels uncomfortably current.
Many systems are now living through a second or third wave of constraint: inflation eroding budgets, workforce shortages limiting capacity, rising demand from an ageing population, and renewed pressure on both local government and NHS finances. The basic challenge Mike wrote about – do more with less, constantly justify your existence, live with deep uncertainty – has never really gone away.
What has changed is the landscape. In 2016, the “new public sector” was an emerging concept. Today, it is the reality:
· Neighbourhood health is government policy, with 43 pioneer sites launching from September 2025
· Integration between NHS, local government and VCFS is no longer optional – it is expected
· Commissioning is fragmenting and reforming simultaneously, with ICBs restructuring and PCNs taking on greater responsibilities
· Scrutiny from CQC is now continuous, not episodic
· Funding competitions reward the most credible, data-led, system-aligned proposals
For today’s leaders in primary care, NHS trusts, local government and the voluntary sector, “How to Survive Austerity” still earns its place on the shelf as:
· A reality check on how tough the environment really is
· A practical playbook for protecting what matters most while you navigate it
· A framework for emerging as a leader rather than a casualty
Coming Up: The Series
Over the coming weeks, At Scale will be breaking down each element of the CHERISH framework and updating it for the 2025 public sector landscape:
· Post 1: Get Clear on Your Service – why the 30-second pitch matters more than ever
· Post 2: Know Your Numbers – costs, outcomes and the data that wins arguments
· Post 3: Tell a Value Story – framing your service for commissioners and the public
· Post 4: Map Your Stakeholders – navigating neighbourhood health partnerships
· Post 5: Re-shape How You Work – productivity and partnership in integrated systems
· Post 6: Lead Through Uncertainty – keeping teams focused when the ground keeps moving
· Post 7: Position for the Future – what the new public sector demands from its leaders
Each post will include practical tools, updated examples, and connections to the current NHS and local government context.
