What's wrong with our public services?

The NHS and the police , is it a drama, a crisis or a mess?

A Doctor, with  a pipe? Seen in Emergency Ward 10A Doctor, with a pipe? Seen in Emergency Ward 10

Now here's a funny thing, it has changed so much over the years, traditionally public service was seen as just one of those things but now it has a life of it's own. The concept of service has been turned around no longer are we the public served but we serve the services. Consider the NHS which has gone from its roots in medicine to being the national religion and people who dare to question this move are apostates. How did this happen? Clearly there is no single reason but the quaint belief that public services are 'free' is there along with other perceptions. At one time people took a pride in their health but now visits to their GP or hospital A & E department are routine and often for trivial matters. It's as if they don't care and seek a form of entertainment as if it's a right.

In 1937 The Citadel by AJ Cronin was published, Cronin was both a Doctor and novelist and this book was a publishers' dream in that it was a record best seller. Although technically correct it was loathed by some sectors of the medical profession. But we may assume that most people bought it for its entertainment value. Cronin was on good terms with Aneurin Bevan and this relationship is generally thought of as the start of the NHS as an idea. Cronin also wrote scripts for the BBC 'soap', Dr Finlay's Casebook, from 1962 till 1971. But the was not the first TV soap to dramatise a life in medicine. It was simply the BBC response to Emergency Ward 10, released by ITV in 1957. Since then a steady stream of similar shows has followed establishing the idea that illness is a valid form of high drama. We may wonder why this is so and congratulate the drama producers in their choice of theme. Just imagine if they had chosen coal mining, and why not?

The advances in mining and the contribution of coal mining to the post WW2 economic recovery have generally gone unreported. Yet in 1957 UK mines were producing coal at a lower cost than any other European country. But step by step mining took on a downward spiral and went from a major employer, around 800,000 to be defunct in about 30 years. By contrast the NHS was going the other way and in 2017 the headcount was around 1.1 million. Had the drama producers chosen mining there might well have been gaps in afternoon TV. For it is hard to imagine such programmes lasting, then again this could have been a benefit to the health of a nation of couch potatoes!

So just how popular is this giant thing the NHS? Political people regardless of party seem to be in awe of it as do some of the media and assume the whole population are too. But this is not the case with many families who will have plenty to moan about and with justification. But they tend to complain about the service, both quality and efficiency. Politicians tend to be more bothered about the money, as they should. The sums are astronomical and hard for most people to appreciate beyond the fact they are paying for the NHS. It does not take much effort to find examples of extreme waste with notice boards of hospital wards carrying pleas for staff to heed instructions on the correct use of expensive resources in full view to the public. And more worrying and unsettling, instructions on how to administer drugs with respect to correct dosage as opposed to over dosing. You would have thought that trained staff knew all about the relevance of the decimal point when calculating the strength of drugs, that is 0.1 and 0.001 are very different concentrations and muddling this could be disastrous for the patient. But failing NHS staff seem first hard to detect then take ages to get sacked for some serious shortcomings.

The reporting of the NHS follows predictable political lines. The gruesome stories of these cases will be found in the tabloids while the liberal left press will tell us how nurses are regulars at food banks. The upper levels of NHS management are always ready to go public with their latest funding 'problems' so the liberal left press are full of stories telling how just about anything you care to mention from climate change to Brexit will bring the whole show to a halt unless more money goes their way. But you sense this is all wearing a bit thin. Prior to the Brexit vote politicians and public figures hithertoo taken seriously were telling us how the sky would fall in if we dared vote Leave. Well we did vote that way and the sky stayed up but the public are no longer so ready to give time to naysayers. It has been noted that many of the problems the experts talked about regarding Brexit were not so much the possible impact upon the public but the impact upon the organisation they worked for, a very different thing. In time there must be a radical overhaul of the NHS. Then some very nice jobs will be 'at risk' and the experts will seek to scare and bamboozle the public into supporting the staus quo. The experts could be in for a shock as to the public reaction if they try yet again to turn a crisis into a drama, the patience of patients is wearing thin.

It's the same with the police. First we go all the way back to 1955 and the BBC TV series, Dixon of Dock Green. This drama was a follow up to the 1950 film, The Blue Lamp, which also starred actor Jack Warner in the lead role. As with dramas about hospital and medical themes the producers had struck gold and from then on a steady stream of docu-dramas about policing and crime has issued forth. And in both cases the quality has been variable as producers vied with each other to get good ratings. Naturally the delicate balance between the social realism and the factual content sometimes got blurred. But what was clear was a drift away from the staid authoritarian figure of PC George Dixon portrayed by Jack Warner in the early days to something a good deal less savoury. On TV we saw a laddish aggressive police culture where 'low life' were abused. The problem being the police alone decided who was 'up for it' and did so in an arbitrary way without evidence but eventually this came back to haunt them. As however, a tendency to abuse football fans, Irishmen or what was to hand cannot last forever. Although the public seemed to like this sort of TV drama it did not automatically follow they liked this style of policing. They knew it was, like hospital dramas, only based upon selected facts.

And muddling up real life with fiction has its limits, in time two major miscarriages of justice, Hillsborough and the Birmingham Six became beacons for police led injustice. It's at this point supporters of TV companies will puff up with pride at, 'their role' in bring this subject to a 'wider public'. Well yes, but with conditions attached to this view. For TV had invested much time in portraying all public services with a 'comfortable' form of social realism that suited their quest for good ratings. It was late in the day when they faced up to the uncomfortable aspects of what was done in the public's name. But then again perhaps some sympathy is called for here, think of the BBC, it's hard to be critical of 'the state' when you are the state broadcaster!

The Birmigham Six case has its origins back in 1974 while the date for Hillsborough is 1989. In both of these cases we are left wondering how people in positions of power and trust thought they could get away with such corrupt behaviour. But in the case of the Birmingham Six no one in authority was ever brought to trial. While the wrongly accused were released after 17 years in prison and waited another 10 years for compensation. With Hillsborough as of November 2017 six people are to appear in court on charges related to the 1989 event. A wait of 28 years and with as yet no firm indication of how long proceedings will be although 2019 is suggested as a possible date for a verdict. It is even thought that this stalling process could include attempts to prevent any meaningful trial taking place. On any level you care to specify the impact of the whole affair has been significant, one Hillsborough defendant alone has so far been given over £7.5 million pounds of legal aid.

With the NHS and police, like any public service, no matter what the problem is it takes an absurd amount of time and money to get to the truth. When in front of the Royal Commission on Criminal Justice which was set up to deal with the problems highlighted by the Birmingham Six case MP Chris Mullin stated -

with certain honourable exceptions, most of those who preside over our criminal justice system are congenitally incapable of owning up to mistakes, let alone taking the steps necessary to prevent a recurrence

Mullin also stated -

that the seeds of most miscarriages of justice are sown within a few days, and sometimes hours, of the suspect's arrest. In the Birmingham case, confessions were extracted in circumstances ranging from threats of violence to sleep deprivation and systematic torture. These confessions, said Mullin, also required the fabrication of custody records, denial of legal access, and also the willingness of doctors, prison staff and even the courts to overlook or explain the inconvenient injuries to the six accused men.

Mullin also claimed that

crucial evidence in the Birmingham case simply disappeared without trace. Other evidence disappeared from police custody before reaching the Director of Public Prosecutions, and that because there was never an inquiry into the Birmingham Pub Bombings investigation,we may never know how much has been suppressed and by whom.Mullin claimed that around two-thousand statements judged by the West Midlands Police to be 'non-material' disappeared.

The Royal Commission on Criminal Justice was set up in 1991 and duly reported, then changes were made to the various systems shown to have failed but allegations of malpractice still come to light. In 2014 it was said that files related to the Stephen Lawrence case were destroyed in 2003. And this is just one example.

But time moves on, and following the financial crisis we found ourselves with a new phrase, 'too big to fail', normally applied to banks and other similar organisations. It implies a status that is for various reasons, not just size, that renders the organisation beyond normal control. It seems ideal for public services. For many public service workers appear to have bought into this mythology. It's as if they have spent far too much time watching docu-dramas and are divorced from reality. We see that the NHS in Lancashire has conducted a survey in which 10 year olds were asked, 'if they were comfortable in their gender'. It's hard to know what was the purpose behind this idea, although claims were made about 'helping' to develop policies. As to be expected there were complaints and again as to be expected at the time of this story being reported there was no comment available to the press from the NHS Trust.

And with the police we have the absurdity of the Damian Green case. If you have come late to this it may seem complicated, it starts in 2008 with a raid on his office in the House of Commons and his private home. At the time Labour were in power with Gordon Brown as PM and Jacqui Smith as Home Secretary. Brown had replaced Tony Blair to get the job he always saw was his by right. However, by then the nation had grown weary of his party and there was sense of things running down. Looking back we see Smith as a good deal less than popular Home Secretary with both the public and her party and no doubt aware of the public mood. Damian Green was the shadow immigration minister and from Christopher Galley, a civil servant, getting leaked documents.

This irked Smith who took it out on Sir David Normington, the Permanent Secretary at the Home Office who did what you do in such circumstances, raised a posse. Included were, Sir Gus O'Donnell, the Cabinet Secretary and Chris Wright, the Director of Security and Intelligence at the Cabinet Office. Eventually Michael Martin the Speaker of the Commons and Jill Pay, the Serjeant-at-Arms joined the mob. Bob Quick an Assistant Commissioner at the Metropolitan Police had been contacted by Wright and it was he who led the raid on the home and office of Green.

As may be expected the report on this event raised as many questions as it answered. Despite what the posse may have thought or suggested to others none of the documents leaked were of national strategic importance. We may therefore wonder if a deliberate or accidental case of group-think was at work here, in either case it's bad. It may have been politically awkward for the government but by overselling those involved made it worse for themselves. None of those named seemed to have used their own judgement, simply going along with the mob. At the time of the raid it was noted by many that some of the Metropolitan Police appeared to be awfully fond of the Labour government. Who had responded in kind.

Indeed it was later to be the case that the now PM, Theresa May when Home Secretary under David Cameron, had a very difficult time with the Metropolitan Police because that was the way some of them had decided it should be. Thus suggesting that the way the Green case has been handled is open to scrutiny. Furthermore, it was not the Green case that forced Quick to resign. That came after a stupid mistake of his own making and one rather hard to follow considering his counter-terrorism role in the police. Hence it does seem like an act of revenge to wait almost ten years before making accusations and statements that helped lead to the resignation of Green.

Perhaps some of the police are feeling satistfied now, they should enjoy it while they can. For after an eerie silence in contrast to the general clamour that has marked out the Green case, Cressida Dick, the present head of the Metropolitan Police, made a statement. She condemed Quick and former Detective Constable, Neil Lewis, and said they will be investigated by the Information Commissioner over alleged breaches of the data protection laws.

So is that going to be the end of it all? Probably not. Pick any 'crisis' in the Metropolitan Police in the last 20 years and a number of things are clear. Post crisis we will be told 'lessons have been learnt', but that will not be true. As the Metropolitan Police nevers learns but plods from one crisis to the next, also the crisis does look to be avoidable. Like all over-large public services it never really changes having created a mindset that says the maintenance of the status-quo is the very basis of the service to the public. In other words it's self-serving before anything else. It does look as that attitude may no longer work as the public mood is changing and the vendetta by long retired police officers counter productive. For whatever Green did 'wrong' the world is not a better place for the actions of the officers.

It would do well for the police and all public servants to look at changing their attitude before being forced to do so.