The NHS (and Hermann Goering)

Here is renegade Michael Gove special advisor, Dominic Cummings,  on how government departments work. He’s talking about Education, in England and Wales:

…..government departments are so dysfunctional that even the great officials who could manage things properly are seldom allowed to by the system. At the start of 2011 there was massive resistance to this. By September 2012, it was normal. (Also, we were greatly helped by exponential improvements in the Private Office – the unsung heroes, often women 25-35 working in the early hours to fix errors made by middle-aged men (on 2-3 times PO salaries) who left at 4 not caring if something works or doesn’t.)

Part of the reason No10 does not work is that senior people issue airy instructions (usually in response to a column rather than as part of a serious plan) but, not understanding management, they do not know how to follow through and ensure things are done. (Some of the junior people do do this and helped us.) By the time it realises its instructions have been ignored, months can pass. (I remember one very senior No10 person saying to MG and me one day ‘good job I fixed the planning law changes for you’. In fact, they had told their officials to do that, then forgot about it….

In fact. that is a pretty accurate description of how central government of one sort or another tends to bugger up the honest endeavours of anonymous lowly paid staff, and if it succeeds despite these ‘middle-aged men issuing airy instructions’, those bastards (please excuse the language) then take the credit, in a permanently desperate bid for the voters’ affections.

That’s what happens in the NHS, where, to paraphrase Hermann Goering (he was  referring to ‘culture’, though there is some

Gratuitous Nazi picture
Gratuitous Nazi picture

doubt whether he actually said it), when I hear the phrase ‘I’m strategic, not operational’, The Knife reaches for his revolver. ‘Operational’ is usually ten times more challenging than ‘strategic’ in the NHS, where the latter term is an excuse to dream up typically unworkable ways to spend taxpayers’ money, or in the current era, drive future generations further into debt.

Operational issues are immediate, real, often urgent and frequently difficult to solve. Try, for example, to keep an acute hospital open to admissions when the staff rotas have just imploded, and the local MP is whingeing. The trouble is, the only way anyone is usually good at public sector strategy, is if they’ve earned their spurs on the frontline operational stuff. Politicians never have, and in the NHS, the number of civil servants who can truly boast this on their CV seems to be diminishing rapidly.

(I should emphasise that given modern day sensitivities, The Knife is only using Goering as a vehicle for a pithy quote. It is not a cheap attempt to draw parallels between NHS political behaviour and Nazism. After all, the latter were a dysfunctional elite hierarchy motivated by power, fear and a desire to boss around huge numbers of unthinking minions, whilst claiming some sort of  moral high ground, the NHS on the other hand….er…hang on a minute…)

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