When T.S Eliot spoke of the folly of trying to ‘Devise systems so perfect, that nobody will need to be good’, he effectively described a distinction between the left – who instinctively turn to systems to get things done, and the right – who tend to believe in focusing on individuals, people, and their values. In a world where the centre-ground has become over-crowded with political parties all frantically claiming it, and a rainbow array of party hues (Blue Labour, Red Tories), this is a distinction that still makes some sense.
In fewer areas is this distinction seen more clearly than how we think of our public services. Whether we think of them as the people who work in them on the front line, or the systems they work in.
This is why the NHS debate that has arisen in the wake of the Mid Staffs scandal is so important – and why the question over the future of David Nicholson is about much more than just one man. It is about how we see the NHS; as systems, driven by managers – or an organisation that is as it is because of the people who work in it.
However ‘New’ Labour wanted to describe itself, the legacy of its reforms of the NHS are now sadly characterised by imposing system after system, and target after target. And it was sadly predictable that this emphasis on devising the perfect system, including targets and a complex universe of different bodies and different tick-boxes, would do what history has shown societies based on someone’s idea of perfect system tend to do: erode the autonomy and identity of those who work and live in that system.
Back in 2008, the man to whom we are now looking to turn around our NHS, Obama’s former healthcare adviser Don Berwick, wrote a report on the state of the NHS.