Is it right for “health professionals”, government ministers and star TV presenters to assume that the trade-off that they choose to make – essentially that abstinence now is worth it in terms of future life benefits – is the right one? And should be imposed on others?

The increasing interference of beauraucrats in all aspects of our lives is turning us into teenagers, where they know what is best for us. This is wrong – people should be free to lead their lives as they choose, making their own decisions not only about smoking but about all the other trade-offs that face us in daily life. That is adulthood.

Which is a shame because the concept of professional freedom needs targets, otherwise it lacks democratic legitimacy. We as tax-payers have to be able to direct what we get for the money we give to the government. So, for instance we say we don’t want to wait for excessive lengths of time in A&E. This is a perfectly reasonable demand, and one that many people would be prepared to pay some extra tax for. However, what does this goal mean in practice? What is excessive? How long is it reasonable to wait? What about quality of care as opposed to time waited – is there a trade-off? What is the right trade-off? All these questions need to be thought through and answered – which may be complex and difficult, and certainly risks alienating entrenched “professional” interests. But it needs to be done, and the result of all that debating and thinking has to be a target, e.g. four hours. There is then a chain of democratic accountability from us as taxpayers and voters through to these who provide us with public services that meet our requirements and that we are therefore happy to pay for. 

The next question is, how is the target achieved in hospitals? There are two approaches to answering this: 1. the centre decides the correct processes, procedures and mechanisms and orders everyone to follow them; 2. the centre sets the target and says to the hospitals  – you are full of professionals, you figure out how to do it. The latter option respects (to an extent) the autonomy of the professionals and gives them the space to innovate and deliver services in ways that best suit them. It is a compromise between total professional freedom – the “knights” delivering whatever they feel like – and total central control. Whilst many professionals might not like any crimping of their autonomy, they have to accept that the chain of democratic accountability means that ultimately they must deliver what the citizenry want, and targets leave them free to find individual ways to do so.

So it seems to me that the principle of targets is essential to providing many public services. It is clear, however, that there have been significant problems with them in practice, e.g. are they set at the right levels?, do they conflict with one another?, is it possible to game them?, etc. But these difficulties could be overcome if there was the political will and managerial competence to do so. However, the concept is so badly damaged that I am not sure that it can be rescued – in which case a future Conservative government will also have major problems in delivering improved public services.

Finally, my comments above have assumed a model of limited competition in public service providers. In a proper market, we don’t set the participants targets, e.g. as a society we have created no targets telling Tesco what to sell. Instead, Tesco responds to market signals to deliver an offering that meets consumers’ demands. Could that model work in the public services, in which case we could do away with targets? Possibly, but it is a big leap to believe so. There are many problems, for instance the fact that there are natural monopolies (accident victims can’t shop around for A&E departments), often big information and knowledge disparities between user and provider (e.g. patient and doctor) and large external costs of failed public service provision (e.g. poor schools may eventually be forced out of business but only at a huge cost to the children that have gone through in the meantime). None of which are arguments against increased public sector competition, but it doesn’t strike me that competition will improve quality significantly in the short term.

 From: Toby Hiles [mailto:Toby.Hiles@which.co.uk]
Sent: 19 September 2007 15:19
To: Subject: Use of Which? in GMB/AA press release Thank you for your previous correspondence to our Customer Service Centre and your more recent letter to Peter Vicary Smith, which has been passed to me for our response.Please accept our apologies for the unusual amount of time it has taken to respond to you on this matter. Upon investigation it the GMB informed me that although quoting the AA customer service having dropped from first to third in a paragraph suggesting a timeframe of 2003, in actuality it referred to an article from April 2006 (Which? April 2006, p22 Breakdown Services Rated).As you rightly mention the attribution of Which? research in this press release is incorrect, and while it has taken some time to convince the GMB of this fact, with a number of suggested changes by them passing across my desk. None of which was acceptable. It has therefore finally agreed to amend the wording on its press release to make no mention of Which? at all. I enclose a copy of the revised press release, which can also be seen at http://www.gmb.org.uk/Templates/PressItems.asp?NodeID=94958.  also a copy a copy of the September 2007 magazine which you may already have, which on page 20 contains our latest review of breakdown services.Once again please accept our apologies for the exceptional and unusual amount of time it has taken to complete our investigations into this, and rest assured that procedures are now in place to ensure any future delays are minimised. Please also be assured we will be keeping a close eye on the GMB in the future to ensure that if they are thinking of quoting Which? research in any of their press materials in the future, at the very least they are accurate.Once again thank you for your continued and extended patience, and for bringing this important matter to our attention. With thanks and kind regards,Toby Hiles

Will that stop the “breast is best” juggernaut? I doubt it – too many campaigners have a vested interest in portraying the formula milk companies as evil villains. They love the good feeling they get from fighting evil transnational corporations such as Nestle. So a little bit of scientific evidence isn’t going to change their minds.

Which begs the question, why is wrong for Brits to emigrate and take their culture with them, but it is just fine when others immigrate to Britain and import their culture?

Could it be there is a double-standard in the minds of the liberal intelligensia who populate most of our media, namely British (and particularly English) is bad and boring, non-British is vibrant and exciting? Perhaps that explains a lot about why we were foisted with multi-culturalism for so long in this country – it wasn’t about treating others cultures as equal to the indigenous one, it was that the libs who run these things actually though incoming cultures were betterthan all that nasty Britishness.

• “Activities are not properly budgeted and even where budgets are set they are not adhered to”
•  ”mismanagement [that] turned an event which ought to have been a money-spinner into a money-loser”
• questions whether an activity “was the correct prioritisation of slender resources”
• complains about staff whose “whose job descriptions are unclear and certainly unpublished”

It is beyond satire that one of the hard left’s icons is using the language of management – resources, budgets, job descriptions – to attack what is a rag-bag of Socialists whose experience of actually running anything must be close to zero.

Welcome to the real world George.

What is striking about this article is what is missing: no doubt that if this had been a privately owned company the BBC would have elicited quotes from their usual sources, including Louise Christian , to the effect that profit-seeking caused the accident.

It seems that to the BBC (and many others in the media) if a private sector organisation gets something wrong that is evidence of the general failure of the private sector, normally phrased along the lines of “putting profit before people/safety/whatever”.  In contrast, if a public body makes an error there is no extrapolation to the general nature of the public sector. We don’t see comments such as “putting an easy life and doing the minimum required before people/safety/whatever”.

explanations should be forthcoming [as to] why the warning was not heeded and the necessary steps were not taken to avert the outrage

It is just such sentiments that demonstrate why there must be no inquiry. Because if there is, it will spend months poring over scraps of hearsay evidence and examining every tiny detail of who said what to whom. The media will have regular frenzies – we will be repeatedly told that the intelligence services failed because some bloke somewhere claimed beforehand that he knew something, which then wasn’t acted on.

And at the end of it we won’t be much the wiser – because who really knows what goes in the secret world of intelligence. But the result of all the sound and fury is that the country will be left with the lasting impression that the outrage was all the fault of the spooks. Rather than the Islamofascist terrorists who actually detonated the bombs.

Let the memory of July 7th stand – as an act of terror – rather than becoming transmogrified into a beauraucratic error.

 None of which happens at the moment.

According to Which?, the banks raise about £4.7bn annually from unauthorised overdraft fees.  There are about 47m adults in the UK, of whom about 2m do not have a bank account – leaving 45m that do. Each adult will therefore have to pay about £105 per year to replace the lost revenue to the banks. Yes, that’s right – the responsible will have to pay extra to subsidise the feckless.

Why do the self-appointed consumer groups, and Which? in particular, focus so much on a minority in such a way that will end up costing the majority more? Why hasn’t the press been all over the iniquity of this? Why don’t the 75% speak out? Something is broken in society when we get such big and important questions so wrong.