Emancipation
England, Northern Ireland, Scotland & Wales
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It is the height of social irresponsibility to permit political decisions impose upon the very professional standards required to uphold best medical practice.
It is also equally deplorable to confuse management principles relating to economics and finance with medical ethics. |
Why the public sector is working less effectively
As public sectors try to centralise activities they also try to concentrate the managemet of information. This process creates a self-generated complexity. Sometimes this level of complexity creates a dangerous level of confusion which engulfs the very solutions designed to improve operations and sometimes facing impasses which defy effective solutions. This results in the risks associated with centralised solutions increasing in a circumstance where there is a lack of relevant knowhow and experience to tackle the new level of complexity.
The obsession with centralization is often driven by a political party interest in generating large budgets over which they have control. The way in which such budgets are allocated and applied offers the same political parties a means of levering their power through financial patronage. The policies which result are sold quite often in terms of promoting "equality" of treatment. In technical and economic terms the development of highly centralised systems involved a systems design strategy known as divide and rule. Al of the processes making up the activity, such as a health service, to be centralised and broken down into individual logical procedures. But the very process of centralization changes the ecology of the system into a more complex ecosystem where the original logical proccedures no longer apply. As a result there have been serious failures observed in some public sector operations such as women going to hospital to have a baby and dying from infections contracted during their visit. Data management within the public sector, in spite of the promotion of images of service ethics and public responsibility, has been shown to be insecure with millions of records of personal information being lost by a range of public services including the military. In both cases these failures have been the result of the failure to isolate possible sources of infection on the one hand and data from easy access on the other.
The evolving chaos
These circumstances under highly centralised circumstances have been exacerbated by the attempt to apply centrally determined management performance criteria to the processes which determine the relationships between nurses, doctors and their patients. Indeed, after an intensive drive in this direction the government seems to be realising that this has been counter productive to the extent that they have endangered the life of patients.
Political processes which cast caution to the wind
The common factor in all of these cases, and many more, is that they involve public sector activities characterised by a significant level of service centralisation, including that of how information is managed. Since centralisation is very much a plank of past Labour policy and continues as a covert policy, anyone criticising centralisation from the standpoint of rational explanations as to why efficiency will decline, are summarily dismissed as being of the opposing political camp. This says two things.
When any systems are concentrated through centralisation, additional levels of complexity are created including functional relationships which formerly did not exist...
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One is that political policy objectives have quite often over-ridden the interests of the very people whom policy is considered to serve. The other is that the level of decision analysis used to design and implement such policies has been lamentable. This in turn is a function of the deficient intellectual grasp politicians have of the complexities involved and the need for those in the relevant professions to spoon feed politicians in terms they understand. Unfortunately this level is explanation is usually inadequate to address the true levels of complexity involved. Sometimes the professions themselves fail to declare with adequate force the reliance of policy successs upon factors which are either imperfectly understood or, in some cases, unknown.
Who is the policy for anyway?
Whereas many British politicians pay lip service to the importance of individual freedom, the majority belie this by becoming intellectually shackled to their political party collective whom they serve with devotion and often at the expense of the people and their invividual freedoms. Politicians in fact do not like the expression of individual freedom because such expression does not fit neatly in their monolithic view of society and the policies best suited to that society. For the modern world where a rational view of democracy is one in which there is an equitable participation of the whole electorate, the British political parties are a bizarre abberation. These are run as tiny private collectives with a sum total national membership constituting less than 1% of the British electorate. These unrepresentative groups drum up, amongst themselves, sometimes involving a handful of enthusiasts, policies they deem adequate for all of the people of Britain. This archaic and inefficient process continues to ignore the fact that the people of Britain, that is the remaining non-party members making up 99% of the British electorate, are very diverse in their interests, points of view and indeed preferences.
Freedom, It is
so important |
Statistics cannot cancel reality
The soothing soporific stew which is consumed by political party policy makers is the use of statistics to bolster their case. It is obvious that in statistical terms the "average" does not in fact represent any but a few individuals. Class has shifted from being a statistical term to a basis for classifying society to the degree of affecting social relations which are used as policy justifications and manipulated by all political parties. And yet hidden within the confines of averages, means and standard deviations describing the state of the people there is a challenging specificity in what each person considers to be important to them as well as relevant to society as a whole. In spite of this, or rather because of it, political parties do not attempt to address the preferences of all but only to promote policy solutions which will attract a sufficient number of votes as to secure control of governance. The outcome, under the British political system is the voting into power of political parties who enjoy no more than 20% of the support of the electorate, that is they do not enjoy a majority support in the country. On the other hand their prize for "winning" under the first-past-the-post system is a dominant voting majority in the House of Commons. And so the scene is set whereby a private minority faction can gan power over the public sector accounting for 40% of the British economy and to be handed the levers of power enabling it to force upon the remaining 80% of the population, policies they have never supported.
One apparent weakness in our systems, indeed, our constitution, is that the practitioners in each area such as medicine or information systems design simply accept and apply policies which they know are nor supported by the majority of the population. There is insufficient robust debate and censure of politicians by professions applying rigorous ethical and technical standards leading to a compliance, under political pressure, to tolerate substandard operations which put people's personal data and even their lives at risk; this is unacceptable.
But the solution is not to try and work out a solution which sustains excessive centralization but rather to simplify the ecosystem by decentralization and higher professional standards freer from political interference. |
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