David Aaronovitch: Delivery is a challenge for all of us – not just government

'One million people work in the health service – the system is too damn large to be run from the centre'
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The Independent Online

The word "deliver" has a complex etymology. In the sense that the political classes – politicians and journalists – have come to use it, it means (as my dictionary has it) "To present, render, hand over". Milk is delivered to your house each morning, as is the post. The delivery boy (I was one once) cycles round with the groceries you ordered, a van arrives with the washing machine the husband bought last Thursday at John Lewis's.

When the government says that it will "deliver" on services, it is understood in this way. By the time of the next election, the government mini-van will be arriving outside the national front door bearing excellent hospitals, peerless schools and an assortment of clean buses, frequent trains and empty highways. Or else. As consumers of these things the rest of us must now just sit back and see if it can do it. If not, we will turn into 60 million Sharron Storers: 60 million flailing tongues, 120 million flashing eyes, 600 million sharp, indignant digits. God knows how many eggs.

This picture paints Mr Blair not as Prime Minister in a hugely complex, fast-changing, inter-dependent nation, but as Zeus, as Odin, as Jehovah. "And lo, wonderful services for all, created he them. And all the doctors and nurses, teachers, and cleaners, drivers and guards, and all things that did heal and teach. And on the seventh day he rested, plugged in his amp and strummed him his Stratocaster."

The Government cannot of itself deliver good services. You only have to recall that a million people work in the National Health Service to realise that the system is too complex, too diffuse, too damn large to be run from the centre. The centre can provide money, can provide assistance, can help create an atmosphere, but it is the million who will deliver improvements or it is nobody. Actually, even that statement has to be qualified. In an article in this month's Prospect magazine (each copy sold is a blow against stupidity, comrade) Nick Timmins and Barry Cox point out that since the Government began to measure success by health outcomes – rather than inputs or outputs – the patients themselves now have an important influence on delivery. If they choose to smoke or drink excessively then the NHS falls short of its targets and the Government fails to deliver.

In fact the language of divine delivery is not maintained in the Bills promised in the Queen's Speech. Something substantial has happened since the PM inveigled against "the forces of conservatism" and showed the scars they had left on his back. The NHS Bill is a decentralising measure, in which money and decisions are to be located closer to practitioners, and the often-derided health authorities are to be broken up. Timmins and Cox quote a recent report by the Cabinet Office's Performance and Innovation Unit. This unit, operating close to No 10, pointed out that "excessively direct methods of government that appear to treat front-line deliverers as unable to think for themselves, untrustworthy or incompetent, undermine the very motivation and adaptability on which real-world success depends".

If this is true, the day of the great central reorganisations are over. Government should usually set objectives, agree a budget and then retire. No wonder, then, that Labour finally decided last year that it could live happily without the former chief inspector of schools, Chris Woodhead. He was associated, classically, with the idea that too many teachers weren't up to it, just at the time when the message had to change to one of empowerment.

Let's not be too glib here. In certain places at certain times, clearly understood central initiatives pushed upon a reluctant profession can work. Literacy and numeracy hours are a good example.

And many demands for central action do not originate with government but with the public or in the media. One shudders, for example, to think how many unnecessary new regulations and checks will be imposed upon GPs because of the Shipman case – when all that was really needed was a modicum of lateral thinking among the doctor's colleagues. And is "post-code prescription" a sign of a failing system, or is it the inevitable consequence of professional discretion?

What should the relationship be? Something interesting is happening in our primary school at the moment. Among all the other things that staff have been required to do, the school was also charged with creating a development plan. This could have been a chore, a bit of form-filling, a list of ticks on a piece of paper. But it has been seized by the head and her deputy, altered and agonised over by the teaching and non-teaching staff, until it has become the property of the school. Add to that the training in management offered by the Investors in People scheme (forget paint guns and flip charts), and we are beginning to define excellence for ourselves, based on the needs of our children and our staff.

As this process develops we will want to change some of the objectives given to us by the centre. We will want to experiment. And as we do, we are more likely to be able to solve problems than some official back in the department. I was intrigued yesterday by something proposed by Sir Kevin Satchwell, headmaster of Thomas Telford School, which recently became the first non-selective state school to get all its pupils through five GCSEs at A, B or C grade. He said that he now wanted to be able to train his own student teachers. In fact, he went on, "Every school could be allowed to train its own students on a reasonable salary – cutting out the bureaucracy of being taught in a traditional PGCE course". And, more to the point, tailoring training directly to the school's need.

Diversity creates problems. On the same day, the general secretary of the Secondary Heads' Association, John Dunford, argued that we should be worried about the fragmentation of the schools system. There were dangers of the creation of complex "hierarchies" of schools. And he's right; the inevitable risk of allowing greater professional autonomy is that some may be left behind. I think that this is a risk worth taking (and dealing with) if it turns sullen infants into great deliverers.

Here's the next snag with Pollyanna Aaronovitch's Grand Plan: not everyone wants to be a great deliverer. I was struck by the tone of many of the contributions to the Unison conference this week, as I have been by speeches at the teacher union conferences. It's not just that the people receiving and paying for services are often seen as the enemy but there's also an unthinking conservatism. The involvement in any way of any private management in public services is labelled "privatisation" (this is partly Labour's own fault), when it is no such thing.

This has got to change. The final point made by Timmins and Cox is a good one. If the spending of the next five years fails to give a mostly affluent nation the public services that it wants, then it will turn – finally, perhaps – to private services. And here I should add that my dictionary gives another definition of "to deliver". It is "to save, rescue, set free".

David.Aaronovitch@btinternet.com

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