One sign of our poor grasp of mathematics in Britain is the common belief that no performance in the public sector should be below average. Who, after all, would want a school for their children which was less than excellent or choose a hospital with less than four stars. Our politicians have been persuaded that the way to ‘drive up’ standards is to measure and publicise, or name and shame, while ideologues speak in terms of markets, consumer choice and competition. Among the unintended consequences are large numbers of consumers inevitably disappointed at having to settle for less than the best and a significant minority of service providers labelled as failures. Even those that might be considered good enough may be condemned as ‘bog standard’.
None of this is of recent origin, for public services have long had to meet the high expectations set by politicians with inadequate resources, because Britain has aspired to have Scandinavian provision funded by American levels of taxation. Whenever the gap between rhetoric and reality becomes too obvious (ie there’s sustained media criticism) politicians are readily convinced that reorganisation is the answer. This has the great merit of apparently using the same resources more effectively, or even getting better value for money. Among the benefits commonly predicted are ‘providing seamless services’, ‘reducing bureaucracy’ and ‘devolving decision-making’. Unfortunately these benefits are rarely achieved in practice.
In reality, there’s no ideal way to organise public services: they are bound to be divided into departments or sections, each with specialist functions, separate budgets and competing priorities. However, despite the constraints on resources, staff will find ways to co-operate across whatever organisational boundaries have been laid down. Over time they agree protocols for working together and, more importantly, develop trusting relationships in which give and take can be relied on. That is until the next media storm or financial crisis, and the next reorganisation looms.
The first effect is that staff become pre-occupied with their personal futures, faced with the prospect of competing for their own or some other job. Planning becomes pointless while structures and personnel are in flux. Meanwhile, the process of change consumes enormous amounts of time and energy, wasting any new resources which might have been available. Eventually, the dust settles: staff find their feet in the new environment and begin building the relationships and understandings essential to make an inevitably imperfect organisation work as well as possible.
Given the predictability of this ‘silly cycle’, driven by top down reorganisations, it’s no surprise that so many NHS staff have come out against the upheaval currently proposed by Andrew Lansley and David Cameron. Especially since it’s even less clear what government is hoping to achieve this time. Perhaps they hope that making GPs responsible for budgets will moderate their aspirations on behalf of patients, or perhaps they really do believe that competition, with all its associated costs, will produce more, better and cheaper services ? Sadly, it seems that they’ve invested too much personal credibility in another reorganisation and are now determined to press on regardless.