Wednesday, 7 September 2011

New NHS Bill - Who will be responsible for the NHS?

I have just made it my goal to explain one aspect of the new NHS Bill and give it some political context. Why? Heaven knows.

This is what I’ve learnt. At the moment, and in accordance to the “2006 National Health Service Bill”, the Secretary of State for Health has the “duty to provide” health services for people.

Yet this new NHS Bill making the rounds removes this “duty” from the Secretary of State for Health. They are no longer “legally and constitutionally responsible” for providing these services.

So who will be responsible for providing these services? “Clinical commissioning groups”.

You may be wondering, “does it matter who is responsible for providing these services so long as the services are provided?”. I’m glad you asked.

It matters because it has to do with “accountability” and “responsibility”.

Under this new bill the “duty to provide” will be passed on to unaccountable “clinical commissioning groups”. What does “unaccountable” mean? It means that we don’t vote them in, and, correspondingly, we can’t vote them out. That’s the trouble with taking roles away from elected officials and passing them on to unelected groups.

And as for “responsibility”. Try to take your mind back to the boarding school you never attended, and picture an authority figure towering before you after you have done something naughty and booming “who’s responsible for this?”.

If this new bill becomes law, nobody will be ultimately responsible. The people in charge will be “clinical commissioning groups”. Not people who can be held responsible for their actions and brought to a court of law if need be.

Do you know who these groups are? Me neither.
Granted, you may not even know who the Secretary of State for Health is. But at the end of the day, Mr Andrew Lansley had to be voted in by the citizens of this country before he was given this “duty”. And we know his name. He is a real person, alive and everything. Ultimately, the ball stops at his feet.

This whole situation reminds me of this documentary I saw a few months ago. These female hotel cleaners in London were trying to get their wages raised to the London living allowance.

But they were caught in the middle of this “lack of accountability” dance. The workers would go to the hotel and say “raise our wages”, only to be sent back with the excuse that “the hotel doesn’t manage your wages, it hires an agency”. Then they would go to the agency and say “raise our wages”, only to be sent back with the excuse that “the hotel doesn’t give us enough money to raise our wages, nothing we can do, go to the hotel”. Three years on, and they keep dancing.

This is what the “lack of accountability” dance looks like. You may have found yourself caught in it more than once. We often experience it as “the failure to get anything done because nobody seems to be responsible for it”. So, for instance, you call a phone number and ask for something to be done only to be told that “we don’t deal with this issue, you have to call somewhere else”. After they gracefully give you this other number, and you call it, you find almost the exact same response from the person at the end of the line “we don’t deal with this issue, you have to call somewhere else”. At its most ludicrous, the second “somewhere else” may in fact turn out to be the first place you called, which instantly sends you into a spiral of rage, confusion and hopeless frustration.

And this is what corporatism does: it dilutes responsibility to the point that nobody can trace it any longer, and nobody is found responsible for anything. Above all “Nobody” is responsible. Which means the ball never stops at the feet of a real, breathing human being.

This also means that when things go wrong, they go very very wrong indeed. If I can direct your attention to the Grand financial crisis of 2008… Who caused the crisis? The banks, of course. But “who”? Well, “nobody”. Of course, when it came to paying for the damage, “Nobody” was nowhere to be found, and the taxpayer had to foot the bill. Also, when it came to taking responsibility for the damage, “Nobody” did not make an appearance. And nobody else did either. The Government couldn’t be held responsible because the Government has very little responsibility over banks.

For yet another example you can look at the Oil Spill in the Golf of Mexico.

Now, the Grand financial crisis of 2008 was bad enough. But can you imagine what could happen if some shady “clinical commissioning group” messed up somewhere? What would we do? We would understandably rise in anger and point our finger at the government. We would ask the Secretary of State for Health to take responsibility for what happened under their watch... And then we would see the Secretary of State shrug their shoulders and say something akin to “we don’t deal with this issue, you have to call somewhere else”.

That is what happens when you remove accountability. The ball no longer stops at a person we all know because we elected them. Instead, some group or other is in charge of things, which means that when things go wrong and we confront this amorphous, inhuman entity, the response we get comes from its PR department is something like “measures will be taken to avoid similar outcomes”.

Yet when it comes to matters of Health, “similar outcomes” could be personal tragedies.


smashesthep said...

Yes, the bureaucracy is mind boggling, and tragic given the fact that people's health is at stake.

One point though. I work in a public university, and there is every bit as much bureaucracy (possibly more) without the corporatism.

Excellent post!

Mary Tracy said...

Oh, let's not start on the bureaucracy inside Academia. But if you're interested in it, Mark Fisher's "Capitalist Realism" is a great place to find well articulated discontent.