FrontPoint Systems Ltd

So does the provenance of criticism have a bearing on its veracity?

The verdict of the Better Government Initiative, contained in a series of reports to be released over the next few weeks, is damning.

Government departments have “serious deficiencies”; the combined output of Parliament and the executive contain “too many disappointments and failures”; and “emphasis on ‘management’ has led to more bureaucracy at the expense of substance” in the Foreign Office.

“Health, education and the armed services have had constant change, insufficiently discussed and thought through.

“We’ve had nine revolutions within 10 years in the NHS. We’ve gone away from markets, then back to markets. It’s just disruptive and demoralising.”

“What has really damaged the public’s trust in politics is the failure to live up to promises… Ordinary people want the money spent on the NHS to have brought about the improvements it should have done.”

“Teachers, nurses and doctors can see how much micro-management is going on, that makes their job harder and seems to treat them as unintelligent creatures.” There is a similar problem in Whitehall. “Civil servants are not expected to analyse problems and produce intelligible policy,” he says.

“Ministers come up with an idea and expect civil servants just to do it. You can’t just come down on civil servants if they don’t deliver when you haven’t been very precise about what you mean by delivery.”

“Constant change, often couched in impenetrable jargon has had a depressing effect on morale. People feel that they no longer feel they know whether they are coming or going, that they are unappreciated and ignored… This is not management in any real sense, it is certainly not leadership and it undermines the effectiveness of the organisation.”

Hmm, so where does it absolve the authors from responsibility for standing by while all this was happening? Not to mention the very many failures of years past? After all, it is not as if the civil service has clean hands in all this as can be seen below. But I will take allies wherever I can find them.

Sophia Christie in the HSJ punctures a few bubbles relating to the way in which policy seems to be populated by some remarkably persistent ideas that pop up every decade or so in search of believers.

Several weeks later, Lord Darzi announced polyclinics as the solution to primary care capacity in his interim report for Our NHS, Our Future (or the On/Off review).

The last time I remember polyclinics taking centre stage was the late 1980s when Margaret Thatcher sent teams of civil servants overseas to investigate alternative funding for the NHS. They came back from Germany with polyclinics, which at least diverted attention for a while from personal insurance as the answer.

However, the theme of finding community-based activities for hospital consultants is a recurring one. In his London review, Lord Darzi rightly identified a key principle as ‘localise where possible, centralise where necessary’. However in On/Off he also references US achievements in shifting outpatients to community settings. Given the lack of primary care in the US, much of this outpatient activity would have been seen by a GP in the UK anyway.

Meanwhile the many GP fundholding initiatives of inviting consultants to sit in GP surgeries and see a fraction of the patients they could have in a clinic should have been a lesson in both (in)efficiency and inequality.

At-least someone is paying attention & is willing to display a healthy cynicism. Now to help educate the rest of her colleagues.

Share This