July 29, 2010
Local councils will soon find their desks swamped in paper. Soon the very wood that constructs the tables will be obscured by these reports (the only way to know the table is there, I guess, will be the reassuring knowledge that the mountain of paper is not on the floor.)This is part of Cameron’s much trumpeted ‘Big Society’ pledge, as he hopes to put control, power and monetary freedom in the hands of local councils, to be moulded and used as they see fit. Custom made legislation for the tall, short, fat and thin, dependent on dimensions. In many facets of government, the sections obscured from public view by technicalities or the lack of interest, this will be a welcome change from the bloated tangled knot of bureaucracy, but the strength of this ambitious plan will not be measured in those venues, it will hinge on the frontline service, including healthcare.
In a NHS whitepaper released earlier this month, Andrew Lansley outlined his view for our health service. He wrote: “We will be clear about what the NHS should achieve; we will not prescribe how it should be achieved. We will legislate to establish more autonomous NHS institutions, with greater freedoms, clear duties, and transparency in their responsibilities to patients and their accountabilities.” It is in the GP’s and local council’s hands concerning how treatment, organisation, and more importantly, funding should be administered. This tailored approach, it’s hoped, will alleviate some of the major qualms concerning the NHS. On the ground, on the frontline, they will understand the allocations far greater than any politician. But what the politician will know, and what the GP won’t, is how much money there is in the first place and how much there is to be shared around. The great conservative quango hunt, undertaken by the coalition government, has resulted in nine healthcare related organisations to be made smaller, funding slashed, or removed altogether. The knot may seem less densely mangled but should such an upheaval be coupled with swathes and swathes of cuts?
The needs for hospitals and healthcare services are not political, but their funding is. The freedom to shape local services cannot blind the NHS to the stricter budgetary concerns afflicting the government. Say what you will about quangos, say they are expensive to run (apparently costing the country over £180 million), say they have financial motives behind their work, say they do not understand the work that goes on in the NHS, there are many things to be said, but what they can do, when operated honestly, is to create a buffer between the health service and the government. They can mediate, translate and inform; they dilute the science, making it palatable for the political tastes, whilst conveying the legislative or budgetary realities to the councils and health services. They also offer up a wide angle lens. Due to their size and organisation they are able to take in account the national picture. Funding cannot be given for all that is asked, there simply isn’t enough to go around. Money is segmented between areas dependent on demographics, services and situations, but the view of the GPs and the local councils, one penned in by personal and professional interest, will only focus on what they are and are not getting.
The quangos that have been cut have had their remits enveloped within other agencies creating larger cumbersome bodies that may lack the manoeuvrability and adaptability of the old organisations. But for the coalition, for the Big Society it is an easy sell. All the coalition need to do is to repeat the word ‘quango’ coupled with the figure ‘£180 million’ as many times as possible and as quickly as possible and many will be onside, cheering on the dismantling process. But with less money to go around and the demands of the NHS showing no sign of slowing down, the dangers of giving the children the keys to the candy store is that the promised freedom for the local councils will be perpetually out of their reach. Invariably the politics will get in the way and as a result Cameron’s push to limit bureaucracy may in fact muddy and complicate the issue. The knot remains.