“In December 2005 I watched a BBC interviewer, Jeremy Paxman, lash out at a junior minster for the inadequate supply of foam to meet a fire in Hertfordshire … it did not occur to either interviewer or interviewee to point out that putting out fires had nothing to do with London Ministers. They were a local responsibility.”
I just finished reading Thatcher and Sons by Simon Jenkins. I won’t even try to outline his detailed analysis of the rise of Thatcher and Blair, because frankly I can’t hold a candle to his writing and dissection of the facts. Instead I’d like to talk about the points he raised.
Problem: Central Targets
Schools, hospitals, jails and police stations are all run to meet a set of centrally set targets. These targets are not written by teachers, doctors of police officers, but are instead decided by administrators and managers in the heart of government who have never worked in the departments they regulate. These targets are nationwide and do not take into account any local variance in ethnicity, income or health status. A GP in the richest parts of London is told to meet the same heart attack targets as one in the poorest parts of the Hebrides.
Millions are spent each year to collect, collate and analyse data from all these sources to see if they match the targets central government sets. Countless hours are wasted filling out paperwork to generate these statistics by those employed to aid the public. All this data is used for one simple purpose.
If you meet all the targets and quotas you receive more money next year. If you miss them you get your funding cut.
This means one thing – richer areas get the best provision and the poorest ones get the poorest. If most crime happens in poor areas, the police stations in these poor areas are fined for their high crime rates, while the police stations in wealthy areas are praised for their surprisingly low crime rates and receive bonus funding.
The taxpayer pays statisticians to work out which areas of the country are struggling so they can have their funding taken away.
These statistics are also manipulated now more than any time in the past as funding depends so heavily on them. I remember my school would force the struggling pupils to take their exams at a different examination centre so the poor results would not feature on their results paper, meaning the received more money in the next year.
I don’t know enough about being a doctor, a teacher or a police officer to comment on how rife this sort of statistical manipulation is, but I do know one thing; if my next pay-cheque depended upon statistics, I’d do everything I could to skew them in my favour. This skewing renders the entire system pointless as all the results are hugely biased.
Solution: Local Allocation
In the past, hospitals were given more money if they needed more money to tackle the problems in their community. High rates of HIV in the local population? Here’s money for your HIV department. Successfully reducing rates of heart attacks? Let’s relocate that money to areas where they need that money more.
Funds should be allocated on the needs of the population today, not on the outcomes of yesterday’s services.
Instead of getting service centres to report their successes and failures to us, we should match the best provision of healthcare to the unhealthiest areas, the best crime-fighters in the most crime-ridden areas, the best teachers to the most uneducated. We cannot do this by sending down decrees from on high; a politician in Westminster simply cannot know which parts of the country need help in a particular field.
The best way to do this, and the system used in other European countries, it to let local government decide what to do with their health/police/education funding and allocate it based on their own needs. Give them a pot of money and let them run with it. Who knows better what the money should be spent on than the people who will end up using the money locally?
This also eliminates the huge wastage that comes with multi-tiered bureaucracy seen in Whitehall and saves vast amounts of valuable doctor/teacher/police time.
Problem: No Accountability
In the UK we currently have a bed crisis in our hospitals. There aren’t enough beds in the hospitals to allow surgeries to happen. Who is to blame?
Is it the patient’s fault for staying in hospital longer than they need to?
Is it the doctors at fault for not getting people out of hospital quickly enough?
Is it the managers fault for not managing the beds properly?
Is it the regional CCG’s fault for allocating money to the hospitals incorrectly?
Is it the Minister for Health’s fault for setting incorrect targets on admission times?
In other countries maybe a solution would have been found, but in the UK we came up with an ingenious solution. Nobody is at fault. The system is just broken. Nobody is to blame, so nobody steps up to the plate and therefore nothing is changed. The layers of bureaucracy protect each individual level from any blame as it is everybody else’s mistake, and therefore ultimately nobody’s mistake.
I have the feeling Odysseus would have really liked the modern NHS. Polyphemus not so much.
Solution: Local Accountability
One of the main reasons this doesn’t happen to nearly the same extent in other countries is simply the fact that the buck stops earlier. If the local hospital is failing then the local councillor is absolutely and completely responsible. All the constituents know who they are and will fight tooth-and-nail to save and improve their own local hospital and get rid of the councillor who messed things up if they have to. When things start to go wrong locally, politicians step in because they are completely aware they will be held to account by their constituency for things going wrong.
Instead of taxing people locally with council tax then sending most of it off to central government to be slowly dripped back down through giant NHS behemoth, why not let local councils use the tax they already gather to fund the hospitals that are already there?
Make government local, and it will become locally accountable, because people care about their own things far more than the broad ideas sent down to them by politicians.
People have been convinced that local government means less efficiency and poorer outcomes even though all countries in the EU run with a more devolved system than the UK and do better for it. They can name their local mayor, their local MP, their local councillor. Can we Brits say the same?
I am certain that no politician is ever going to read these points and local government is never going to gain any more power because it would require a government to actually consciously chose to devolve some of its power back to the people.
This post was therefore entirely pointless.