Town & Country Planning, December 2006
My wife is pregnant, a condition that brings with it more contact than usual with the NHS. There we were in the waiting room at King’s College Hospital (KCH), waiting for the second scan. All around us, couples of all shapes, sizes and races were staring lugubriously up at the television we had been supplied with, where a game show blared out, set rather too loud.
It was clean and warm, otherwise the whole experience might have been debilitating as well as frustrating,
When we had waited an hour and a half after our allotted appointment, and we were finally called in, I mentioned the wait to the doctor.
As politely as I could, of course.
He explained that they have emergencies every day which puts their timetable out. Fair enough, I suppose, though you might think that – if it really happens every day – perhaps it might be possible to plan for a little.
But then the real reason became clear. Despite a schedule which assumes a 45 minutes per patient, our session – normal (fingers crossed), or so we were told – took an hour and a half.
If I was really cynical, I might suggest that these indefensible waits were all to do with pushing up what the hospital earns from its parking charges, but I know this isn’t the case,
KCH is a vast institution, and once more the hidden costs of being treated in an organisation which is too big becomes clear. Small organisations are sometimes able to lie to themselves about timetables, but big ones do so all the time.
The scans take an hour and a half, yet the management persuades themselves that they take 30 minutes less, because otherwise they have to confront the problem that they are treating too many patients with too few resources.
Or they need to train the staff to speed up, and neither of those is very welcome.
The poor patients, who give up maybe an afternoon’s work to be there, or pay extra childcare, or miss school pick-ups, are the ones who suffer.
Later in the weekend, I found to my horror that Lambeth Council had cut down the line of mature trees next to my local railway station. I have no idea why they did this – let’s give them the benefit of the doubt.
Since then, they have replaced them with silver birch saplings and landscaped the whole verge with beautiful turf. You and I know that this will not last: the trees will not be watered, the verge will not be maintained, and soon there will be nothing left.
But local government is a complex business staffed by managers who no doubt believe this is money well spent from their budget. Because the organisation is too big, it is able to lie to itself about the almost certain fate of the new trees.
Before I sound hopelessly like a character from One Foot in the Grave, let me tell one last story from a few days later, at Cambridge railway station on Remembrance Sunday.
We no longer have a full rail service in the UK seven days a week, of course. Large chunks of it are closed and dug up every Sunday, and on this occasion all the trains had been replaced by buses.
But nobody at any of the various train operators involved was aware that, on Sunday mornings in Cambridge, they close off the end of Station Road for a Remembrance Day parade. All morning, the buses with their fuming passengers were therefore trapped on the station concourse.
A smaller organisation, where arrangements were made by local staff, would know that his was the situation in Cambridge every Remembrance Sunday, and taken appropriate action.
This wasn’t so much a matter of managers lying to themselves. It was simply centralised ignorance. Once again, it was only ordinary punters who suffered, and the staff who had to deal with them. Their rage probably never reached those who made the decisions.
The argument that small organisations delude themselves less easily than large organisations is not quite the same as the struggle between local versus central, but it is related. Those who know the details of the situation are disempowered, and those who know only the outlines take the decisions.
The colleague of mine who watched his train to Norwich leave without any passengers is a case in point. They had all been told to wait elsewhere, but because central targets about late departure were more important than the passengers which were evidently absent, the train left without them.
Three incidents, small in themselves – four if you count the ghost train to Norwich – but they happened within a few days of each other. Once you start looking at public administration around you through this particular lens, you see the same thing everywhere.
One of the examples wasted the money of taxpayers (the trees). The rest just wasted the time of customers and service users, but so much so that it must break any assumed reciprocity between them. Nor was there any great difference between public and private sectors.
In theory, of course, large centralised organisations are more effective and efficient. In practice, as we all know, they are vastly more ineffective and inefficient, but in different ways.
The trouble is that most public service organisations in the UK are in thrall to theory and the management consultants who promote it.