An Unnecessary Role

embracing false choices

Archive for the ‘Health’ Category

If I was Johann Hari…

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I would take every post Paul Corrigan makes, top and tail it with some reference to Bruce Springsteen. He is essential reading for anyone with an interest in the ongoing health reforms and public service change in general.

This post last week shows how the Government’s reforms, far from being localist or decentralising, will in fact result in a centralisation of healthcare commissioning. It is a cutting critique of the centralising tendency:

There is a common sense belief that you need a national centralised system of grip to save sums of money of this size. However like a lot of common sense beliefs, the idea that the only way to save money is through central power is just not true. In fact the illusion of command and control in the NHS is just that – an illusion. Running a national programme that tells people which budgets to cut in Wigan and Wolverhampton gives the appearance of something happening, but it’s just that  – an appearance.

And continues with one of the best interpretations of the central-local divide I’ve read – as one of accountancy versus economics, of the centre attempting to berate local structures into saving money and delivering quality services against a self-sustaining, empowered and incentivised set of local decision-makers driving out cost.

There are two very different world views about how economics works here. The first, from the top, is that public money can be controlled by a set of accounting officers who shout at the people underneath them to do certain things in line with a plan. This is called public sector accounting.

The second is a set of economic incentives that depend upon organisations and individuals operating within those incentives to develop better value for money. This is called economics.

The Government set out in those halcyon days last July believing in economics, but have increasingly lost their nerve and now believe that a strong centre shouting at people will save them the money.

Crucially for the NHS they are wrong. As a method of improving value economics trumps accountancy every time.

As a way of looking at localism, it’s easy to view this as hopelessly managerial, preoccupied as it is by questions of service cost, value and quality, but one of its main selling points is that local decisions are more often than not better decisions. And if you want to deliver a political programme, the quality of decision making is at least as important as the values that underpin them.


Written by samelliot

July 14, 2011 at 8:30 am

Posted in Finance, Health, Labour