This is the text of an article in Public Servant magazine. I would like to have written something more substantial, but the word limit (which was perfectly reasonable) was limited. As it were.
Paying excessive attention to 'efficiency' and function militates against good overall care. The values that are supposed to ensure people are well-treated get subsumed.
We live in an age of fundamental suspicion. One could argue that fifty years ago the default position of most citizens was to trust unless given evidence that trust should be withheld; now the default is to suspect everyone, trust no one and deny everyone’s integrity.
Perhaps it is no surprise, then, that this is reflected in the culture developed in our public institutions. Couple this with a media that hears a politician sneeze and accuses him of deliberately trying to infect the vulnerable, and you have got a vicious circle of suspicion.
But, if that isn't enough, we then create a culture of competitiveness and 'efficiency' that uncritically assumes that the only measurement of 'the good' is financial. Hence, the NHS, for example, bounces from centralisation to localisation and back, education abandons local accountability and cedes power to the Secretary of State in Westminster (whilst thinking it is gaining greater autonomy – but see what happens if an academy struggles or the said Minister changes his fancy), and vast sums of money are spent in ideologically-driven yo-yo re-engineering.
If only there was a basic understanding of the difference between 'efficiency' and 'effectiveness', we might be in a better place.
In other words, we now have a deep cultural problem across our society – a functionalism that compromises public service. The cultural associations run deep and to question them is not easy to do – not least because they quickly assume the status of 'orthodoxy', from which heretics find themselves dismissed with ridicule.
Changing this situation cannot be easy and, by definition, solutions will necessarily be long-term and complex. It is possible that some of our systems might have to collapse before the construction of something more coherent and effective becomes possible.
For example, is it any surprise that health visitors find themselves hot-desking in an attempt to reduce rental costs for offices, but then lose the very context that allows for ready exchange of information, informal mutual encouragement or advice, joined-up consultation on particular cases or issues? The 'human' stuff always finds less value than what can appear on a balance sheet.
And, of course, this sort of thinking derives from a confusion of ends and means. If the end is to reduce costs (finance-driven), then the exercise becomes merely functional. If, however, the end is to enhance service to real people – to which end finance is a means – then different values might apply and priorities be set. This is not to deny the need for financial probity and wisdom, but it is to ask what the end is to which the finance becomes the means of getting there.
Somehow this situation requires a rejection of the sort of box-ticking mentality that leads to hospitals losing the plot. If the Francis report exposes anything, it is that paying obsessive attention to the engineering (form filling, box ticking, time accounting) militates against good overall care because the means become the end. The people get lost. The values that are supposed to ensure that people are well treated as dignified human beings get subsumed – not deliberately, but at the level of assumption in the complex dynamics of making sense out of chaos) – into something different. And when this happens bad practice becomes inevitable.
Naturally, recovering a culture of trust, integrity and clarity about what constitute ends and means is no easy task. It requires the political will to change the vocabulary of public rhetoric. It demands an open and constructive public debate about what is the end to which we aspire and for which the money we pay is intended to be a means. And this will need a re-articulation of what might untrendily be called 'anthropology': how to enable people to flourish.