First published by Common Weal
The First Minister has announced £300 million to clear the backlog in accident and emergency (which was of course actually £100 million, but for three years). This was his headline-grabbing contribution to party conference. But it’s not at all clear the positive headlines will last even a few months. It is unlikely that this is actually going to have the effect it intends. In which case it would be considered ‘another fail’. What’s going on?
There is a lot of discussion in Scotland about the many failures in government and there is plenty of commentary stressing the importance of fixing these failures and preventing more of them. Unfortunately, the public debate about what it is that is making things go wrong is pretty poor.
So we get plenty of ‘the wrong priorities are being pursued’ or ‘the personnel aren’t good enough’. Of course that often just means ‘I don’t like these priorities’, and while there are certainly weaknesses in the Scottish Cabinet, policy-making is not an individual act, it is a large team effort. These explanations are too simplistic.
Another pointless homily is ‘you need to stick to bread and butter issues like the NHS and the economy’. Well, the poor state we’re in is a result of decades of governments sticking to bread and butter issues like the NHS and the economy and making an absolute pigs ear out of it through privatisation, managerialism, under-investment and dogma.
A journalist telling a politician to get the economy sorted is like a politician telling a journalist to sort out the economics of the media and start making some profits. In principle the argument sounds right, but it is of almost no value to say it.
Unless we can find the root of the errors, we can’t prevent them. So rather than wooly stuff about ‘voters’ priorities’, where should those who hold government to account be looking? At Common Weal we’ve highlighted absolutely lots of factors, not least the shoddy design process for public policy, the constant practice of making announcements before working out what they mean, and the endless recourse to managerialist solutions.
What is not challenged anything like enough is Scotland’s penchant for ‘slush fund government’. This has been almost the primary method of government over the last ten years and there is absolutely no signs of it slowing down or of any lessons being learned. We need a much more focussed debate about this to begin.
So what is slush fund government? It is the practice of treating government like a resource allocation process which doesn’t actually involve policy. There are two ways to look at it. The less cynical way is to believe that governments see resources as limited and so allocating resources becomes the primary task of governments. Getting resource allocation right in terms of need becomes the role of a government in this conception.
There are problems galore with this conception, not least because it’s not true. There is no algebra which says ‘drug deaths are X, so rural loneliness is 0.7 x X while business support is 3 x X’. Public policy is not a shopping list. Even more than that, you can’t just price outcomes. You can’t say ‘the price of not having crime is £1.2 billion’. It’s not how the world works.
But perhaps the more fundamental problem is that this blinds us all to what is actually causing the problems that public policy is supposed to address. Think of an analogy – you have to get a room up to a given temperature and you have a certain amount of resource for logs for the fire (it’s that time of year…). You exhaust your quota of logs. What do you do?
This resource allocation model says ‘right, we’ll need to cut back on groceries and buy more logs’. A policy management approach says ‘or we could shut the window’.
In Scotland you get away with ‘slush fund government’ for a while because no-one in Scotland properly tracks where this money then goes
However that is the less cynical explanation for this approach. The more cynical approach is that this is really ‘government for journalists’. In this version, the first purpose of government is to persuade journalists that you are doing a good job so they will persuade the public to vote for you. So you do whatever journalists will notice.
This means setting up lots and lots of working groups (really, lots and lots and lots), each one a message that you care about the issue concerned. You set targets to show you’re focussed (until you miss them). You make big announcements and then tell the civil servants ‘just the usual folks’, which ends up meaning ‘churn away until you work out what this means and whether it is possible’.
But perhaps above all you performatively allocate money to problems. Whenever you are criticised for something, wait five minutes and announce a sum of money to create a bid fund based on that problem. When you are in a rut, pick something popular or fashionable and announce a sum of money to generate a story that attaches you to the popular thing. If voices rise to say ‘you ought to…’, you don’t need to do the thing, you just need to announce a fund for the thing.
And you get away with it for a while because no-one in Scotland properly tracks where this money then goes. Well, sometimes I do and it’s enlightening in a kind of unenlightening way. For example, I had been working with a group on social loneliness (particularly older people). They were a network of local voluntary groups based in communities.
I’d been suggesting the idea of a campaign of ‘who knows your gran?’ to highlight that these groups are working on these issues right inside the communities where loneliness is a problem. So when a £10 million fund for loneliness was announced I tracked it. Every penny went to big, corporate NGOs based in city centres. They put out press releases about how brilliant the government is, and then that’s the job done.
I am not aware that there has been so much as a tiny bit of evidence that this £10 million resulted in any measurable drop in loneliness.
This is treating public resources like a re-election slush fund and it is deeply corrosive to good public policy. So let’s return to the NHS waiting lists. Common Weal has done loads of background work on this problem (which I now need to write up), and the heart of the problem is not something that money will fix alone.
Put very simply, poor management of the NHS has pushed the entire service to operate at close to capacity, which is a disaster in health, which is not linear – the average annual capacity is nothing like enough to cover seasonal peaks. To deal with the busiest months you need overcapacity. The result of this was to place increasing strain on staff, causing some to leave and to reduce capacity further.
The solution to that was to put the remaining staff under more pressure – and this became a vicious circle. The backlog in waiting lists is because key specialisms and key support roles just don’t have enough staff now (or not enough hospital beds). In our health group we talked for weeks on end about how to address this. Everyone was clear about one thing – you can’t bribe the key staff back in with money alone.
Sadly it looks like the Scottish Government is about to fall into another cycle of electoral politics-focussed, short-sighted short termism
To explain, a lot of the people who left took early retirement on good pensions and have no incentive to come back. Others have moved on to other things. Fundamentally the reasons they left have not changed; the conditions remain the same. You can’t make life better for just some nurses working in areas of backlog. You need a more systematic approach to making working life better for NHS staff if you want to attract people back.
And even then, poor historical workforce planning means the pool of people to try and entice in probably isn’t big enough. Too many have gone to facilitate a mini-boom in private healthcare. Using the announced money to send patients private is therefore just another vicious circle.
We believe there is a package of measures that can address this (as best as possible) in the short term, reverse this in the medium term and ensure it doesn’t happen again in the long term. But I can’t get you the answer to that in a headline, because it involves lots and lots and lots of separate actions across separate aspects of the delivery of healthcare in Scotland.
That’s how you fix policy problems. But it takes time and you need to wait for results. That’s what good government is. That’s how, one day, you can get out ahead of your omni-crises. That’s how, one day, you get a reputation for good government.
Sadly it looks like the Scottish Government is about to fall into another cycle of electoral politics-focussed, short-sighted short termism. A Council Tax freeze (which was not modelled, not discussed with anyone, not thought through, just pulled out a hat hours before conference – the definition of utterly dreadful policy-making) might be popular in the General Election, but the disasters it will cause in local services will be a big liability in the Scottish Elections.
The its-not-300-its-100 million pounds gets headlines, and then in about a year it will almost certainly be clear that it hasn’t achieved its objectives. The money will have been spent, the problems are unlikely to have been fixed.
If you want to know why everything is going wrong, understanding this process of a decade of slush fund government which spends lavish sums of money on extremely wasteful eye-candy while failing to roll its sleeves up and deal with the messy reality of actually governing will certainly help.
And if you want to know why we seem set to see a further decline in the quality of infrastructure and public services, the fact that under a new leader it looks like slush fund government is the true continuity government would also be a good place to start.
By chance, this was published at the same time as this really excellent article by Marion McLeod which is about precisely the same thing, the total waste of public money in child support by pretending that vanity projects and good policy are the same thing. I encourage you to read it.