Robin McAlpine – 21 November 2022
Last week I wrote about how to begin to save the NHS and I warned that if the left doesn’t define what ‘saving the NHS’ looks like, the right will. And as if on cue we get a leaked story about ‘co-payment’ for NHS services.
Should you be surprised by this? Is this a sign that it really has got really bad? Is this the crossing of some rubicon that everyone involved in floating it is utterly horrified about? The answers are no, yes but not in the way you think and no, not in the slightest.
No, you shouldn’t be surprised, or at least not if you are the kind of person who has ever worked in or near senior positions in the Scottish public sector. The radical, free-market reform of public services is an absolutely routine opinion which is held by the people governments appoint to run or advise on public services.
Yes, this really is a sign that things are bad, but not because the public sector governance class have floated a radical policy they have never considered in the past. The writing-down of this idea (usually only spoken of in private) shows that people think the crisis might be big enough to actually get away with pushing this policy from their private realm into the public one.
So no, while it is clearly unwise to typify every person who is involved in public sector governance in Scotland as of the same view, the pool from which they are recruited (senior business figures, financiers, their lawyers, their consultants) means that hard-core free market views are to be found all over the place in public service.
You need to understand this to properly understand a lot of things that go on in Scotland. Just to take one example, the Scottish Government’s ferry headaches are largely its own making but are exacerbated by a privatisation-friendly CMAL which was ideologically opposed to the whole ‘build ships in Scotland’ proposal from the beginning.
Let me take you through this a little. First (and apologies for being a little patronising here but this is something a remarkable number of people get confused about), it’s important to understand the difference between ‘management’ and ‘governance’. Management is a full-time, hands-on job and involves actually running the public services. Governance oversees and leads the managers.
‘Manager’ is a full-time paid job which you do as an employee, governance is a notionally voluntary role in which you give up some of your time to shape the strategy the managers work to. They’re the staff, you’re the Board. And the first thing you do when you become the Board is to decide that Board members aren’t voluntary at all but remarkably well paid.
When I called for health to be clinically-led last week I meant the opposite of turning doctors into managers – I mean turn doctors (and nurses and other staff) into governors. If the healthcare workforce (and other genuine stakeholders) led hospitals we wouldn’t have got into this mess in the first place and clinical staff wouldn’t have been drawn into the bureaucracy of being pseduo-managers.
There is a problem at the top of management where the very senior officers have a tendency to see themselves as peers of their Board rather than peers of the staff they are managing, but generally the public sector is filled with good and well-meaning administrative staff.
The problem is that they work in a context which is often defined by governors who drive a managerialist approach to running public services, much Iike the way they run their own corporations. Managerialism is driven more by governors than by the people who work in the administration of public services.
So who are these governors? First, it seems like there ought to be absolutely loads of them because Scotland is stuffed to the gills with quangos. (In fact, there are quite a bit over 100 of them and I like to play ‘quango denominator’ when I’m bored, as in ‘how many quangos per…’. So for example Scotland has about one quango for every eight GP surgeries, or only 1,500 police officers per quango.)
But there aren’t loads of governors because they’re a tiny class of person who sits on many Boards (one person you’ve never heard of called Mike Cantlay has been on more Boards than anyone has counted, from running airports to protecting natural heritage to funding universities to promoting tourism). They make a living from this, and they need never bother with democracy.
To become a professional Board Member you just need to be liked by very senior civil servants and not disliked by very senior politicians. And, to ensure they like you, what you do is you then invite retired very-senior-civil-servants into the club, you protect politicians when you are in office and then you invite retired politicians into the club too.
That’s who actually runs public services in Scotland (as a very useful Ferret investigation showed) – influential bankers, retired senior civil servants, well-connected industry insiders, powerful chief executives and former politicians. This is not the radical left. This isn’t even near the middle of the political spectrum. These are the free-market zealots.
So what do they talk about? I’ve had lots of experience of this as a young(ish) professional who sat in meetings with them for the first decade of devolution. Over that time there were really consistent views I heard expressed. Here are some of them.
First, the NHS is not sustainable. They have never believed the NHS is sustainable. They hold dinner events to persuade others that the NHS is not sustainable, should be part-privatised and must offer much less healthcare. I know, I was at one of them. They all love the arts – but are disdainful of artists who they see as being untidy and distinctly ‘not with the programme’.
They believe with all their hearts that the biggest mistake the Scottish Parliament made was abolishing tuition fees. That was their model for the ‘reform’ of public services. They love ‘co-payment’ – any version of charging people for public services. They believe that only cities matter and that towns are a dying concept.
In fact since this last statement might sound outlandish, let me share an anecdote with you. I was invited to a ‘strategy day’ for the most senior echelons of public life. I was the token progressive, and there was a token artist and a token environmentalist as well, but everyone else was a senior financier, business figure or civil servant.
We were given flip charts with quadrants and we had to stick post-it notes with various ‘current issues’ into the relevant quadrant (certain-uncertain, important-not important). My group was a retired CEO of a multinational corporation, a very senior lawyer and some senior civil servants. Suffice to say I was the only one in the group not determined to place ‘the decline of towns’ into ‘certain, but not important’.
When you look at the failure of public services in Scotland (and sadly there is more to look at by the day) you almost always then look to the politicians. They get it in the neck for what happens. But it is rare that the people technically responsible for overseeing the failures are ever scrutinised or held to account.
It is a deal – the elite governing class protect politicians and cover up failure, so the politicians protect governors and cover up failure. It’s a deal, and it stinks.
Right now Scotland faces a series of crisis – a public finance crisis, a NHS crisis, industrial action crises, a public health crisis (drug and alcohol deaths are just the headline), an environmental crisis and a host of others. You might wonder how one Cabinet Minister (or even all of them together) are supposed to fix these crises.
In reality they don’t. They phone someone else up and ask them to fix it, and that someone else is often one of the governing class. And the governing class says things like ‘privatise Northlink Ferries’ or ‘sell our renewable energy dirt-cheap to oil corporations’ or ‘take away the last green space of Aberdeen’s poorest community and give it to Aberdeen’s super-rich to concrete over’.
Progressive voices who want to highlight the injustices of anti-democracy usually point to the House of Lords. They’re pointing in the wrong place. The elite class who run your public services in the shadows have much, much more power than any Lord or Lady snoozing on the red benches.
Charging the wealthy for health services is their wedge attempt. They say ‘wealthy’ in the hope that they can play on the current public disdain for the very wealthy. As soon as they have broken the NHS apart with that wedge they will simply widen it further as they go. ‘Did we say rich? We meant anyone not on benefits.’ And then one day you look at where we are and think, eh, who voted for this?
A week tomorrow we launch Sorted: A Handbook for a Better Scotland, or our book of solutions to Scotland’s ills. It has a simple plan for how to remove this governing class from public life for good (unless they want to try and get elected like everyone else). These are the steps in the book I think are more urgent.
The legislation to end feudal rights of power in Scotland was finally passed in 2000. Nominally at least. In reality, that is nothing more than optimism. Roughly the same people are running the country now as were in 1622. It has to come to an end – for the sake of public service.