“We need more people in handcuffs… there’s not nearly enough people in handcuffs” Michael Portillo’s choice of words on BBC political programme, This Week, might have caused Jacqui Smith to titter, but he was spot on.
What Portillo was questioning was a culture in which people at the top – in private and public sector roles – can get away with it and are not only not held accountable for their actions, omissions and failings, but that they are not subject to any kind of sanction, civil or criminal, for their behaviour.
And not for the first time, did I find myself nodding in agreement with this former Tory and wondering how that happened.
It happened because no longer cowed by the need to play the game because he stepped away from it, Portillo is now liberated to say what the rest of us think and to view the goings on at the summit of British culture and society through the same kind of real life spectacles the rest of us wear. Even he can’t believe the audacity of claims that there is little to be gained from sacking or prosecuting miscreants.
So what do you have to do to get arrested or at the very least, the sack? As Michael Portillo noted, not a single person from the top to the bottom in the NHS has resigned or been disciplined over the Mid Staffordshire Trust scandal. Hundreds of people died needlessly as a result of substandard care and staff failings at two hospitals for which the trust was responsible, concluded the inquiry report. The details make uncomfortable reading. Afterwards, current affairs programmes discussed how it could come to this – how did people paid to care forget to do so? – and representatives of the various parts of the NHS workforce blanked the question in an elaborate game of pass the parcel. Not us, but them or the favourite fall guy, the system and the culture is to blame, they reckoned, conveniently ignoring that culture is shaped by people and their attitudes and behaviours.
In Scotland, we glanced cursorily and concluded somewhat smugly that it couldn’t happen here,. In Scotland we have different values at work with a care-oriented and patient-centred health service which is the envy of others. Really? For every example of beyond-the-call-of-duty, exemplary care any of us can relate, we can all also suggest one that didn’t quite make the grade. In truth, there is little that is patient-centred about the way hospitals and community services are run: if they were, for a start, we’d have basic services available in the evenings and at weekends as a given.
Take a look at recent agenda-setting attempts by the NHS in Scotland to see how institutionalised and focused on producer interests, our great health service actually is. Two weeks ago, research suggested that hospitals with 100% single patient rooms would be a very bad thing, with some patients agreeing that they feared if they were in a room on their own, they would get forgotten about or not be able to get help when they needed it. Practitioners and volunteers agreed. Yet, the issue here is not single patient rooms but the inability of the NHS to rethink how it might go about providing for patient care in such circumstances. The very fact that some patients fear dying alone because no one will come should tell us something is far wrong with the current system.
Today, health experts are calling for the morning-after pill to be made available in Scotland’s schools to bring down the number of underage pregnancies. This kind of top down, medical fix it approach is much beloved of health practitioners and will solve nothing, for it fails to address the underlying complex social, economic and cultural issues behind the high rates of teenage pregnancy in some parts of Scotland.
Admittedly, it is but one suggestion in a package of proposals from an expert group singled out to create a headline, but to suggest that allowing greater accessibility to contraceptive measures in schools is prevention at work suggests an alarming mis-understanding of what preventative, early intervention activity truly is. It might fix an immediate problem, and helpfully enable the NHS to meet its targets on teenage pregnancy, but it will do nothing to address the propensity of teenagers in Scotland to engage in increasingly high risk behaviours in substance use and early sexual activity as they move through adolescence, particularly in comparison to their peers in other European countries. Where are their more thoughtful solutions to this?
Elsewhere, the horsemeat scandal is so tangled and layered, that no one can really unravel it to get to hard facts. That job is made more difficult by the existence of powerful actors and players who are adept at pointing the evidence trail away from themselves. Since BSE and foot and mouth, Scotland has lost much of its infrastructure which enables us to keep locally grown and produced food local. Getting raw produce into the supply chain often requires sending ingredients on journeys to England, Europe and in the case of shellfish, Thailand before it ends up back on our supermarket shelves. Producing food is a global business and complicit in it all are the supermarkets.
Yes, we need to find out how horsemeat found its way into beef products but let that be the start, not the end of a process of critical examination of the food chain in this country. And if that examination concludes that we need to regulate more and invest in enabling more people to eat more, locally produced food at an affordable price, then so be it. The supermarkets, in particular, have argued for light touch regulation, yet have largely failed to remove all manner of nasties from our food. It’s time to make laws which require them to do so. It’s not just our well-being at stake here: if global food companies and their purveyors can get away with this kind of thing in highly sophisticated markets, imagine what corners are being cut in much poorer parts of the world.
One thing we can discern is that this scandal came about because far too much leeway was given to producers at the expense of consumers. They have all treated us – and especially poorer families and individuals – with contempt. Just like the NHS, if the food industry truly was people-centred, it would look and act quite differently.
And this upside down approach to well, everything has created a rotten and rank culture in which those with little power at the end of the supply chain, be it a private or public sector one, have to put up and shut up. Even if they die as a result of the decisions taken by the omnipotent.
It won’t do. And we must use the opportunities created by these crises and more to re-configure the power structure. We can start by holding to account those who fail, cheat, lie and break the law. Putting more of them in handcuffs would be a start.