It is a nonsense to equate what State employees get paid with the quality of the services that the State delivers.
We have massive waste and very bad value for money but that's not because people are overpaid (or underpaid), it is because of the inefficient structures and lack of sanction and accountability at all levels and lack of skills. All of those factors are the fault of those in charge, primarily the Departmental Secretaries and Senior officials in the Departments and the respective Ministers offices. The solution is thousands of small solutions. We should cut spending through greater efficiency and better accountability. We've had all sorts of scandals in health and policing but those responsible just retire. They should be facing criminal charges and long terms in prison. How can we criticise people for being inefficient when the people in charge make them inefficient because of how they tell them to do their job? This is a country, not a corner shop. Change will take time, decades. I believe that it is already happening but at to slow aa pace and in to ad hoc a fashion.
The best way to get people to do their jobs better is to talk to them and ask them what they would change. Change doesn't mean more of the same, it means the same doing more with equal of less effort.
In my experience process improvement makes people more productive, obviously, but it also makes them less stressed and happier in their job.
We don't need grand gestures but we do need a plan with clear goals and clear objectives in areas such as health. We then need a ruthless adherence to that plan. Toyota, who invented LEAN (lead by two American academics) have a efficiency improvement percentage target if 1.5% per annum. That doesn't sound like much but over 40 years it makes a massive difference. Given that we are starting at a lower base maybe we should set a target of a 50% increase in efficiency. At a 2.5% per annum increase in efficiency (or reduction in systemic waste) would give us that 50% from our baseline in 16.5 years. There's no need to sack anyone, natural wastage will take care of numbers, there's no need for pay cuts, there's no need for strikes. There is a need for massive changes to work practice and retraining and, more than anything, a massive change in mindset, but if the result is more stress and a heavier workload then you are doing it wrong.