Can't See The Wood For The Trees?

The old cliché about 'joined-up thinking' actually has much more substance to it than those that employ it for empty rhetorical effect could ever know [pictured, a graphic from Six Sigma (US) which I think demonstrates my point nicely with or without the spelling and grammatical errors]. The problem we have in so many areas of life and our economy and politics is fragmentation of intent through poor planning and outsourcing; through bad management, reactive thinking and lack of strategic coordination. The big irony at the heart of it all is that blind centralisation of resources is at the very heart of the issue: the very thing that was meant to streamline and make efficient all of the necessary services that drive our society has achieved its diametric opposite; replacing actually [organisationally and cost] efficient service structures, such as the NHS, tax, transport, urban infrastructure and repair; public transport, social services, public amenities, &etc. &etc: the list is actually endless; with gigantic, over-managed [and poorly managed] and under-resourced structures beholden only to the shareholders of huge outsourcing contractors and so-called 'trusts' which care little for the actual services, still less having any understanding of how they actually work and should properly function. Profit before effectiveness: dividends before public service. The water companies are the prime exemplar of this egregious trend: privatisation of erstwhile publicly owned and government controlled services has brought this archipelago pretty much to its knees since the Tories' great garage sale of our industrial assets commenced in 1979.

Is there a way back from the brink? I bloody hope so, for our children's sake; and the baton is now firmly in the hands of a newly transformed  Labour government here in the UK today. The seeds of change are there to be grown, moreover, with more devolved power to the regions and the actual independent nations of the UK, backed by hopefully adequate centralised funding. Simplification and greater efficiency and more importantly, effectiveness, can and should follow from this. We need to, in the NHS, for example, centralise patient data records properly, so that we can identify patients across their journey through the system, something that was taken as read in the 1950s and 1960s, but which is systemically impossible under the present, hopelessly fragmented non-system; meanwhile devolving power to clinical staff rather than teams of disinterested businesspeople whose only training and knowledge is in the abstraction of 'business' itself.

The health service is exactly that - a [public] service - not a business. We should be closing down the big general hospitals and getting back to atomic specialist hospitals that can concentrate clinical and surgical expertise in manageable and accessible local amenities, so that waiting lists can realistically be brought down to negligible levels, and patient care be brought back into absolute focus. We need more GPs in more local practices, managing themselves as it used to be when I was growing up. We need more adequately-equipped pharmacies; and so on: distribution rather than concentration. Therein lies the public service paradox that we've struggled with for half a century now: how to rationalise both the need for commonality of organisation across the board of a public body and the practical imperative that shows that the fragmented and abstracted privatised approaches to complex public organisations are doomed to ultimate failure. We need to listen to those that know and have training and experience and not try to squeeze them into some arbitrary 'business' model confected and managed by overpaid idiots with no vision, and we need proper, joined-up, systemic thinking to manage the whole affair...