Wednesday, January 07, 2015

The unsustainable crisis in public services

The crisis in hospital accident and emergency departments is in the news. The crisis in policing has practically identical systemic roots. As do the crises mental health, the ambulance service, all corners of the NHS, care for the elderly and disabled, the prison service, criminal justice and legal services, the border control & immigration services, social services, social welfare, transport... the education system is a certified basket case.

When you divide complex, deeply interconnected and interdependent public service systems up into competing quasi-autonomous silos and then instruct the leaders of those silos they will be evaluated on the basis of single figure simplistic targets or metrics - e.g. A&E waiting times - you cannot be surprised when the silos focus on those metrics at the expense of everything else; including the effective operation of the individual silo, not to mention the (up to 99% of) work they used to provide as a service to other parts of the overall public services system.

People can't get to see a GP, so they call an ambulance or go to A&E. A&E can't cope so they sit in corridors or ambulances whilst A&E waiting times go up or get massaged. Ambulances can't get to emergencies because they are waiting to offload patients at busy A&Es or because they are dealing with non emergency cases to meet the 8 minute target. There is inadequate support for the elderly and frail so they are in hospitals rather than having appropriately tailored care in appropriate environments. Police officers are dealing with vulnerable seriously mentally or physically ill people because ambulances and other services are overstretched and unavailable, in thrall to their very own distortionate targets.

It would be ridiculous to say one rectangle was bigger (and better) than another because it had a longer base, without knowing what the height of either was. It would be ridiculous to say we can produce better pigs by weighing them. Yet somehow, and in the surreal political and media frenzy of the run up to a general election, it is ok to "measure" complex public services this way.

The political normalisation of this insanity throughout the public sector has to stop.

But it won't.

We are completely incapable, as a society, in this world of short attention spans, social media outrage mob rule and 24/7 attention-grabbing-focused news media, of holding a mature public debate on any of this.

Single words, phrases, soundbites, expressions, nuances, personality traits are rabidly seized upon by the media, political opponents and the outrage mob as sticks to beat anyone who ventures an opinion outside of the mainstream. The Tory, Lib Dem and Labour gangs can't help themselves, even amidst their almost total rabid agreement on everything lest they upset the Murdoch press or the Daily Mail, they choose to attack each other, rather than develop enlightened evidence based policies. They have nothing to debate in policy terms because they are committed to the same failing policies.

I learned at the weekend of a dedicated, bright, enthusiastic, successful young teacher deciding to leave the profession after several years because of the unreasonable demands the schooling system visited upon her, her colleagues and the kids in her school.

Someone doing an enormous amount of good, 24/7, for the children in her care, decided she no longer had the physical or emotional capacity, as an individual, to compensate for the systemic insanity of an education system failing the majority of children.

It takes an enormous amount of integrity to walk away from something of huge importance to you, when you realise you can no longer make a sustainable difference, in spite of the occasional and even spectacular pockets of success.

She's now in temporary employment in the retail sector and enjoying, for the moment, the serenity of closing the book on the job, as soon as she leaves at the end of each day. The retail sector's current gain is the education system's enormous loss.

Update: edited for a couple of spelling errors.

No comments: