Meet the new boss - same as the old boss

Politics is theatre, and those who strut and declaim on the stage do not usually write their own script. The more sober of politicians’ autobiographies acknowledge this. Looking back on their career, their authors describe their achievements in limited terms - getting a new law passed against the odds, changing public perceptions of a problem, or perhaps averting a crisis. Read the political memoirs of the former Labour MP Chris Mullin, and you find ambition for office tempered by a realisation that a minister has little or no influence on policy, and spends his time reading out (usually badly-written) speeches prepared for him by civil servants. The actual job of politicians is in reality a salesmen - to sell policy to Parliament and the public. What better person to do this than a natural actor (Tony Blair) or a public relations professional (David Cameron).

There are of course politicians who can claim, with some justification, to have changed the direction of the country. Margaret Thatcher blundered into the Falklands War, and pushed for the Poll Tax, while Tony Blair became unpopular in Britain but popular in Washington by promoting war as an alternative to diplomacy. However, many of the policies associated with a senior politician predate their time in office and bind their successors. All British governments for the past 20 years have promoted the interests of  the financial sector over those of manufacturing industry, have sought to undermine employment rights (calling this ‘flexibility of labour’), and have facilitated the plundering of the public purse by management consultants, IT firms and the PFI/privatisation complex.

Chris Mullin’s memoirs are also a guide here. They show that each government ministry (or part of a ministry) is at the hub of a set of stakeholders. These usually comprise key business and financial interests rather than the wider public. The ties between ministries and stakeholders are held together by exchanges of senior staff and the availability of well-remunerated positions for senior civil servants and politicians when they leave office. This works to create great continuity in public policy, which may only occasionally bend to public protest. Note that this is not a conspiracy theory - the policies of different ministries or parts of ministries may conflict, resulting in a policy stalemate. The Iraq War enquiry reveals major divisions between and within military, intelligence and diplomatic services. The one group not included in these debates was the British public, despite a million-strong march on the eve of war.

An example of this continuity is the reform of the NHS proposed by our coalition government. This is presented as a radical innovation, but bears all the marks of every other management reform (or ‘redisorganisation’) of the NHS since the 1980s. As usual, it is hyped as devolving power while actually centralising control. The recipients of the supposed devolved power in this case (as in 1997) are consortiums of general practitioners, but the central NHS commissioning board will have extensive and expanded powers to make sure the GP’s do what they are told. The consortiums will certainly not have much power over what they commission. Like all the NHS reforms since the early 1990s, this one confirms the steady drift to the marketisation of healthcare services. Consortiums will be required to choose the lowest price tendered, and providers will be able to compete on price. Needless, to say, even this limited power can not be contemplated without diverting funds to the giant management consultancy combines, who will move in to manage the commissioning consortiums, supposedly on behalf of the GPs. The previous two heads of commissioning in the NHS have gone to work for more than a pittance with KPMG. I would not of course suggest that the current one had this in mind when the NHS awarded a large contract to KPMG for commissioning in London.

Finally, this re-organisation, like all its predecessors in the last 20 years, has been rushed, with many details not worked out, no feasibility trials, and no effective project management. Why is this? I think there is a Darwinian explanation. After so many re-organisations, the NHS has become a bizarre ecological niche, to which NHS managers have evolved in response. Only those most able to respond rapidly and with enthusiasm to the latest shift of policy (in whatever direction it takes), espy the best time to jump ship, and rapidly create a new mini-empire for themselves can hope to survive. They naturally shape their environment to suit these survival skills, which means ever more redisorganisations. Each one of course is applauded by the well-rewarded management consultants, the usual squad of compliant social policy academics, and the politicians who read out the speeches written for them.

Read also: http://stuartcumella.blogspot.com/2009/12/pic-complex.html