Lifeline Services

The public debate around public services is beginning to heat up - the newspapers are full of opinion pieces and there finally seems to be an acknowledgement that it's perfectly OK to criticise our 'lifeline' services - without becoming anti-police or anti-NHS. 

Well that's a start - although I did read a rather bizarre article in the Guardian the other day in which some left-wing professor argued that the shameful failings in Mid Staffs and Morecambe Bay - were all caused by privatisation and 'marketisation' of the NHS.

Anyway, here's a much more intelligent and throughtful contribution to the debate  from Dominic Lawson writing in The Independent - in which he argues that both 'left' and 'right' find it difficult to face up to their sacred cows - by standing on the side of the consumer or customer or patient or victim of a crime. 

Now that's exactly what we need - more straight talking - then we might see some real change in the behaviour of services which are a mixture of good and bad - but don't respond to well to honest criticism.

From the NHS to the police, public servants are putting their own interests first

By Dominic Lawson

Recent revelations show just how embedded is a culture of self-preservation among those whose first duty should be to you and me

there are two professions we trust with our lives. One is the police; the other is doctors – along with the nurses who act on their instructions. This explains the overwhelming public interest in revelations of the betrayal of that vital trust, both by the NHS at hospitals in Stafford and Morecambe Bay and – the most recent lifting of the veil – the police’s alleged attempt to smear the family of the murdered teenager Stephen Lawrence.

There has been an almost pathological refusal to accept the evidence of malpractice as it has piled up over the years, even when it has been as stark and unambiguous as a mound of corpses (whether in the Mid Staffs mortuary, or at the Hillsborough football stadium). Those on the left have been particularly wilful in dismissing the very idea of callous misconduct within the NHS: the nationalised health service monopoly, free at the point of use, represents their ideal of the best of Britain, and any denigration of it therefore an act of malevolent political subversion.

There has also been deep reluctance to wake up to the fact that policemen may have used their privileged position as the sole provider of public safety to defame and frame, rather than allow the public to discover their incompetence. In a mirror image of the left’s blind idolatry of the NHS, many on the right have remained so blinkered because they regard the maintenance of law and order as the highest political ideal – and therefore cannot quite face up to the fact that those who by their very choice of profession exemplify this priority are not paragons of virtue.

There is another common factor, so obvious that it should not need pointing out. Both the NHS and the police are effectively monopoly providers. If you don’t like the way you are treated in your local hospital, there isn’t another one down the road where you can take your custom; and similarly, if the police have dismissed your concerns about the neighbouring family which so enjoys tormenting your disabled child, there is no rival local law-enforcement firm to go to instead.

Also, because both services are provided by the state, you, the end user, do not give them the money directly, let alone through an act of preferential choice. Your taxes are extracted to pay for them, but as far as the nurses and police are concerned, your satisfaction is not critical to their professional well-being and even promotion. As long as Whitehall is vaguely satisfied, that is good enough for their salaries to be kept on an upwards trajectory; and Whitehall has no way of measuring a nurse’s smile or a policeman’s nod of sympathy.

Because their funding comes from Westminster rather than individual consumers, such monopoly providers of public services are intensely political – and can be more unscrupulous in protecting their reputations than the most ruthless private corporations. This can be seen in the hundreds of millions of pounds spent by the NHS in pay-offs which prevent the recipient from revealing anything to the public about what actually happened. It is seen in the behaviour of the Care Quality Commission in – allegedly – seeking to bury a report which laid bare the failings of its own investigation into deaths through medical incompetence of mothers and babies in the Morecambe Bay NHS Trust. And it is seen in the way that, over the Hillsborough stadium catastrophe and (now we are told) the Stephen Lawrence case, police forces were allegedly prepared to defame victims with the sole purpose of maintaining their reputation.

In the case of Hillsborough, it was a Conservative Government which refused to believe that the police could so behave; in the case of the Morecambe Bay baby deaths, there is evidence that the last Labour Government was deeply uncomfortable with the idea of the NHS’s abject failings being exposed: a letter from the then Health Secretary, Andy Burnham to the CQC has come to light in which he reminded its executive that its role was to “maintain public confidence in the NHS”. No: its role was properly to uncover failings, regardless of any adverse PR consequences.

Yet the same Andy Burnham was outstanding in his support of the Hillsborough victims’ campaign. As I say, left and right have very different sacred cows. But the conclusion is the same – it seems that for some health-service regulators their own organisation’s reputation is a higher priority than the quality of healthcare they are tasked with invigilating; and that far too many policemen believe their own brand image is more important than the justice they are sworn to uphold.

This, by the way, is all in accordance with public-choice theory, as pioneered by the Nobel-Prize winning economist James Buchanan, who died earlier this year. Buchanan pointed out that individuals within the political process, rather than the commercial sector, were just as dedicated to maximising their own economic benefits as any employees in a profit-making organisation. Thus we have seen the grotesque spectacle of NHS doctors taking industrial action in protest against Government plans to make them provide 14.5 per cent of the value of their index-linked pension (rather than their existing contribution of 8.5 per cent), as if unaware that the average doctor’s pension would cost about £2m to buy on the open market – and how many of their patients could afford that?

I’m sure men and women don’t go into the NHS with the idea of getting the most out of the public with the least effort. But I can’t forget the remarks to me of someone who recently left the NHS after more than a quarter of a century: “I am completely disillusioned. I thought it was vocational, but good people get the stuffing knocked out of them. It doesn’t seem to matter if you are thoroughly mediocre, just so long as you don’t actually kill anyone. I’ve actually heard people say, ‘This place would be great if the patients and relatives would stop interrupting us’.”

Now that the veil has been lifted – both on the police and the NHS – they had better get used to being “interrupted”.