Government is useless because government is unaccountable

I’ve been thinking again about government. You know that thing that, if you watch the telly or read the news, seems to screw up all the time. This finding applies regardless of where you are (except that in places like Russia and China government’s screw ups are not reported on the national media) since the ability of government to screw up seems universal.

In the UK we’ve watched with varying degrees of incredulity as the inevitable happened with the 2020 exam results. It’s clearly not about the particular brand of politician since all four varieties in our four nations screwed up (as did unions, bureaucrats and opposition). The events come in a long and dishonourable tradition of government being, as a client of mine once observed about the UK’s biggest building society, “unable to manage their way out of a wet paper bag”. But this, of course, implies that somewhere in the system something is going wrong.

It’s popular, indeed expected, for the media to lay the blame, like a cat with a recently captured mouse, at the door of political and administrative leadership. Like the cat, the recent expertise (gained by a couple of five minute telephone interviews with the first experts on the TV channel’s phone list) of the media is designed to say: “you’re absolutely useless, here’s how it should be done”. The media then launch into an extensive hunt to capture a minister or a director and have their head prominently displayed on a pole outside Broadcasting House while they dance around celebrating a victory for the people.

None of this really solves the problem but it gives the impression that somehow government is being “held to account” by the noble media champions of openness, decency and good ratings. Politics and politicians of course indulge this media pitchfork mob because there’s nothing we like better than seeing our enemies’ heads on those poles.

Government, of course, largely gets away with all this failure. Nobody ever looks seriously at why government is so useless at much of what it does since the media prefer to turn the failure of government into the exclusive failure of whichever politicians oversee government at the time. Or failing that getting some nervous, blinking NHS Trust chair (or one of the myriads of essentially anonymous directors, chairs and presidents of failing government agencies and institutions) to fall on his or her sword.

You see the unconsidered reality here is that government is useless. Not the politicians or the directors or the civil servants or the council chief executives but government. Every year there’s a parade of failure from different parts of government. One month it’s prisons, the next its some part of the Byzantine construct that is the NHS. All followed by a scandal in procurement or local government. We’ve seen crises of administration in benefits, in child protection, in social care, in collecting taxes…everywhere across government, from the highest and grandest parts of Whitehall down to the smallest town council. As I said, government is useless.

The real question we should ask isn’t which head to put on which pole but rather why government is so bad at administering the schemes, programmes and regulations that it creates. How does a simple little control measure or a necessary fix to some perceived problem because a crisis of administrative chaos? It can’t be, at least from my experience, the people who work in government. Such folk are not much different to the people who work in the non-government bit of the economy (some good, some bad, some lazy, some attentive, some creative, most just doing their job as well as they can).

The usual answer (at least from those who advocate for government – lots of government) is that it would all be fine if there was more funding. With that funding going towards more administrators one guesses – there is magic in numbers after all. But as government gets bigger and bigger, as it gets more and more money, there’s little to suggest that the administration improves in equal measure. The parade of failures, crises and disasters continues.

There’s another set of people, mostly but not universally, conservatives, who think the problem is that we don’t have enough good management. You know the sort – “what government needs is a good dose of business sense, get some people in from the private sector and it’ll soon be sorted”. Again, the problem is that this has been tried. The 1980s Conservative governments commenced (and Blair’s New Labour ones continued) a process of turning the operations of government into agencies run on business lines with boards of directors, annual reporting and all the fancy logos, mission statements and virtue-signalling we see in the grander parts of the business world. We dragged businesspeople into government positions with offers of knighthoods and bigger wages than the prime minister and, just like the civil servants and ministers, these people delivered a parade of administrative failures, cockups and disasters.

What government probably realises is that business leadership looks good because bad business leadership goes bust or gets sacked not because there’s something innately superior to that leadership. And badly administered businesses likewise tend to do badly, lose business and disappear into the maw of other better run businesses (unless of course government, as it likes to do, intervenes to protect the bad business from the effect of the market- especially if that competition is some sort of dastardly foreigner). Simply importing “private sector management” doesn’t work unless you import private sector accountability at the same time.

And here’s the thing – it’s the lack of accountability that’s the problem. I know that the “let’s get a minister’s head on a pole” campaign is what the media thinks we mean by accountability but it isn’t because the political corpse of a minister is replaced by a new live one who is served by the same unaccountable system as the unfortunate swinging from the gibbet outside parliament. And once there’s a body the media and opposition aren’t really interested in the subsequent resolution (or more likely non-resolution) of the actual problem.

In most of government’s administrative disasters there are real humans who suffer. Young people unsure about their exam results, soldiers dead on a battlefield or legless in a hospital because vehicles lacked armour protection, people dead in A&E departments through neglectful care, or families with no money for food because the benefits administration cocked up. Government is swift to chase private sector failings that cause such problems (and indeed as fast food restaurants are discovering when there isn’t even a problem) and to load on new regulation, controls and restrictions. Yet the same failings in government seem at best to be ignored and at worst rewarded. This is because the private business that gets it wrong must sort out the problem to its consumers’ satisfaction or they’ll go somewhere else but there's no such consequence for the government agency. Most folk don’t get this choice with government; all we get is an occasional vote that might change who’s in charge at the very top but not much else.

The obvious answer for me to this parade of failings isn’t more government, more funding or more new rules. There may be occasions when something can be sorted with a bit more administrative resource but mostly this is simply buying more mops to clean up after the flood. What we need (and how long have real liberals been saying this) is more choice and less government. I know this wouldn’t get rid of all the cock up and failings or even the desire for the media to have ministers’ heads on poles, but it would begin to offer the ordinary person just a little more protection from those failings. And where you can’t privatise the operation then devolve it to as near the front line as you can get so we can see the whites of the eyes of the people making the decisions that affect our lives.

Government may be useless, but we can make it less so by having it only do what it needs to do and doing that closer and accountable to the people.

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Writing on Con Home - why we don't need fewer councillors

Something of a rant but with the serious point that elected people, especially councillors, are the way we hold the unelected people to account:

But far from us needing fewer politicians, we need more. Rather than taking the decision-making further away from ordinary residents with unitary councils, regional mayors, and combined authorities, we should, as Conservatives, be wanting to get more decisions made right down in the communities where those ordinary residents live, by people they know and can speak with. Right now, our system of local democracy doesn’t function well, and the lack of real accountability is a big reason for this.

Whole piece on the always excellent Conservative Home.

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"Hello I'm Unaccountable" - welcome to the guidance state

This happens in the UK too - administrative agencies and government departments from planning through the police to the NHS use 'guidance' to create rules without reference to democratic accountability:

Federal agencies issue memoranda, notices, letters, bulletins, circulars, directives, and blog posts (among other things) to evade the rulemaking process established by Congress in the Administrative Procedure Act (APA). Agencies euphemistically refer to these documents as "guidance." Guidance has been responsible for revoking permits to conduct business, barring Americans from working in their chosen occupations, prohibiting taxpayers from taking deductions, levying post-conviction penalties for crimes, and seizing property, without statutory or constitutional authority and without due process. Think of guidance as an off-the-books way for the government to ignore commonly held understandings of fairness. It's a shameless, unconstitutional scheme designed to skirt judicial review, avoid public scrutiny, and evade accountability.

Almost all planning processes rely on guidance with (often tenuous) links to the National Planning Policy Framework. ASBOs and PSPOs are framed in such a way as to make almost any action subject to arbitrary police intervention. My favourite in recent times was the police officer defending 'playing music' in a car as antisocial behaviour. I asked whether perhaps the choice of music might influence the decisions of officers to which he replied that "we would act according to guidance". Which could mean that playing The Grand March from Aida is OK but blasting out drill music isn't, we don't know because we (in this instance a Regulatory and Appeals Committee) don't have the guidance because it isn't yet written.

Among the most egregious examples of 'guidance' are in the field of human resources management and, in particular, what might be termed 'equalities'. Much of the growing denial of female spaces isn't based on regulation but rather on guidance vaguely linked to the Equalities Act and vigorously policed by campaign groups. Similarly we see gender- or race-based selection (of dubious legality) widely applied along with the active closing down of critical voices and challenges to this 'guidance'. Furthermore 'guidance' forms the basis for appeals, accusations and, too often, references to tribunal processes. And once the tribunal has decided to back the guidance (or more commonly the organisation caves in and settles) it takes on the de facto authority of a law despite never having been anywhere near the scrutiny to which laws are supposed to be subject.

The proliferation of executive agencies, public sector 'corporations' and assorted quasi-governmental partnerships has resulted in the collapse of accountability. And, with the lack of any challenge to administrative orthodoxies, the result is a system open to corruption, external pressure and a focus on 'lowest common denominator', super-safe management. The systems of scrutiny - local and national - are dominated by anything other than effective, focused scrutiny. These systems combine grandstanding politicians, policy-making by anecdote, sob stories and appeals to authority rather than a measured and analytical examination of the services supposedly being 'delivered' to the public.

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Accountability (public sector newspeak version) is complexity.

Scrutiny

“Surveyor, in your thoughts you may be reproaching Sordini for not having been prompted by my claim to make inquiries about the matter in other departments. But that would have been wrong, and I want this man cleared of all blame in your thoughts. One of the operating principles of authorities is that the possibility of error is simply not taken into account. This principle is justified by the excellence of the entire organization and is also necessary if matters are to be discharged with the utmost rapidity. So Sordini couldn’t inquire in other departments, besides those departments wouldn’t have answered, since they would have noticed right away that he was investigating the possibility of an error.” Franz Kafka, The Castle

Accountability in public services matters and probably matter more than accountability in traded private services. As consumers we do not get much choice in who provides our refuse collection service, our health care, our social services and much else besides - short of migration, that is.

I don't know about you but I've a suspicion that accountability is talked about more and made more complicated than it needs to be, and because of this the extent to which public services - and servants - are accountable is compromised. You only need look at the contortions engaged in by NHS grandees in avoiding personal accountability for services under their direction, to know there's a problem. And just so you know, the same goes for local councils, for the MoD and for services such as prisons and courts.

Part of this lies in the perversion of accountability as a concept. Here's a paragraph from an interview with academic, Toby Lowe, who specialises in public sector management. I present it in two halves so you can appreciate the point I'm making:

True accountability is not about counting but asking people to give an account of their actions as part of a dialogue in which they explain the decisions they have taken in the specific context they are working in.

This is a pretty good description of accountability and something that happens too infrequently and, when it does, very badly. You only need sit in a typical local council scrutiny committee or watch MPs parade their prejudgements at a select committee to appreciate the problem with our process of holding public servants to account for "...the decisions they have taken in the specific context they are working in."

Lowe chooses, however, to complicate the simplicity of "what did you do, give us the basis for that decision, how did you plan to assess whether your decision was right, what was the review process" - straightforward scrutiny - by producing an elaborate and extended further qualification of accountability:

It’s also not just about the traditional hierarchical relationship. There are multiple accountable relationships. Your peers could ask you to account for your decisions, as could a member of the public who is receiving the service – or an ombudsman or professional body. The main thing is that real accountability involves a conversation.

For sure we're broadly accountable in all these ways (to a greater or lesser extent) but the essence of public sector accountability is that services are accountable, through their representatives, to the public. It's not that, in an purely administrative context, there aren't other relationships involving accountability but that if you don't understand how accountability in the relationship with a colleague is less important than accountability to the public you serve then you've missed - and I suspect Toby Lowe has - the whole point of public accountability.

The problem here is that accountability becomes just a management tool - Lowe talks about 'learning' and 'autonomy' but at no point recognises the central requirement that the service is, first and foremost, accountable to the public. The process becomes personal or management development rather than accountability:

The learning element in particular requires a radical rethink. How within an organisation do you create safe spaces for learning and reflection, where people can talk openly about errors and uncertainty with their peers?

Probably a good thing but we need a further step - if we are to base service delivery on greater autonomy (again probably a good thing) then those delivering the service have to "give account of their decisions" in a place and a manner that allows those to whom they are accountable to make a judgement as to the effectiveness, the ethics and the efficiency of those decisions. Simply saying "it's complicated" strikes me as a cop out and merely provides a screen behind which those who should be accountable are able to hide.

We have a variety of problems with public accountability, from the distance between the theoretical decision-makers and the actual service through to the use of appointed boards to oversee provision without providing adequate space for any real scrutiny of the service's ethics, behaviour, decisions, and effectiveness. This is made worse by the conflation between 'accountability' within the decision-making process (to colleagues, managers and so forth) and real accountability to the public. This not only provides cover for politicians but also allows senior management to bury their responsibility and accountability in a confusing and complicated set of management processes.

Accountability is not complicated. In the private sector, if I don't like the service I get from one supermarket, I can complain and get satisfaction or exercise consumer sovereignty - make the supermarket accountable - by taking my shopping elsewhere. We don't get this option with public services and this is doubly true for vulnerable groups like the ill, the disabled and the homeless. And right now the effectiveness or otherwise of these services - their accountability - is either lost to the point of non-existence in Kafkaesque bureaucracy or else is under the direction of badly chaired, poorly briefed and overly partisan political scrutiny processes. Changing this, not creating "safe spaces for learning and reflection", is what we need but that would require political leaderships and senior managers to accept real accountability and the responsibilities that go with it.

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Why the EU isn't working for ordinary people (Italian version)...

Tim Parks writes about Italy and the problems with its tanking economy and grumpy electorate - and, in doing so, he bashes the EU nail firmly on the head:

There are two logical ways out of this impasse and the irresponsibility and frustration it breeds. One is a move to a genuine political and fiscal union of Europe; the other is a return to increased national autonomy outside the Euro. Present animosities make the first solution unthinkable. There is no appetite for it. Yet the economic power of the markets to punish any move to leave the Euro makes the second solution suicidal; as Greece has shown.

What we can expect, then, is more and more empty rhetoric and clownish behaviour at a national level; more and more people voting in a spirit of defiance, while tacitly accepting that their vote means nothing. It is a system in which you vote for someone because of what they say they would like to do, not what they can actually do. In short, if you don’t rule your country you can’t expect a viable ruling class.

I keep banging on about how the reason for leaving the EU is to allow us - in most areas of life - to govern ourselves, to give us the chance to do the opposite to how Tim Parks describes Italy and elect people because of what they are going to do not for their chasing of rhetorical unicorns.

Earlier today I took part in a brexit debate at Bradford College - my opening remarks were:

I voted to leave because the EU is distant, unaccountable and fundamentally undemocratic. For all the trappings of democracy – flags, anthems, parliaments, five presidents and periodic elections – there’s no way for us – “we the people” as it were – to change who rules us. For me, if we were simply a member of a trade pact, the sort of thing we joined in 1973 (before I could vote), then I’d be arguing to remain a member. But we’re not a member of “just a trade pact” – the EU wants to have a say in how much tax we pay, in consumer choice, in what is taught in schools, and in the organisation of transport, health and welfare. This is not simply a trade pact.

There are down sides to leaving probably including a short-term economic hit but the big gain is that we can begin the long job of restoring trust in government, in saying to those millions who, for probably the first time in their lives, cast a meaningful vote that we hear them and will give them back the some of the control over government that elites in Westminster and Brussels took away.

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Was the Brexit vote a call for more accountable, less distant - even local - government?

Sociologist Geert Hofstede, as part of his work looking at the different dimensions of culture, created the idea of 'power distance' - “the extent to which the less powerful members of organisations accept and expect that power is distributed unequally.” Because people feel - physically or psychologically - a long way from where the decisions about their lives are made they become less engaged and involved. This may well explain why, in most developed world democracies, voter turnout rises as social class rises - and this difference has been growing:

In the 1987 general election, for example, the turnout rate for the poorest income group was 4% lower than for the wealthiest. By 2010 the gap had grown to a staggering 23 points.

While 'I can't be bothered' or 'I don't understand politics' might be the sort of explanation we get when we canvass non-voters from lower social classes, it is likely that people in these classes no longer feel that their voting makes much difference to what the government does once it's ensconced in nice warm offices down in London. More importantly, other than that periodic opportunity to vote, people feel unable to influence government in its process of decision-making on things that affect them.

If we look at the levels of government, from the parish council up to the EU and other international bodies, it seems more likely that people (and in particular people from lower social classes) are able to influence the decisions of their parish council far more than they are the decisions of the European Union's Commission and Parliament. Those people can and do organise to go to the parish council, a body filled with people much more like them than higher tier levels of government, and argue for a particular course of action. And, more importantly, see that course of action enacted.

The problem in England is that fewer and fewer decisions affecting people (and especially working class people) are made in places close enough to those people for their voice to be worth expressing. So people don't bother. Worse still, since the national decision is necessarily broad brush, the minutiae of how that decision is implemented in a given place are discussed by bureaucrats without reference to the voters these minutiae impact.

Since democracy is as much about how accountable decision-makers feel as it is about how many people vote, the systems we have at national and supra-national levels act to exclude people. Decisions are made about what's taught in schools, about how money for health care is distributed, about where houses should be built - a myriad of things that affect us directly - without the public having the means to contribute or, more importantly, for the decision-makers to feel in any way accountable to that public.

The answer is, of course, making politics more local, not just in homage to Tip O'Neill's maxim that 'all politics is local', but because local decision-making is more accessible and therefore more accountable. This probably makes it better decision-making and it certainly means the politicians can't hide behind layers of Kafka-esque bureaucracy when confronted with their dafter decisions. As Tim Worstall put it (in explaining one reason why Denmark works so well as a culture):

Instead they have what I call the Bjorn's Beer Effect. You're in a society of 10,000 people. You know the guy who raises the local tax money and allocates that local tax money. You also know where he has a beer on a Friday night. More importantly Bjorn knows that everyone knows he collects and spends the money: and also where he has a beer on a Friday. That money is going to be rather better spent than if it travels off possibly 3,000 miles into some faceless bureaucracy.

So, if you're looking for ways to improve English government perhaps, instead of moving decisions ever further up the tiers of government, we should do the opposite and move decisions down to the most local level possible. The EU called this 'subsidiarity', spoke at great length about it, then proceeded to ignore it in favour of ever more 'harmonisation' (bureaucrat speak for what the Daily Mail calls the "postcode lottery"). If you're looking for reasons why those disengaged lower social class voters turned out to vote in the Brexit referendum, the fact they felt - perhaps for the first time - that they were actually involved in making an important decision might be a big reason. And, although the stated reasons for voting to leave are many and varied, the fact that the EU is distant, complicated and (in the terms we've discussed) essentially unaccountable sits at the heart of people's choice. "Taking back control" isn't about sovereignty or the UK parliament, it should be a call for us to get decisions about peoples' lives right back down to where those people have a fighting chance of influencing what's decided.


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Tax offices, roast potatoes and the accountability of experts

Anyone who was even half-awake will have spotted the roast potato story. You know, the one where the UK's Food Standards Agency (FSA) advised us that we'll catch cancer from crispy roast spuds, well done toast, thin crust pizza and trendy thrice-cooked chips.

"The Government has been accused of “massively overreacting” by telling people not to eat crispy roast potatoes or browned toast despite there being no scientific proof of a link to cancer.

Experts said the Food Standards Agency’s (FSA) new campaign, which warns people against cooking starchy foods at high temperatures for long periods, risks undermining support for “real” public health priorities like tackling obesity."

The thing here is that it's "the government" providing this advice, the government that's run by those people we elect. Or so we're told. Especially during court hearings about who's the boss, parliament or government. Now I've trawled through dozens of news reports looking for a comment on this story by a minister of the government that has made this announcement. An announcement that is so misleading and lacking in evidential support that it undermines the credibility of the FSA, the organisation set up by the government to make sure our food is safe. Nor (although I may have missed it) has anything been said by Heather Hancock who chairs the FSA "Board".

What's clear here is that no-one is looking the FSA's experts in the eye and saying something like: "Are you really sure you want to tell folk roast potatoes are bad for them on the basis of a very tiny increased cancer risk? You'll look very silly." Or, after said experts have rushed out with their shocking advice, no-one is pulling them into the office and telling them to go and change the bloody advice to something that doesn't make the FSA look like a bunch of rather dumb health fascists.

Let's imagine for a second that some MP - maybe Philip Davies - asks the appropriate Secretary of State (it's pretty tricky to actually find out who this is by the way) what's going on and why, despite the lack of scientific evidence, they thought is just fine to tell folk not to eat well-done toast. I'm pretty sure that the minister in question will respond with some sort of well-honed quip followed by an explanation that the FSA is a "non-ministerial department, supported by 7 agencies and public bodies" so nothing to do with me guv.

All this brings me to the matter of tax offices. Now, whatever we think of Her Majesty's Revenues and Customs, there are a lot of people working in tax offices. And, here in Bradford we have two of these offices - one in the centre of Bradford and one at Shipley. The nice people at HMRC propose, as part of some sort of reorganisation or restruture, to close these offices and open a brand spanking new shiny office. The problem is that HMRC propose to put that office in Leeds. Apparently (although this isn't very clear) because they don't think they can recruit the right quality of staff if they're based in Bradford.

It may well be that all this is absolutely the right thing to do, that the efficiency and effectiveness of tax collection will be enhanced by the merging of these offices into the new super-office in Leeds. But just like the roast potatoes it's pretty difficult for us to make any persuasive contrary argument - such as why not have your super-office in Bradford. I know this because Philip Davies did ask questions of the correct minister who defended the HMRC decision. It's important to note here that the minister, for all his willingness to respond, is not really in a position to overrule the HMRC on this matter because HMRC is a "non-ministerial department, supported by 2 agencies and public bodies".

There's nothing new about this problem and ministers have for three decades hidden behind the semi-detached nature of these "non-ministerial departments" with their "boards" and "directors". From the prison service through defence procurement to decisions about overseas aid such agencies act without proper accountability while making pronouncements and decisions affecting millions without the benefit of public accountability. They are the experts and neither their "boards" not ministers seem able to control what they do.

Here in Bradford we'll keep making the case for those tax officials to come to Bradford but the experts in question - the HMRC management and its property advisors - do not have to do anything except politely nod, smile and proceed to remove a few hundred jobs (and a pile of business rates) from Bradford. And the worldwide coverage of roast potatoes will fade while the advice remains on the FSA website and gradually becomes, like salt and raw milk, received wisdom among those who enforce food standards.

There's plenty of good reasons to have agencies of these sort and plenty of reason to listen carefully to what experts tell us. But there are also good reasons why our Government - by which I mean the secretaries-of-state and assorted ministers not officialdom - should be accountable for their decisions and empowered to change them if they seem wrong or unhelpful.

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Quote of the day - on the accountability of the NHS

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In Christian Niemietz's 'Diagnosis: Overrated' is this observation:

The idea that the NHS is run by ‘the people’, as a joint endeavour, is a romantic fantasy. The NHS is an elite project, and this could not be otherwise. Collective choice is not a substitute for individual choice and ‘voice’ is not a substitute for ‘exit’. The illusory ‘accountability’ mediated through the political process cannot come anywhere near the accountability of a marketplace, or of a properly designed quasi-market setting, in which providers stand and fall with the choices consumers make, and depend on them for their very economic survival.

Anyone with experience of the NHS's sclerotic organisation will know this to be absolutely true.

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"A spokesman says..." On NHS executive pay and accountability

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A couple of days ago our local paper contacted me following the latest batch of Taxpayers Alliance agitation about the pay of senior executives at Bradford Council. Quite right to make the challenge - this is, after all, public money. My response (given that I really don't agree with the Taxpayers Alliance on this one) was:

Councillor Simon Cooke said while he had "a lot of time for the TaxPayers' Alliance", it was time the campaign group recognised that billion-pound-turnover organisations like Bradford Council would have well-paid chief executives.

He said if the council didn't pay competitive salaries, it would lose its "very best people" to the private sector.

He said: "The argument is really marginal to the costs of the council to the taxpayer.

"They keep repeating these things time and time again. It's really not the kind of line I'm happy with at all.

"I don't think anyone who works for Bradford Council - and this is not a reflection of the quality of their work - is overpaid."

You don't have to agree with me. And remember that those big salaries are all agreed by us as councillors - we vote on them at full council meetings. It's open and transparent - if you don't like what we decide, you have the chance to elect someone else.

Today I'm reading the same story only this time its the NHS.

Figures for Bradford district showing how many NHS employees get in excess of £100,000 revealed Airedale NHS Foundation Trust has 74 including four non-clinical employees, Bradford District Care Trust has 24 employees including three in non-clinical roles, Bradford Teaching Hospitals NHS Foundation Trust has 220 employees including its four non-clinical Trust's board members while NHS Airedale, Wharfedale and Craven CCG has none, NHS Bradford City CCG has two non-clinical employees and finally NHS Bradford Districts CCG has two non-clinical staff.

The same applies. If we want the best quality of staff then we've to pay the sort of salaries that attract the best staff. However, there's a problem - for most of these organisations no-one was available to be accountable, to respond to the Taxpayers Alliance's criticism:

"A Bradford Teaching Hospitals NHS Foundation Trust spokesman said..."

"A spokesman for Airedale NHS Foundation Trust, said..."

This concerns me - whereas criticism of Bradford Council gets substantive response from three people who are in positions to influence the decisions, for the NHS the critic is fobbed off with an anonymous 'spokesman'.

This reminds me just how the NHS is more or less unaccountable, how difficult it is to level any substantive criticism of their decision-making, and how impenetrable the system has become to anyone not granted privileged access.

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So you thought the World Health Organisation was accountable to governments? Think again.

Does the man on the left have too much influence over international health policy?

Today's egregious piece of nannying fussbucketry is about the health risks associated with eating processed meats like sausages and bacon:

The World Health Organisation is reportedly planning to declare that bacon, sausages and other processed meat cause cancer.

Red meat is also expected to be listed as being “probably carcinogenic to humans”.

A source told The Daily Mail that the announcements were expected to be made on Monday with processed meat put in the same category as cigarettes, alcohol and asbestos.

Truth be told, the WHO isn't really doing this at all merely repeating again that there is some evidence linking the heavy consumption of these foods to bowel cancers. The problem is that, as we're finding out with sugar and found out with salt, the health establishments in western countries use the WHO as the source for 'evidence' to substantiate decisions around all-population health interventions (erroneously called 'public health').

For once, I'm not going to raise questions about the validity of the research on which the WHO bases its argument (although the reporting in the Daily Mail, Independent and other media is utterly misleading and appalling). Instead I want to talk about the World Health Organisation itself.

The WHO was set up in 1948 and describes its primary role as to "direct and coordinate international health within the United Nations’ system". To do this the WHO employs over 7000 people working in 150 country offices, in 6 regional offices and at their headquarters in Geneva. The organisation's recently approved budget is $4,385 million which is spent across the following areas: health systems, promoting health through the life-course, noncommunicable diseases, communicable diseases, corporate services, preparedness, surveillance and response. Although most of the spend is still on communicable diseases, disaster response and preparedness, there has been a gradual shift towards a focus on 'non-communicable' diseases like cancer, heart disease and diabetes. This reflects success (not much of which is down to the WHO) in reducing levels of communicable disease.

Now you'd have thought that this $4.4 billion budget comes from the members of the WHO - the 194 countries who subscribe to the organisation. However, you'd be wrong. While a lot of money does come from members (which is means tested to reflect differentials in national wealth), the biggest part of the WHO's income comes in the form of 'voluntary' contributions.

That money comes from two separate sources of funding: assessed contributions from WHO’s 194 member states (means tested) and voluntary contributions from member states and non-government funders such as foundations, investment banks, multi-national corporations, and non-government organisations.

Back in 2011, 80% of the WHO's income came from those voluntary contributions with the single largest contributor in that category being the Bill & Melinda Gates Foundation (BMGF):

Just one foundation, the Bill and Melinda Gates Foundation (yes Bill Gates, the man who gave the world Microsoft and his wife) donated most of that – slightly more than $446m in fact. That’s more than any other donor except the United States and 24 times more money than Brazil, Russia, India, China and South Africa combined

And these voluntary contributions aren't freely available to the WHO, they come with strings attached - how that $446m gets spent is determined by Bill and Melinda not by the WHO.

On one level this isn't a problem because the WHO gets extra money to spend on its great work improving the health of millions. But on another level it is a problem. The WHO is, as a UN agency, granted authority and influence over public policy decisions. In most cases this isn't direct - the WHO has no regulatory authority - but things such as the Framework Convention on Tobacco Control show how the organisation can lead on international, regional and national policy. As vapers discovered when directing their campaign to the European Union, that body was able to use the FCTC's statements on e-cigs as the basis for decision-making.

This means that private organisations like BMGF and Bloomberg Philanthropies, by providing much of the WHO's funding while exercising control over how that money is used, are more influential than the majority of national governments. And because these are philanthropic institutions there is little control or regulation of that influence (unlike for corporations or groups of corporations). The truth is that the WHO is more accountable to Bill Gates and Mike Bloomberg than it is to its recognised governance structures, let alone national member governments or the public in general.

The WHO - like other UN agencies - has a veneer of democratic accountability covering over its effective control through collaboration between private foundations and the organisation's management. You might have thought the WHO was accountable to governments, but you'd be wrong.

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The NHS is not "ours"

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I sit on Bradford's Health and Wellbeing Board. This observation is pretty much spot on:

Dear NHS worshippers, sorry to be a killjoy, but look, the NHS is not ‘yours’, and never has been. You have no control over it. You feel like you are in control when you spin your little toy wheel, but try steering the car in any direction other than the one where it is already heading, and see what happens. The ones who really drive the car are the political class and the medical establishment. ‘Democratic accountability’ is a mirage. All it really means is that healthcare managers answer to bureaucrats, who answer to other bureaucrats, who also answer to other bureaucrats, who, after some more detours, answer to some politician. That’s democratic accountability. Feel powerful now?

The result is that healthcare delivery planning becomes an academic exercise. Nobody sat round the table in Bradford - yours truly included - feels remotely challenged, let alone worried about the decisions we might make (assuming we actually make any). We won't be held to account for those choices. The same is true for the boards of Clinical Commissioning Groups, the senior management of Hospital Trusts or any of the many other 'pseudo-business' structures and systems of accountability that litter the NHS landscape.

The result, of course, is that decisions are made very slowly. And when they are made the default is to indulge either the prejudice or the convenience of clinicians or managers. This doesn't mean every decision is wrong but it does mean that the organisation is deeply conservative preferring to sustain the structures, systems and operational principles developed for a paper-based (and smaller) 1950s NHS. It wouldn't surprise us if Sir Lancelott Spratt were to appear in the hospital corridor attended by clucking nurses and stressed looking junior doctors.

The problem isn't fat cat salaries or a glut of managers but rather than the managers getting those salaries aren't accountable for the decisions they make. So long, of course, as those decisions are made within the comfort zone of the NHS system. As a result, when really hard decisions have to be taken - closing a hospital, moving a specialist unit - they are made in a manner that absolves management from any negative consequences. Or not made at all.

Right now the NHS is busy talking up its financial problems. It has run a deficit (one that's slightly less than 1% of its budget but a deficit nonetheless). Senior managers and 'clinical leaders' are talking sternly about burning platforms, which apparently is jargon for a financially-mismanaged hospital rather than the consequence of an explosion at an off-shore oil well. And endless reams of unintelligible documentation clog up the in-boxes of those who perhaps have to make a decision at some point. These don't talk about what we actually need to have to deliver a great health system but instead consider "whole system thinking" and "effective governance". Then we're asked what a "remodelled system" would involve without having any coherent picture of the current system.

That the NHS delivers for most of us most of the time is a credit to the front line staff - those doctors, nurses and so forth that we think of as "Our NHS". But beyond this front there is an impenetrable jungle of non-accountability - that bureaucratic paperchase described in the quotation above. The primary purpose of that bureaucracy is to ensure that the 'whole system' is accountable meaning. of course, that no individual is accountable when things go badly wrong. In truth system accountability means there is no accountability.

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The case for democracy under devolution is simple...

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I wrote this under the ancien regime - it still applies:

So, dear readers, you need to stop with the 'we don't need more politicians' nonsense and understand that unless you elect people directly to make decisions on your behalf, you make it harder to hold the decision-makers to account. And you need to tell your councillor and your MP that devolution is all fine and dandy, an absolutely spiffing idea, but only if the spending of that public money is subject to your accountability through the tried and tested method of having the chance to vote the bastards out if you don't like them.

You've a choice between devolution managed by bureaucrasts and government appointees or devolution under the control of people you elect. Having a mayor and assembly works for London - I've no doubt it will work for Yorkshire too.

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Crime down, drinking down but more licenced premises. Hogan Howe is talking authoritarian rubbish.

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The Hillsborough enquiry reveals how police called for dogs rather than ambulances and every new day reveals another example of the police failing to respond to cases of child sexual abuse - given this it would be a good idea if the leaders of the police showed a little humility and addressed themselves to the enormous lump of timber in their eye rather than mounting yet another illiberal assault on private businesses.

“We need to make sure there is good control of the supply of alcohol. This means licence numbers, density and licensee-regulation being a priority for local authorities, however much they would like to develop their local economies.

“We know that many injuries occur inside or outside licensed premises, and if we can close down repeat offenders, we will.

“But do we really need as many licensed premised chasing limited business. The system needs reform and we need to police it better.”

This from the same jumped up little fascist who called for CCTV in every home, wants water cannon to deal with disorder and who leads an unaccountable, dysfunctional paramilitary force.

The failings an inadequacies of police leadership and management are legion. It's not just the high profile cases - Hillsborough, the killing of Jean Charles de Menezes or child abuse in Rotherham - it's an every day in every community problem.

In answer to "Britain's Top Cop" as the tabloids would call him - no we don't need more control over the supply of alcohol. You already have all the powers you need to deal with drunks, to respond to badly managed pubs and to manage the effects of alcohol in our communities.

Britain has about 204,000 licensed premises a figure that has risen by some 3% over the last five years. And during that period our consumption of alcohol has continued to fall - it has dropped nearly 20% over the last decade. So it's no surprise that violent crime is now at its lowest level for over 30 years:

The CSEW covers a broad range of victim based crimes and includes crimes which do not come to the attention of the police. Decreases were evident for all major crime types compared with the previous year; violence saw a 23% fall, criminal damage fell by 20%, and theft offences decreased by 12%.

This represents a 16% decrease compared with the previous year’s survey, and is the lowest estimate since the survey began in 1981.

I for one am completely fed up with top police officers making out that there's a problem where there isn't while at the same time making excuses for the complete failure of the police to deal with a real problem such as child sexual exploitation.

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Oxford - more evidence social work is not accountable

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Inevitably the finger will point at those in high authority (and this is always right - if you doubt this read Lord Carrington's letter) but there is, for me, a much deeper malaise in social services. Perhaps it relates to the way in which social workers are taught or trained - my feeling is that the left wing sociology dominating social work courses, a sort of Heinz Kiosk "we are all guilty" approach, has contributed. But there's no doubt we have a problem and the Serious Case Review into grooming and abuse in Oxford reminds us (it should also remind us that the problem isn't party political - Oxfordshire has a Tory leadership after all):

Blyth said that from 2005-10 there was sufficient knowledge about the girls, drugs and prostitution and their association with adult men to have generated a rigorous and strategic response from police and social workers.

This knowledge included many “worrying” warning signs over a number of years involving more than one girl, multiple alleged perpetrators, who were usually Pakistani, and a strong association with children in care. But this was not passed on to the highest levels of management or acted upon until 2011, when police and social services finally started to piece together the organised grooming and sexual exploitation.

So for perhaps as long as six years, social workers in Oxford simply allowed what was happening to carry on. The abuse was in front of their eyes but was not seen as a problem worth reporting to senior management.  This may be true but it must raise serious questions about supervision, management and appraisal within Oxfordshire social services. And at the heart of this is a culture that - as the report makes clear - tolerated under age sex and seemed not to understand that, in UK law, having sex with a minor is always a crime.

However, the fundamental problem here is that authorities simply believed there was nothing that either could - or in some cases even needed to - be done:

The fact that scores of professionals from numerous disciplines, and tens of organisations or departments, took a long time to recognise CSE, used language that appeared at least in part to blame victims and see them as adults, and had a view that little could be done in the face of ‘no cooperation’ demonstrates that the failures were common to organisational systems.

The shock of the public at failings of this sort has begun to change how local authorities view child sexual exploitation and, in particular, the situation where that exploitation involved girls in their mid-teens. Every example of street grooming throws up the same limitations - girls making complaints then withdrawing them, other girls denying there's any problem and the police or social services not following through where they know the situation is exploitative.

In the end (which is the point Lord Carrington made) accountability is absolute. But this means that political leadership in social services needs to be clear - it isn't because successive national governments and the social work profession has undermined it - and prepared to challenge the decision-making of professionals. I don't think, for example, that the leadership of Oxfordshire County Council would consider underage sex as something to be tolerated, to be understood, yet that is precisely the view taken by those acting on that leadership's authority.

The problem in the police is less clear. The move to Police and Crime Commissioners should act in time to make accountability clearer but the situation remains that the police are simply not accountable - in corporate terms - for their operation decisions. We have seen local councillors in Rotherham resigning. Senior council officers resigning. The elected police and crime commissioners for South Yorkshire (eventually) resigned. Yet not one senior police officer in the South Yorkshire force has gone despite so many of the poor decisions and service failures landing at that force's door.

This situation is a reminder of what you get - and let this be a warning to NHS campaigners - when you allow public services to operate without effective political scrutiny. Yet this is the reality across many of our locally delivered services - there is either no realistic scrutiny or else (as with response to child sexual exploitation) scrutiny is simply not possible or even allowed.

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Rotherham and local government's crisis of accountability

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We are supposed to breathe a sigh of relief, to relax as the government imposes five 'commissioners' on the metropolitan borough of Rotherham. The implication here is that the cavalry is over the brow of the hill and charging down amongst the wrongdoers. I intend in the next few paragraphs to disabuse you of this view and to argue that, however warranted the intervention into Rotherham might be, it doesn't suggest that somehow this means that in our particular local council things are more-or-less OK.

First though a reminder of what the Casey Report into Rotherham says:

‘In denial. They denied that there had been a problem, or if there had been, that it was as big as was said. If there was a problem they certainly were not told – it was someone else’s job. They were no worse than anyone else. They had won awards. The media were out to get them.’

Pretty damning. Just as the Jay Report a few months ago was pretty damning. But every single councillor in the country, every chief executive and every council director should read these reports. Not for the shock factor or the schadenfreude of seeing another council in such trouble but to be reminded that, as the saying goes, 'there but for the grace of god go I'.

I'm a local councillor. I've been a local councillor for twenty years. I've been a cabinet member in a big metropolitan authority. I've chaired scrutiny committees. I've been an opposition front-bencher. I reckon I've a handle on how local councils work. And I think the most telling phrase in that quotation above is 'they certainly weren't told'. Because that is the reality of how council operations - and especially social services and social care - work.

A council is a body of men and women elected by the people to govern a specified set of activities delegated, defined or permitted by national government. This means that, in Bradford, "the Council" isn't a lot of officers but ninety councillors meeting together. The problem is that central government has gradually eroded this in the following ways:

1. By giving statutory authority to people appointed by the council (i.e. by those ninety councillors in Bradford's case). This is authority that, because it is set out in statute, councillors cannot challenge yet results in decisions for which we are accountable.

2. By allowing officers the ability to be selective as to what they tell councillors. I was recently asked to submit a formal request for some information (relating to a property transaction) so that request could be considered by officers. Yet I am, as a councillor, accountable for that decision - a decision officers felt I had no right to be informed about.

3. By blurring the boundaries between officers and councillors in decision-making. Health and Wellbeing Boards contain - as voting members - both officers and councillors (as well as board members and executives of health bodies). I am not fussing when I say that, once again, this process raises questions about who is actually accountable and in what way for the decisions we take.

The thread through all of this is accountability. Most of the time it doesn't matter much and we let it slide accepting blurred edges and fuzzy boundaries because we want to get the job done. But Rotherham tells us we need to stop doing this - at least if we want to do our job as councillors (a simple one of making decisions on behalf of the folk who elect us and being therefore accountable for those decisions).

I wrote this a while back - it sums up the problem:

There's a dangerous view out there among professional public sector 'leaders' that we've moved to some sort of 'post-democracy', to a world where what they are doing is too detailed, technical, specialised and private for elected politicians at any level to merit any say over those decisions.

The other day, at a Health & Wellbeing Board, I was informed by the chair (I paraphrase) not to worry my pretty little head about the 'Implementation and Change Board' as they were doing the 'heavy lifting' for the Board and it would all come to us in good time. For 'heavy lifting' read too detailed, technical and specialised for us mere elected folk to be usefully involved. And anyway the Chair was 'briefed' so that's fine isn't it?

The problem we have in local government isn't one party rule (although that doesn't help), nor is it corruption or poor councillors. The problem is that the chain of accountability from the front line to the council - the councillors meeting together to make decisions - simply doesn't exist in any recognisable way. A while ago Simon Danczuk, the Labour MP for Rochdale rather summed the issue up:

We’re also starting to see a worrying cult of leadership. Highly paid managers are seemingly untouchable and distant from front-line workers. The rise of the unsackable, unaccountable and unapologetic public-sector manager is a trend that will only see services continue to deteriorate. And let’s be clear about what that means. It won’t be just missed targets or a poor Ofsted rating. We’re storing up huge social costs. 

The terrible reality is that, unless we resolve this problem of accountability, we will have more Rotherhams. Even more worrying will be all the failures, all the let down residents and all the mismanaged decisions that don't result in Eric Pickles sending in the cavalry. Right now local government is crying out for more powers, for devolution and for central government's apron strings to be loosened. And unless the crisis of accountability is addressed and resolved we won't see the better, more effective government but a whole series of Rotherhams.

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