The Path to Mediocrity

This site has focussed over the last two weeks on radical ideas for next week’s Programme for Government. The brief given to contributors was to forget about the focus groups and, for the moment, about money too: unburdened by any worry about cost and political acceptability, what would they want to do?

You can read more of them here, here, here and here. Professor Adam Tomkins also gave us a plug and set out his own priorities in his Herald column yesterday. This debate is in keeping with our site’s overall purpose – to provide a platform for what we can do, now, in Scotland.

I’d like to focus less on specific policy proposals than on a wider issue – the absence of what might be deemed a guiding strategy for reform in Scotland. Individual policy initiatives pop up regularly in Scotland like hardy perennials: elected provosts, reform to local taxation, an Edinburgh-Glasgow high-speed link. But what about an overall vision for change? Where’s the underlying plan for reform that might knit individual policies together?

Remember Christie?

The absence of a political party in Scottish politics with such a vision is odd, because a blueprint exists, and has done for the last decade. In November 2010, against the backdrop of the sharp post-crash slowdown in public spending, the then First Minister Alex Salmond announced the creation of a Commission into Public Service reform, tasked with setting out how public services had to change to meet the long-term financial challenges of the future. Chaired by the late STUC chief Campbell Christie, the Commission reported back the following summer. It remains a seminal piece of work which sought to get to the heart of how to deliver real and lasting change.

As Professor James Mitchell – a member of the Commission – has recently explained, the Commission did not set out a set of prescriptive policy proposals. Rather it set out a series of competing principles Christie Commission on the future delivery of public services – gov.scot (www.gov.scot) which, it argued, should underpin the reform process – as follows:

  • Reforms must aim to empower individuals and communities receiving public services by involving them in the design and delivery of the services they use.
  • Public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve.
  • We must prioritise expenditure on public services which prevent negative outcomes from arising.
  • And our whole system of public services – public, third and private sectors – must become more efficient by reducing duplication and sharing services wherever possible.

In short, as Professor Mitchell explains Time to deliver – Sceptical Scot, Christie aimed to “upend” the way we think about policy change: less about levers being yanked in Edinburgh or London; more about empowering local citizens and communities to come together to focus on the underlying issues that lead to acute problems in society and which build up “failure demand”. Echoes of this exact point were made just last month by drug campaigners who argue that Scotland will only cut the deaths due to substance abuse when reform builds from the bottom-up – starting with the lived experience of people with drug addictions, rather than the latest pointless policy wheeze dreamed up in Edinburgh in time for Reporting Scotland’s deadlines.

"Brave" is bad.

At the time Christie was published, I remember the scepticism which members of the press greeted the plans: all very well, but at a time when pennies were being squeezed, what chance was there of NHS boards, local authorities and central government pushing through systemic change too? And lo, it came to pass. As Prof Mitchell has written, the thorough transformation of our public services in the way that Christie envisaged has “simply not come close to happening.”

The lack of cash is one explanation, but there are other reasons. The kind of change that Christie envisaged creates losers and opponents. For “integration” read the amalgamation of the police and fire services or – more dangerously –  hospital or school closures. As Councillor Pat Watters noted recently in an interview with Holyrood magazine, ‘If we’re all agreed, why is it not happening?’ – the Christie Commission 10 years on (holyrood.com)

“It will take very brave politicians to say we’re not going to do that anymore. Here’s what we’re going to do. Because people are used to getting service in a particular way.

“I mean, it’s like anything, you go to close a school and all of sudden that school becomes the greatest school that’s ever been.

“It doesn’t matter what the results are, what the outcome is actually telling you, it becomes the greatest school there’s ever been, and it’s about trying to take communities with you when you’re trying to change things, but it’ll take brave people to actually say we’re not going to do that anymore.”

In short, while reform doesn’t guarantee success, it does guarantee a fight. That is what courageous politicians with top notch communication skills are there to do, you might argue. But the bottom line is that, over the last decade we have had a government in Scotland which wants a different scrap. When 50.1% of the population require to be won over to independence, picking fights with vested interests and the status quo in Scotland is not the way to go; better to stick with the tried and trusted scrap with Westminster as the begetter of all things bad.

NHS reform

Witness what happened to another “brave” reform plan, that led by cancer specialist Professor David Kerr, who was tasked by the previous Labour-led administration back in 2005 to set a fresh course for the NHS in Scotland B40206 NHS Summary a/w (scot.nhs.uk).  Kerr spent months traveling around the country speaking to communities prior to his report which focussed on how to improve “pathways of care”. He set out to try and answer the big questions: how can you ensure people get local access to care, as well as access to specialist treatment, in a world where not everybody can have a University hospital at the bottom of their road?

The town-hall meetings Kerr held are now interesting in the context of the growing mood in favour of Citizens Assemblies. In a BBC interview a few years ago Good Morning Scotland – The NHS at 70: The Kerr Report – BBC Sounds, Kerr noted how these meetings confronted controversy head on. Kerr felt he often persuaded people to change their minds. How?

“By being polite, listening and pushing back, folk left with a better sense of what we wanted to do and that we would stick up for them. They felt they didn’t have a voice and I said we would do that for them but that we would try to take these views and turn them into something sensible and deliverable.”

But while his plan for change got cross-party backing when it reported back in 2005, it soon hit the buffers. The election of 2007 saw the high-level reforms of the report collide with street-level politics. Desperate to usurp Labour in government, the SNP ran a series of local campaigns talking up the perils of hospital closures (in fact, even local Labour politicians opposed it too, including former Home Secretary John Reid who joined protests about changes to his own local hospital in Lanarkshire). And, after getting in that year, Kerr’s reform plans were left to wither on the vine – slung in the bottom cupboard marked “too difficult”.

As Kerr recalled:

“They (the SNP) took a rather different view of how they wanted to deliver the health service. Many of the points we made around service re-design, of planning for excellence and making sure there was a rebalancing between different hospitals, I guess they ran on a ran on a pledge of we will keep hospital open, we will keep you’re A+E and we will maintain the status quo – the mean bit of me would say, maybe a wee vote for mediocrity.”

Time to change

In the odd post/pre referendum world that Scottish politics currently occupies, the kind of systemic reform envisaged by Christie and Kerr remains an orphan. It’s not that things will continue to get uniquely terrible across Scotland as a result – but nor should we be surprised if the end result is mediocrity.

It needn’t be so. A reform-minded government which spent as much time communicating the need for culture change as it did about nation change would stand a good chance of taking people with it – and, perhaps, in doing so, demonstrate how Scotland really could make a success of going it alone. Post Covid and Brexit, the opportunity to change this is now upon us. it is an ideal moment to reset and start afresh. 

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