The Camden New Journal has been successful in exposing the failures of Camden council’s care for Jennyfer Spencer, who died alone in her inaccessible Gospel Oak flat last month. With our other excellent local paper, the Ham & High, it has also been a leader in the fight against the closure of the Whittington A&E, and been happy to report the other failures of NHS Camden, as exposed by the Keep Our NHS Public Camden, and others.
But what we need to do is look deeper into the failures of our systems of care – both health and social – to recognise that there’s one central problem at the heart of both: the belief that market forces and “productivity” can somehow deliver better, or even more cost-effective, public services.
A report by the parliamentary health select committee that was slipped out on March 30 has now finally got some attention. It concluded that almost 20 years of “commissioning” in the NHS, since health providers and purchasers were split in 1991, have been a “costly failure”.
It described the 2007 “world class commissioning” drive as “no more than a box ticking exercise”, warned that the bureaucratic costs of commissioning had not been adequately counted, and very strongly indicated that what it did not want was more costly management consultants being employed to react to its conclusions.
I visited the Crossroads Women’s Centre in Kentish Town recently and heard from workers there about how a similar approach to social care is causing suffering and misery to those the system should be helping. They told me of a refugee mother, a victim of torture, who when she asked for limited help to get her children to school was effectively threatened with having them taking into care. She was left with little choice but to struggle on with the help of friends. Money saved – highly “productive”.
And they told me about a couple in the nineties, who when told of a huge bill for care costs, panicked and cancelled the services. The result might well have been tragedy had not when they sought help with shopping the Centre become involved and lobbied for their care to be restored.
What links Jennyfer’s and all of these other cases is the fact that the “care” is at risk of being taken out of both our health and social systems by the market approach. Everyone in the system, from the cleaner to the head of the hospital, from the day-to-day carer of a disabled person to the borough care manager, is being pushed to greater “productivity”. But as Tim Jackson in his brilliant book Prosperity Without Growth explains, in caring, indeed in much public sector work, “productivity” is a meaningless, indeed destructive term.
Imagine a senior nurse, a wise and experienced woman, sitting a whole night through with a dying patient, someone who is not going gently into the dark night, but who needs every ounce of compassion, experience and wisdom that can be provided. That’s dreadfully “inefficient”, utterly “unproductive”. Yet wouldn’t we, if we were that patient, want that care and compassion?
Or what about a carer, job description “do the shopping and clean kitchen and bathroom”. If he sits down with his caree for a cup of tea and a chat, that’s inefficient, it isn’t delivering on goals or “productive”. Yet for one old man that might be the highlight of his week, the only chance he gets to reminisce and interact with another human being as a person.
We have to ask, when the “market knows best” idea has been totally debunked in our banking and financial systems, why does it apparently still hold an iron grip in these critical social fields? What we need instead is for professionals with appropriate skills and resources to be allowed to simply get on with their jobs, to use their creativity and knowledge to seek the best outcomes for their patients. And we need all ideas that this is some sort of marketplace to be banished.