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Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts

Friday, 19 July 2013

The Reform Of Our Institutions Won't Come From The Top

It's been a difficult month to finish this post. Every day another dollop of decrepitude is revealed amongst our rotting institutions. Systemic slaughter in the NHS. The convenient collapse of a major police corruption trial through 'missing' evidence. Police concealing the misuse of private investigators and spying on victim's families for the chance to undermine public sympathy. Sunlight on vast pay-offs to the departing management of the Savile-stricken BBC. The lengths to which the unions will go to control the Labour Party and use it to enshrine their own power. The Church of England deciding to turn money lender. And, surprise, surprise yet another massive bank fine...because, yes, any bank that relies on a public guarantee of its liabilities and massive tax subsidies through ISAs and so on should regard itself as a public institution.

It's a core theme of this blog to contrast the decline of faith in institutions that have evolved to suit themselves at our expense, with the rise of facilitators who exist to help us solve problems more effectively for ourselves.

Our institutions won't align with the interests of the those who rely on their services while they suppress evidence of their ineptitude, or while trustees and management quibble over their extent of their responsibilities, or while politicians spend their time blaming each other for the mess. These are sure signs that our institutions are stuck in denial and that the MPs and Ministers whose job it is to supervise them are stuck in their own cycle of blame.

Until our institutions understand and accept the need to align with the consumers of their services, rather than the desires of their pompous managers, they will not evolve into efficient, facilitative organisations worthy of our trust and respect.

But I don't believe that our so-called political leaders or the managers of our institutions have either the self-awareness or the skills needed to achieve this evolution. They are merely products of 'the system' that so desparately needs to evolve.

Sustainable reform will only come come from the grassroots rather than the top down. It will only come when each of us takes personal responsibility for turning things around, whether by exposing institutional failings or genuinely working to solve other people's problems rather than merely our own. 

In other words, both the problem and the solution are in our hands.


Tuesday, 14 February 2012

It's A Dog(matist)'s Life

The great challenge for political parties in a democracy is that they exist primarily to solve their own problem: how to get a majority of their candidates elected to govern the country. Solving citizens' problems is not their fundamental aim. In fact, the problem of how to get elected is so remote from the day-to-day problems encountered by the country's citizens as to render the internal activities of political parties more or less irrelevant to how our problems actually get solved. The world is too complex for the answers to lie in some political party manifesto, far removed from the activities of market participants and even civil servants. So political parties have to persuade us of their distinctiveness and their relevance. They have to convince us that they could solve our problems, if we would only vote them into power and leave them there. Trends reveal that this process, and party politics itself, is doomed.

Declining participation rates in general elections demonstrate that we don't really value the outcome of our formal electoral processes. And the relentless pursuit of MPs over their expenses demonstrated that, in the UK at least, we don't think much of our formal political representatives either. Instead, we're turning to more direct means of shaping our society bottom-up, through informal facilitators like 38 Degrees, well-organised charities or other single interest groups. We want our politics unbundled, like travel or music. Eurocrats in Brussels also admit to a rise in 'informal institutions' within the fiendishly complex framework of the European Union, and European academics point to 'networks' as the source of "informal processes of economic regulation and institutional change". This cuts both ways. National governments are relying on global businesses to act as 'private sheriffs' (e.g. to enforce their user terms to shut down Wikileaks) and big businesses lobby governments to control our behaviour when it suits them.

So party-political dogma provides a particularly poor lens through which to view this world and solve its problems. It collides with the trend towards each of us having our own personal political manifesto - charting our own, pragmatic path.

The challenge for political parties to remain relevant is particularly evident from The Red Book, a series of essays from Labour Left, the 'home of ethical socialism' within the UK Labour Party. While I don't care a fig for the Labour Party (or the Tories or Lib Dems, for that matter), I started reading The Red Book to see how an ousted political party might try to improve its relevance in 2012.

What struck me in the very first essay, introducing ethical socialism, is that The Red Book takes a top-down approach, rather than bottom-up. First, the ethical perspective is contrasted with that of other segments of the Labour Party, referred to as "Blue Labour", "Purple" and "the Blairites". Then you and me are discussed as if we're in another room, using the terms "middle-income (A/B) voters" and "poorer voters (C2)". Then come the references to the "political establishment and the wider public" and the claim that "politics is about shaping public opinion, not bowing slavishly to it" (my italics). Finally, comes the admission that "a key Labour NEC member" has derided The Red Book and/or Labour Left "as a 'Peoples' Front of Judea' no less" (the irony presumably lost on the said NEC member):



The introduction continues by asking "how to live the socialist life?" and I've highlighted the inconsistencies in bold: 
"At the outset, it means committing ourselves to living in community with all who share our social space. This means, for the better off socialists, refusing the option of buying out of that society alongside developing policies that challenge the choices of those who do... The vision of a harmonious society lies at the heart of a socialist community: and a socialist community cannot exist where we relate only to those whose experiences mirror our own.
It follows from this that we must treat our fellow citizens with decency and respect.
[and later]
"What is desperately needed is an holistic vision of society where the contribution of all its parts is recognised and treated with dignity and respect."
Surely the requirements to treat our fellow citizens with decency and respect, and to avoid relating only to those whose experiences mirror our own - the 'holistic vision' - should mean allowing rather than refusing others the option to buy out of "our social space"?

At any rate, the socialist path immediately loses its way in a series of essays on the difficult subject of NHS reform. The first (by Grimes) denies the NHS is inefficient, claiming it leads the world (contradicted by research on various measures IEA, p. 82), dismisses the idea that people must take more responsibility for their own health, and challenges the application of market forces - we simply need to spend more money. The second essay (by Taylor-Gooby) concedes inefficiency, accepts some of the recently announced Coalition reforms (claiming they were Labour's anyway), requires people to be encouraged to live more healthily and points to local social health enterprises as a means of increasing the efficient allocation of resources. Finally, Grahame Morris MP fears that the "commercialisation" of public services will open the ideological floodgates, but then reminds his by now thoroughly confused colleagues of the need to restore confidence in public services and the public sector workforce:
"Slow moving monolithic bureaucracies at local and national level need to become more responsive and we must recognise that the move towards the private sector was in part inspired by the refusal of some services to adapt and change. Trade unions and staff associations must become part of the solution to improving services...".
As a pragmatist I would agree with Grahame, but doubt the ability of the entrenched public sector workforce to change from within. The idea of exposing the NHS to competition - even from social enterprise - would seem likely to help ensure change is achieved.

It's just a pity that The Red Book is focused more on pointlessly proselytizing about 'living the socialist life' than drawing helpful conclusions based on hard facts. Presumably it has left the faithful wandering confused among the wards of some figurative NHS hospital rather than focused on improving healthcare.

And therein lies the real message in The Red Book: living a dogmatic life is a terrible waste of time and energy that would be better spent helping to clearly identify problems and figure out how to solve them. 


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