In that wonderfully bizarre 1960s TV programme The Prisoner, Patrick McGoohan would rage against his benign captivity in the surreal ‘village’. His memory and name taken, he would reject his new designation as ‘Number Six’ by screaming “I am not a number”.
This idea – that the powerful forces above us both see and treat us not as individuals but as faceless statistics – formed a crucial conceptual part of the 1960s counter-culture. But has it got worse than that? Do we exist in an era where being treated as a number would actually be a promotion?
Two examples illustrate the problem. When Storm Arwen hit a few weeks ago, many people lost their electricity. The various National Grid companies across the UK had the immediate responsibility of managing their infrastructure to return that power. Managing infrastructure is what they do.
And they were pretty successful – most people got their electricity back quickly. But 9,000 people didn’t. In fact 9,000 people were left without electricity for eight days. In the modern world, in the cold of winter and in an era when home working is crucial, that is an eternity.
So what did government do? It ‘liaised with the power companies’. Which is to say that government managed the infrastructure (or more accurately it phoned for a catch-up with the people who were managing the infrastructure).
What didn’t seem to be a consideration was that the infrastructure had something specific at the other side of it – people. The cables were down so the electricity didn’t flow, but in modern government people often disappear from the picture. It is at times as if the electricity is flowing for its own sake.
If electricity is generated by a private corporation and that electricity makes it onto the grid (the only one in Europe owner by another private corporation) then that is one half of the equation resolved. If the electricity makes it as far as an electricity meter where a third private corporation can then sell it, the equation is complete, oversight is a success and all is well.
What happens next is nothing to do with ‘energy’ or the grid or public policy. If this electricity causes severe fuel poverty when it gets past the meter, that is a totally separate subject. That can also be dealt with by managing the ‘superstructure’. Government hears ‘fuel poverty’ so creates a ‘grant fund’ of a generally arbitrary size.
That grant fund is then opened to a network of large service providers (either local authorities or NGOs) who bid for the money to do ‘something’. The money is distributed to these agencies and the government produces another media release about how that in and of itself is a success.
If the electricity doesn’t get to the meter then the role of government is to keep phoning the grid owner until it does. Three days, six days, eight days – get the updates, be prepared to say ‘we’re on top of it because we’re in regular contact’ and send out a success media release at the end.
The 9,000 people who may have been unable to cook, heat their house, keep the contents of their fridge edible, work, look after their children properly? They are incidental to this. Both government and grid owner are managing cables and cables alone – the people at the end of the cables are no-one’s direct responsibility. So nothing is done to help them.
This is a mirror image of what happened with the care homes at the start of the pandemic. The medical experts warned of overwhelmed hospitals so the role of government became to manage beds. There are two kinds of beds, those absorbing capacity and those providing capacity. Government had a single task; convert beds that absorb capacity to ones that provide capacity.
Lists of factors absorbing capacity are scrawled on a white board as ministers and civil servants look on. ‘Delayed discharge’ features high on the list and so a structural response is made – change the factors which are causing the delay. It turns out those factors are largely political.
Because during a previous phase of management, the problem was quite different. Capacity in hospitals is ‘paid for’, priced in. Capacity in care homes is not – and it’s expensive. To balance this, capacity in hospitals is traded for capacity in care homes, reducing the bill for the bit not priced in.
Perfectly ‘sensible’ – all performance indicators met. Until now, when it is clearly not sensible because the management task has changed. No longer ‘save money’ but ‘expand capacity’. So the opposite of what was previously sensible is the new sensible. Get that bed capacity up.
The instruction is given, the order comes down – empty the beds. No-one seems to say ‘but that means decanting vulnerable people who are infected with a highly-transmissible illness which kills vulnerable people into closed environments with more vulnerable people which do not have the equipment to deal with the consequences of what is bound to happen next’.
Because there were people in the beds. That was what was sucking up all that ‘capacity’. But the people weren’t the numbers in this story, the beds were. It was beds that was being counted, not people.
All of this is absolutely endemic in public life now. It is an inevitable consequence of the domination of ‘New Public Management‘, the Thatcherite idea that the public sector is just a business to be managed like any other business – by managers (not practitioners) who manage performance indicators. If the indicator moves in the right direction then everything is self-evidently good.
Problems are converted into these indicators. Often they don’t count the problem, they indicate the scale of the problem so it can be compared against other problems. To a performance indicator a patient who is on their last legs and could die if moved is identical to a healthy patient who should have been decanted into properly-supported accommodation long ago. There is no difference between them.
Which means – absolutely crucially – if people die as a result of this, if people freeze or starve or lose work, it is definitely no-one’s fault so long as the indicators say it is no-one’s fault.
Money shuffles its way around the system, handed from manager to manager, each issuing a media release when it comes or goes, the arrival or departure of the money is the story. Ministry A gives money to Agency B which gives it to NGO C to spend, each skimming some for costs, each trumpeting their success with each shuffle.
Wires are managed, beds are managed, systems are managed. The whole bloody circus has created its own complex religion in which performance indicators can offer redemption to anyone, any time without reference to who is at the end of the wire, who is in the bed, who is crushed by the system.
In this religion, we are not numbers, we just plug our plugs into numbers on the wall, we sleep in numbers, our hunger or cold or pain take place somewhere underneath numbers. We ourselves are incidental.
To get politicians to acknowledge that these issues aren’t abstract an issue either needs to become politically expedient (when politicians want to appear compassionate or ‘in touch with the people’) or highly embarrassing (if the performance indicator becomes just too bad).
You know this is happening when politicians either become highly emotional about how people’s feelings matter or start saying things like ‘there are real people behind these numbers’. Both of these statements are presented as if they are a revelation, that the politicians is exceptionally perceptive to have grasped this fact. That in itself says a lot.
In the system with which we live, a managing class manages abstractions that the management class designs for itself, usually with ease of management in mind. All outcomes are legitimate so long as the abstractions are managed according to regulations, no-one involved cannot be absolved of responsibility so long as they say ‘with hindsight perhaps…’.
What never, ever happens is for someone to say ‘oh, those poor people without electricity – we should send someone to see if they’re OK’. Patrick McGoohan’s Number Six may have resented being a number, but his captors at least made sure he had food, clothing and somewhere warm to sleep…
Great analysis and insight. Explains what had long puzzled me. Thanks Robin,
Norman – I try to explain this to people a lot, because it isn’t immediately obvious. I sat in a meeting with very senior government figures (senior civil servants and advisers) which concluded that the decline of towns was ‘inevitable but not important’. They looked at it structurally from their perspective – everyone works in financial services or retail, right? So there just aren’t going to be jobs outside the city centre. The ‘countryside’ grows food, the cities make money. The towns? No function. I was quite startled by this conversation – so what happens to the people who live in towns? Apparently their analysis tells them that there is nothing that can be done so ho hum, let’s not worry about it.
This isn’t about ‘bad people’, it’s about a system that has been shaped by endless commercial consultancy contracts with big accounting firms. ‘Success’ has become a theoretical process measured by abstract indicators, not an empirical process assessed by whether people’s lives are getting better. The operation continues to be a success, but the patient keeps dying…
Robin
My wife and I were discussing how depressing and frustrating it is to witness stories about bed counting in hospitals. Every day, in every hospital, dozens of highly skilled medical staff are huddled in meetings to establish how many vacant hospital beds are available. Then they phone/visit wards to “hassle and hussle” staff to see if any patients can be discharged. Complex, long operations which have been organised months in advance are cancelled at the last minute due to no ICU/recovery beds being available. This obsession with “bed counting” is ok for the hotel industry but it should never have become routine in the NHS. UK and Scottish decisions to reduce bed numbers over past decades have created this awful situation; Covid has thrown more petrol on it. Numbers, targets, planning, efficiency targets…?
Ian,
I’ve been asking people in the NHS and who have good knowledge of the NHS what it is that is actually wrong with the service (given that everyone and their dog seems to believe something is wrong). This has resulted in a fairly wide range of issues cropping up but one of the most consistent is ‘Scotland seems determined to run the NHS at 100 per cent capacity and the wonders why every period of slightly above average demand creates a mini-crisis’. As one person said to me, medics on the continent are bemused at how anyone can think a 100 per cent capacity health service is supposed to cope.
It’s another example of neoliberal New Public Management. The medics see an empty bed as a crucial insurance policy just in case there is a nasty road accident that night or (god forbid) a plane crash. A finance manager sees it as an ‘under-explored spending unit’. And the politicians, given the choice of backing either the medic and their crazy worries about ‘what if there is a pandemic?’ or the finance manager and their promises of cost savings, the politicians back the finance manager. Do that for 30 years and you get an NHS crisis.
That’s what the care homes were used as – emergency excess capacity. And that is why Scotland has among the world’s worst care home deaths. Political leaders would really, really like us to believe that all of these things are unconnected, that their stewardship of the NHS, the Covid decanting to care homes and the death rates in care homes are three entirely unconnected matters – one a massive success, one an issue that ‘with hindsight’ might have been ‘handled better’ and one an unfortunate series of events.
Robin
More people need to know that running any system (hospital, project, school, your own life) at more than 85-90% capacity makes delays, queues and crises inevitable if there is a significant perturbation. As an abstract thinker myself I find it utterly incomprehensible that those who set all these targets can’t grasp the consequences of a very simple mathematical formula. I can only conclude that either they are not abstract thinkers at all, or they have zero capacity to relate their abstract models to their implications for real peoples’ lives.
Hi Hillary,
It is really, really easy to understand if you think of public services as being something you design and manage on a spreadsheet sheet. On the spreadsheet 15 per cent spare capacity is ‘waste’, or in the more specific language of politics ‘fat that can be trimmed’. And on the spreadsheet they’re not wrong – on average some of the beds are ‘never occupied’. The point is that the real world looks different than the spreadsheet and it turns out that it’s a different bed each day that isn’t occupied. So it’s a bit like that old joke ‘someone in Scotland gets run don by a car ever three days – the poor sod…’ It’s as if there is a lack of awareness that statistics show the general, not the specific.
And as for missing targets – well that’s because the targets are set by politicians who won’t reform the spreadsheet-focussed public service delivery model. So they claim big visions expressed through targets and then deliver them through small-minded financial management approaches. It’s this big separation between the phase where politicians project the future and the bit where they manage the present that these contradictions arrive – in the future we’re resilient and ready for everything, in the present we’re running at full capacity with no scope left to deal with the unexpected.
Within this gap, I fear, is the raw material of anger and disillusionment…
Robin