NHS Groundhog Day

Francis Maude and Andy Burnham even had a lively exchange of views...

One of the bigger items of news this week has been Andrew Lansley’s statement to the Commons about his White Paper suggesting the poor old NHS should undergo yet another reshuffle.

The issue was covered last night on Question Time, and when I heard the start of the original question my brain already started going to sleep. But I gave it a chance, and it turned out to be the most interesting part of the programme.

The main reason for that was because the somewhat left-wing panel (George Galloway, Sally Bercow, Andy Burnham) found itself an unusual ally in the ample shape of Nick Ferrari, the always excitable, never unopinionated talk-show host. The four of them battered the lone policy defender, Francis Maude, a quiet and unassuming man, and were aided by very generous rounds of applause, and one or two bouts of heckling.

NHS reorganisations are probably the most boring thing to happen in this country. But one thing you can’t say is that they’re not regular. Every Health Secretary under Labour seemed to have their very own pet project to implement. Now, step forward the new Tory Health Secretary, who doesn’t want to feel left out.

The whole exercise is pointless. The main reason is simple: it has been tried before in the late 80s and it didn’t work (see Simon Jenkins in Tuesday’s Evening Standard). The goal of is to “put GPs in charge” of the money. I’m not sure why we’d want to do that, as I don’t believe most GPs entered the profession to be accountants.

I’ve said it before, and I’ll say it again, we need bureaucracy. We don’t need waste, and we don’t need over-regulation. Stop the press. But we do need good, professional administrators to handle the difficult organisational decisions so that the people who want to do the caring and the treating can actually do it.

Like most things in life, structures do matter, but only to a point. Beyond that point, the rest is down to the people involved. Just like poor schools failing because of poor management, hospitals and other health organisations too suffer when there is a failure in leadership. If the coalition wants to do something useful, it should be to start in that area, and let the current system at least have a chance to bed down so we can see what impact it actually has. Especially as changing them now is going to have a £1.7bn price tag.

All sounds too easy, doesn’t it. Well, of course it isn’t. Finding good managers is tough. Might it be that they have to be poached from the private sector with generous wages? Talk about a minefield.

What is it about governments, of all colours, that they feel they must be seen to be doing something? I had high hopes that this coalition might actually resist the New Labour hyper-legislation reflex.

It seems to be a poor showing so far.

Some Good News In The Darkness

We love databases cos they do all good stuff like this!

In the past I’ve strongly challenged the idea that what this country needs to protect its children is a bloody great database constantly monitoring the activities of nearly one-quarter of the adult population on it.

So today’s announcement that the Independent Safeguarding Authority’s Vetting and Barring Scheme is to be suspended pending a very rigorous investigation is to be welcomed.

So far this government has been reasonably true to its word of looking carefully at ways to roll back the frontiers of the infant police state that Labour were building. A state based around databases and vast swathes of information about its subjects, all built to make them sound good and thoroughly decent, but with no safeguards as to where they could head, and with little concept of how damaging they are to our civil liberties.

I understand that there is actually some relief within the civil service at this announcement, primarily because the Independent Safeguarding Authority (ISA) was not going to be ready for its July start date. This news will mean no need for embarrassing admissions about yet another bureaucratic failure.

But there’s still some way to go before proper celebration. We don’t yet know the full extent of the “Great Repeal Bill” promised by Clegg and Cameron. The ISA and its associated legislation would have to be included in such a repeal bill if it were to be shelved altogether. Indeed, as I pointed out in one of the posts linked to earlier, there was no need for the ISA in the first place, given the fact that the CRB could easily have done the job.

All it takes is a little imaginative thinking in government. I dearly hope this review gives them enough time to think properly about what is actually needed for the safety of children and vulnerable adults. What risks are we prepared to accept in society?

Sadly, yes, anyone with close, and frequently isolated, contact with children must be checked out. This does include the voluntary sector too. But how much further beyond that do we need to go? Do we really need, as I have seen in job adverts, chefs working for a major English professional football club being CRB checked because they might also be cooking food for the youth teams?

The coalition keeps moving in the right direction with this kind of stuff, and so it fills me with some confidence that we may finally be seeing the limits of state intrusion.

The scores on the doors: ContactPoint child database: to be scrapped. Identity cards, and the national identity database, to be scrapped. ISA bureaucratic, intrusive nightmare: on the abyss. Great Repeal Bill? Jury’s still out on that one…

In Defence Of The Public Sector

My favourite picture of all time. OF ALL TIME.

Over the next few years we’re going to hear more about the “unproductive” part of our economy. We will hear endlessly about how it is pain-free to eliminate jobs from the public sector because they’re not “real” jobs anyway. Indeed, a tortured logic might even argue that rather than the government paying someone a certain amount of cash per year as a salary, they could pay them far less in benefits.

It’s not an argument I’ve ever heard, in truth. I thought it up now. In pure cash terms, its logic is probably unbeatable. I should have been an economist.

But the real point of today’s rant is to fight back against this concept that private sector jobs are the only ones that are productive. The private sector raises the taxes that pay for all those public sector fripperies that we spend over £600bn a year on.

The problem with this argument is that it assumes the private sector exists in glorious isolation. Free, untrammelled, providing the state with a glorious worry and risk-free treasure trove of cash to squander on the poor and feckless.

The private sector cannot provide reasonable and affordable healthcare for the masses. America proves that. Without health, there is no economy. If workers die young, or from preventable illnesses, then the private sector has no one to do its dirty work in the first place. Healthcare requires a huge range of healthcare professionals, from the humble social workers providing care in the community, to the consultant cardiologist earning a six figure salary.

The private sector cannot provide a decent basic level of education. Without education in the first place, none of those doctors and nurses will exist. In that sense, education is more important than all of them. That means we need teachers, teaching assistants and other educational welfare providers. That all needs paying for. Those workers don’t just arrive at the doors of private sector firms magically able to read, write and have a multitude of other skills ready to go.

Then there is order. Who provides it? Certainly not Securicor. We need a network of people to execute and judge the law. Oh, and then make attempts to rehabilitate the offenders, no matter how badly that system works at the moment. Without order, there is no society. Without society, there is no economy.

I could go on. Who built the railways? Who built the roads? Who rescued the entire banking sector from collapse when the private sector had fucked the whole thing up?

But there is one bit underpinning all this. The bit that everyone thinks we can just slash and burn without any impact.

The bureaucrats.

Teachers don’t organise themselves. Healthcare professionals don’t. After all, we want the professionals on the “front line” (we’ll hear that one a lot too) to be actually doing the thing they’ve been trained and want to do. We don’t want doctors having to co-ordinate shift patterns between themselves. We don’t want nurses to have to worry about when the order for vaccines should be placed, and from which provider it should come from to reduce the costs involved. We don’t want teachers having to manage a database of names and attendance records to monitor whether the children that are supposed to be in education are actually there.

The civil service is the glue that binds all of the necessary functions together. Someone has to do the administration. Someone has to organise the lot. Someone has to co-ordinate the parts that overlap and interact. Someone needs to try and do the “joined-up government” that we all wish for.

That’s not to deny that there aren’t efficiencies that could be made. Of course there are. Anyone who says otherwise is lying. My head gets filled with anecdotes on a daily basis from the civil servants I know about the waste and mismanagement.

But let’s not assume that the simple answer to saving money is simply to get rid of the people in the back office. We need to be way more clever than that.

Because if we’re not, those very same “front-line services” that the coalition government love so much are going to take one hell of a beating, intentionally or otherwise.

Don’t Get Rid Of Politicians; Empower Them Instead

When the answer is "more politicians" you're asking the wrong question...

Campaigns like this one really fuck me off…

NFR (Nurses For Reform) believes that the next government must liberate health provision from the costly and counterproductive world of top-down and un-innovative state control.

First point is I’ve never heard of them, so I’m immediately suspicious that, especially as the story was in the Telegraph, we could be seeing a group being used for party political purposes. How many times have we heard about pledges to free healthcare professionals from the iron grip of the bureaucracy from certain right-wing parties…

Second point is that they are totally wrong.

There are enough problems in this country that we can’t solve. People moan and groan about politics and not voting because “it never changes anything”. That’s because politicians have done their level best to absolve themselves of any responsibility for anything by farming out decisions to quangos and other layers of civil service bureaucracy.

Let’s not continue along that course by placing the NHS in the hands of an unelected, nepotistic agency which will doubtless allow politicians to get away with murder, and no longer have to get their hands dirty.

After all, that’s what politicians are supposed to be for. We elect them to take decisions on our behalf because a) we would probably make a hash of it; b) we don’t have time to do the job ourselves; and c) there are some thing we just couldn’t give a stuff about. Agricultural and fishing subsidies, for example. Boring, but important.

We shouldn’t be electing them to wash their hands of doing the job we want them to do. When these agencies fuck up, there’s invariably no way of holding them to account. When politicians fuck up, we can give them a kick in the ballots, or the opinion polls.

But thirdly, this campaign is not good because it distracts us from the real issue. The NHS is a monster. It cannot be run from Whitehall. But the real solution to that is true devolution of responsibilities from Whitehall to local authorities. Let’s give councillors more responsibility. Let’s give them something to do. Let’s make local government more interesting and more relevant to people again.

That principle can be applied across many departments in an attempt to make local councils more responsive to the needs of local people. They are in the best position to judge, after all.

Then maybe, just maybe, we might get the Liberal dream of a federal UK. Oh my!

The ISA To My CRB

Well, I know it makes me feel all warm and fuzzy, but I shouldn't admit to that or I'll be getting barred from working with children and vulnerable adults...

The government likes its three letter acronyms.

A few years ago, in response to the Bichard Inquiry, Labour decided to implement a brand new “vetting and barring” scheme.

As usual, it was a typical Whitehall reinvention of the wheel. The government already had its own vetting and barring scheme. It had existed for a long time in the guise of things like List 99, a central list of undesirable people that we didn’t want working with children, based on criminal records and intelligence.

But this was insufficient. The government decided it would be better farmed out to an “independent” agency.

The Independent Safeguarding Authority (ISA) was born.

Why a new agency? It has long been suspected that the real reason behind this outsourcing was so that the government could wash their hands of responsibility. The government’s calculation was that, one day, an abuse would again occur involving a person not on List 99 – such as what happened with Ian Huntley. Too many questions were already being asked as to why Huntley slipped through the net, some of them rather uncomfortable (e.g. the case of Kim Howells clearing a registered sex offender for a PE teacher’s job). So taking these kind of decisions out of the hands of politicians would, indeed, be politically desirable.

The problem here is that many years earlier, the government created an agency to collate and try to ensure that the system was much tighter. It was called the Criminal Records Bureau (CRB).  Charged with issuing Disclosures on people, based upon nationwide police criminal records checks and intelligence, it is, ostensibly, a neutral organisation which provides employers with information and allows them to take the final decision based on what they receive back from the check.

While they are subtly different – ISA takes decisions on people’s suitability, but the CRB only provides the information required for the decision – they were still overlapping sufficiently that, at first, the CRB were told to prepare to take on the new vetting and barring scheme. They did so, spending money and time in the process. After all, they were ideally placed to deal with this new function in-house. They

Then the government pulled the plug and decided that a new layer of bureaucracy was exactly what the country needed.

This woeful tale is yet another example of the failure of modern politics.

Firstly, the  creation of new bureaucracy when the existing system could be adapted is a ridiculous waste of time, money, will cause needless duplication of resources and will doubtless result in poor communication between the ISA and the CRB.

Secondly, the propensity of the modern politician to farm decisions out to quangos and other bodies (e.g. strategic health authorities, foundation hospitals, trust schools, academies…) means a lack of ministerial responsibility and accountability.

And thirdly, on principle, as we have seen in the news lately, the whole thing is going to lead to a further gross infringement on liberty and a redefinition of the fundamental relationship between adults and children in society.

Who knows where that will lead.

How To Sack A Civil Servant

Of course, before this scenario is enacted, one has to comply with all relevant legislation and conduct a through job performance evaluation, attaching appropriate, relevant, unbiased evidence over a period of time...

As someone with many contacts who work in the civil service, this morning’s article on BBC News about bureaucrats having “no fear of the sack” is particularly interesting.

The article only talks about “senior” civil servants. But I can assure you all that the article is applicable across the entire service.

The problem seems to be that, unless the member of staff commits obvious gross misconduct, or is actually removed through genuine redundancy, a job in the civil service is extraordinarily well protected, regardless of performance level.

Now, I’m not so miserable as to be calling for more and more people to be sacked… but there does come a point where the tales I hear make me wonder just how some idiots got jobs in the first place.

There is a government agency that is current very high in the news agenda. It has, like most departments, got lots and lots of staff.

I understand from my sources that a significant number of these staff are incompetent. In any other half-decent private sector organisation they would have been moved on by now for the fact that they simply cannot do their job. It’s not that they are not trained sufficiently; it is simply a grave error that they were employed in the first place, a failure to weed out the brain dead at interview stage. This tends to happen when a new agency is formed – a large wave of recruitment washes onshore a great deal of debris.

And getting rid of them is a challenge any line manager would avoid like the plague. The procedures for getting someone sacked are long and onerous. Most managers don’t tend to stick around for long enough to see them through, and in any case the managers may actually be too close to those underneath them to want to do anything about it, such is the nature of the hierarchy in the agency in question. (We’re talking about an EO wanting to sack an AO)

Even if they did want to do something about it, they are open to challenge at every turn, facing union action and legal procedures that most sane people just wouldn’t want to trouble themselves with at work. Particularly if their days are stressful enough as it is.

So the incompetence remains, badly affecting the performance of the agency. Some cracks are papered over, but not without the effort of the better staff, upon whom extra work falls in order to make up for the shortfall.

My sources also confirm that, as in the news article above, the problem is very much one in senior management too. The SEOs and Grade 7s are frequently “moved sideways” if it appears they are unable to do their job, upon which time they will simply unleash their idiocy on another section of the agency.

That’s not to say the private sector is a beacon of human resources best practice. Some places are just as bad.

But when it comes to the vital question of whether taxpayers’ money is being spent on delivering efficient and effective public services, there is an endemic culture of tolerating failure that needs a thorough examination.

Even Public Sector Workers Want Cuts

Any recession that involved these things would be very welcome, and would remind me of my long, lost childhood.

Yesterday’s papers were filled with comment on a poll carried out by YouGov for the Policy Exchange think tank. Most of them focused on trust in government, but, as is always the case with these polls, there was a little more to it than they could fit in the headlines.

The full details of the poll are available directly from the Policy Exchange site.

I’ve had a quick look through the figures, and this question caught my eye:

Spending on public services such as schools, hospitals and the police has risen sharply in the past ten years. Overall, how much of the money do you think has been wasted on such things as bureaucracy paperwork and penpushing?

First of all, questions like this bug me. I don’t like to read too much into them, because they are explicitly negative and almost invite the respondent to join in the browbeating of government. The media have conditioned us to “hate” bureaucracy, as if to say that any money spent on administration must be bad. Perhaps they would like doctors and nurses sitting at computers making their own appointments, booking patients in, arranging rooms, etc…

But regardless, there is a widespread impression that vast swathes of government spending goes to feed the paperwork monster (my cousin, I think). This has been true for years and will continue to be so no matter which government is in power. There’s no doubt that fat can be trimmed from the civil service and local government, but the demands of the wider public for such efficiency savings are unrealistic and insatiable.

So this result is not surprising:

• A lot: 62%
• A fair amount: 22%

The next result, however, is more interesting. Instead of it being the result of the entire sample, it drilled down to only include those who worked for the public sector…

• A lot: 59%
• A fair amount: 25%

Overall, the same percentage in these two responses as there was for the entire sample.

In other words, the public sector workers, those who see the waste on a daily basis, are just as likely to be fed up with spending on needless things as the general population. One might have expected the public sector worker to be more defensive of their line of work. They have often been considered Labour’s “payroll vote”… but if even they are getting fed up, I think the battle is already lost.

Cuts are on their way. Even Lord Mandelson has admitted it today… in ways which might even excite the Labour Party, especially if he cancels Trident.

The final remaining political point of interest is this… when the public sector recession begins, will it be so severe that it does indeed cause the dreaded “double-dip”, W-shaped, recession?

If so, the Tories are going to have an extremely bumpy ride in their first couple of years in office.