If it hadn’t been for the horrific events in Paris yesterday, this week would have been all about the NHS – which Labour apparently intends to ‘weaponise’ against the Conservatives.
The irony is that the two parties’ policies on the NHS are essentially the same. There’ll be the usual arguments about how much money each party intends to spend and the degree of private sector involvement they’re willing to countenance, but these are details.
Much more important is what the two policies have in common – which is the assumption that the NHS should be managed from Whitehall. It is a point that was made by John Seddon in the Guardian back in November:
“Politicians don’t know much about management, and nor should they. Since the Thatcher era, politicians have placed themselves at the helm of public sector reform. Regardless of party, their ideas have been much the same — ideas which, when we get down to the nitty gritty, are themselves the principal cause of rising cost and expenditure.
“It is unrealistic to expect MPs to be experts in management. But that being so, they need to recognise this and do the logical thing: get out of management altogether. This is the key change required in the way Whitehall runs public services, if we are to realise the enormous opportunity that exists to improve those services.”
Like any corporate enterprise, the NHS is composed of the people that work there and the systems that enable them to work together. The basic assumptions that underpin conventional health policy dictate that these systems should be designed in Whitehall.
In opposition, David Cameron promised that there would be “no top-down reorganisations of the NHS”, yet upon taking office, the Coalition embarked on just such a course – a decision that was presented as radical reform, but is anything but.
With health policy centred around the design and redesign of NHS systems by ministers and officials, the micromanagement of NHS staff is inevitable – because if government assumes that its designs are right, then it can only blame the people when things go wrong.
Seddon’s alternative approach turns this approach on its head. The people working on the NHS frontline might not be perfect, but they are in a better position to know what’s what than ministers and officials. Therefore, instead of trying to manage people from the centre, we should let them manage systems locally – that is, adapting them in response to changing local conditions:
“It is the imposition of measures and methods by politicians and regulators that is responsible for poor-quality public services, high costs and a culture of compliance that stifles innovation. ‘Best practice’ in the service of big ideas promulgated from the centre and inspected for compliance is, in fact, worst practice, a nail in the coffin of innovation.
“For innovation to flourish the locus of control must shift to the frontline where people deliver public services. Innovation requires freedom to learn and experiment; it can’t happen if it is constrained by consensus and regulation, especially when that consensus is largely developed among people with no knowledge. The Whitehall ideas machine must go.”
Bringing in private sector contractors to help with the design and implementation of centralised systems is not reform either; rather, it is, in Seddon’s phrase, an attempt to do the ‘wrong thing righter’.
Some Conservatives like to blame the Lib Dems for the failures of the Coalition. They’d do better to blame the lingering influence of Blairism – with its toxic mix of managerialism, control-freakery and pseudo-privatisation.