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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2018/jun/21/gosport-scandals-government-targets-banned
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| Scandals like Gosport will be repeated until government targets are banned | Scandals like Gosport will be repeated until government targets are banned |
| (6 months later) | |
| Who should have blown the whistle at Gosport? Nurses, managers, other doctors, relatives or hospital inspectors? Who was in charge of 456 premature deaths, and what does “in charge” mean in the elephantine bureaucracy that is Britain’s National Health Service? | Who should have blown the whistle at Gosport? Nurses, managers, other doctors, relatives or hospital inspectors? Who was in charge of 456 premature deaths, and what does “in charge” mean in the elephantine bureaucracy that is Britain’s National Health Service? |
| The answer is it means nothing. It cannot be otherwise in an institution bigger than any other public or private corporation in Europe. Staggering under a burden of A&E crises, hospital failures, management reorganisations and weekly bad news, Britain’s health service is a dire advertisement for Whitehall’s belief that big is beautiful and centralised is best. | The answer is it means nothing. It cannot be otherwise in an institution bigger than any other public or private corporation in Europe. Staggering under a burden of A&E crises, hospital failures, management reorganisations and weekly bad news, Britain’s health service is a dire advertisement for Whitehall’s belief that big is beautiful and centralised is best. |
| At Gosport, the failures appeared to lie in the reluctance of frontline staff to question the authority of a doctor – even one who was clearly overworked and out of her depth. To nurses, doctors are gods. Responsibility thus slithers round the hierarchies of the NHS and the General Medical Council. As we shall doubtless see at Grenfell, modern public administration is so technical and complex that “responsibility” never really sticks at any one point in a decision cycle. But since everyone howls for a culprit, the mob hauls some wretch to a lynching so it can feel better. At Gosport it is apparently the doctor, but why not the managers or one of many ministers? | At Gosport, the failures appeared to lie in the reluctance of frontline staff to question the authority of a doctor – even one who was clearly overworked and out of her depth. To nurses, doctors are gods. Responsibility thus slithers round the hierarchies of the NHS and the General Medical Council. As we shall doubtless see at Grenfell, modern public administration is so technical and complex that “responsibility” never really sticks at any one point in a decision cycle. But since everyone howls for a culprit, the mob hauls some wretch to a lynching so it can feel better. At Gosport it is apparently the doctor, but why not the managers or one of many ministers? |
| Gosport scandal exposes blame culture in NHS, says Hunt | |
| A bevy of recently public scandals – Grenfell, Windrush, train schedules, cannabis oils and now Gosport – shows that the classical model of civil servant versus minister has collapsed. There are too many people involved. The hero of Yes Minister, Sir Humphrey Appleby, lies dead at the crossroads, killed at midnight, stake through heart. On that stake is pinned one word: targets. | A bevy of recently public scandals – Grenfell, Windrush, train schedules, cannabis oils and now Gosport – shows that the classical model of civil servant versus minister has collapsed. There are too many people involved. The hero of Yes Minister, Sir Humphrey Appleby, lies dead at the crossroads, killed at midnight, stake through heart. On that stake is pinned one word: targets. |
| A quantified measure of performance, refined by Tony Blair’s consultant-led Delivery Unit, was supposed to be the politicians’ precision weapon against Sir Humphrey’s craving for continuity and, as he saw it, good government. It said ministers should stop consulting and discussing; they should just give the civil service targets to meet, preferably hundreds of them. The result was distorted hospital admissions, crazy power stations and chaotic social benefits. It took the Treasury five years of austerity to regain control of public spending. | A quantified measure of performance, refined by Tony Blair’s consultant-led Delivery Unit, was supposed to be the politicians’ precision weapon against Sir Humphrey’s craving for continuity and, as he saw it, good government. It said ministers should stop consulting and discussing; they should just give the civil service targets to meet, preferably hundreds of them. The result was distorted hospital admissions, crazy power stations and chaotic social benefits. It took the Treasury five years of austerity to regain control of public spending. |
| Of all unachievable targets, none was more so than David Cameron and Theresa May’s cut in immigration. I have a letter from a retired immigration official explaining the consequences. It could be met, if at all, only by sweeping up thousands of long-term residents as “low-hanging fruit” whenever they came into contact with the public sector. To my knowledge, this “hostile environment approach” – sudden meetings, “lost” documents, instant “fees” – broke the civil servants’ code of conduct. This demands dealing with the public “fairly, efficiently, promptly, effectively and sensitively”. Home Office officials deliberately did the opposite of all these. | Of all unachievable targets, none was more so than David Cameron and Theresa May’s cut in immigration. I have a letter from a retired immigration official explaining the consequences. It could be met, if at all, only by sweeping up thousands of long-term residents as “low-hanging fruit” whenever they came into contact with the public sector. To my knowledge, this “hostile environment approach” – sudden meetings, “lost” documents, instant “fees” – broke the civil servants’ code of conduct. This demands dealing with the public “fairly, efficiently, promptly, effectively and sensitively”. Home Office officials deliberately did the opposite of all these. |
| Permanent secretaries accountable to a Commons committee can demand a “letter of direction” when given an outrageous order by a minister. Lesser officials have no such recourse. As my Home Office correspondent points out, governing at the front line is so often a matter of “blur and nuance”, of sensitivity to individual circumstance. That is specially so with vulnerable immigrants, where each case requires sympathy and the exercise of discretion. The target culture has no room for this. It says: keep your head down and watch the figures. If anything goes wrong, such as the recent heartless handling of epileptic drugs, the minister can take the blame. | Permanent secretaries accountable to a Commons committee can demand a “letter of direction” when given an outrageous order by a minister. Lesser officials have no such recourse. As my Home Office correspondent points out, governing at the front line is so often a matter of “blur and nuance”, of sensitivity to individual circumstance. That is specially so with vulnerable immigrants, where each case requires sympathy and the exercise of discretion. The target culture has no room for this. It says: keep your head down and watch the figures. If anything goes wrong, such as the recent heartless handling of epileptic drugs, the minister can take the blame. |
| The health secretary, Jeremy Hunt, is roasted over the NHS each week in the Commons. At the Home Office, Amber Rudd had to take the rap for May’s half-baked targetry. But blame breaks no bones. The real victims of “hostile” public administration are the dead at Gosport, the tenants at Grenfell, patients needing cannabis and the self-harming pupils of today’s exam obsession. These pay the price of target terrorism. | The health secretary, Jeremy Hunt, is roasted over the NHS each week in the Commons. At the Home Office, Amber Rudd had to take the rap for May’s half-baked targetry. But blame breaks no bones. The real victims of “hostile” public administration are the dead at Gosport, the tenants at Grenfell, patients needing cannabis and the self-harming pupils of today’s exam obsession. These pay the price of target terrorism. |
| A new public servant hero has replaced Sir Humphrey. It is the whistleblower. Hunt places a heavy responsibility on whistleblowers to help him run the NHS. He rarely fails to mention them and eulogise them. They are a public service fifth column, a Jesuit Order of moralists, lurking behind every curtain and under every bed, to warn ministers of some impending horror and thus avert dire headlines. | A new public servant hero has replaced Sir Humphrey. It is the whistleblower. Hunt places a heavy responsibility on whistleblowers to help him run the NHS. He rarely fails to mention them and eulogise them. They are a public service fifth column, a Jesuit Order of moralists, lurking behind every curtain and under every bed, to warn ministers of some impending horror and thus avert dire headlines. |
| In reality, whistleblowing requires a desperate courage in any organisation that relies on loyalty and personal relations. That particularly applies on the pressurised front line of public service, where the ethos stresses obedience to “policy as laid down”. For all Hunt’s proclaimed protection, whistleblowers rarely recover from putting their colleagues in harm’s way. More to the point, any organisation that must rely on brave individuals to enforce good behaviour is rotten. The NHS spends millions on inspectors, inquiries and consultants. What are they doing that they need back-up from whistleblowers? | In reality, whistleblowing requires a desperate courage in any organisation that relies on loyalty and personal relations. That particularly applies on the pressurised front line of public service, where the ethos stresses obedience to “policy as laid down”. For all Hunt’s proclaimed protection, whistleblowers rarely recover from putting their colleagues in harm’s way. More to the point, any organisation that must rely on brave individuals to enforce good behaviour is rotten. The NHS spends millions on inspectors, inquiries and consultants. What are they doing that they need back-up from whistleblowers? |
| Profile: Dr Jane Barton, GP and the Gosport hospital scandal | |
| These departments are not evil, any more than British government is evil. They cannot work sensitively – let alone accountably – because they are bureaucratically obese. The most inefficient parts of the public sector are the biggest: the NHS, the defence ministry, the Home Office, the BBC, Network Rail. Their apologists say they are so often found to be at fault because their self-correcting mechanism is working. They are nowadays so transparent. But transparency merely blames; it does not cure. There appears to be nothing to stop another Gosport from occurring, short of a whistleblower. It is on whistleblowers that our lives in old age depend. | These departments are not evil, any more than British government is evil. They cannot work sensitively – let alone accountably – because they are bureaucratically obese. The most inefficient parts of the public sector are the biggest: the NHS, the defence ministry, the Home Office, the BBC, Network Rail. Their apologists say they are so often found to be at fault because their self-correcting mechanism is working. They are nowadays so transparent. But transparency merely blames; it does not cure. There appears to be nothing to stop another Gosport from occurring, short of a whistleblower. It is on whistleblowers that our lives in old age depend. |
| I know many civil servants who are dedicated to serving the public with care and humanity, within the resources available. They resent it when this ethic is undermined by a cynical quantity ordered for an arbitrary political boast. Targets should be banned. | I know many civil servants who are dedicated to serving the public with care and humanity, within the resources available. They resent it when this ethic is undermined by a cynical quantity ordered for an arbitrary political boast. Targets should be banned. |
| • Simon Jenkins is a Guardian columnist | • Simon Jenkins is a Guardian columnist |
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| Windrush scandal | Windrush scandal |
| Grenfell Tower inquiry | Grenfell Tower inquiry |
| Cannabis | Cannabis |
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