Coffee House

How to be an anti-politics party in government: make the public sector accountable

3 March 2013

One of the lessons from last week’s Eastleigh by-election – and indeed the Italian elections – is that voters don’t like politicians at the moment. It’s easy for those like Nigel Farage to mop up this anti-politics sentiment in the same way as Nick Clegg could say before the 2010 election ‘the more they attack each other, the more they sound the same’. But how does the Conservative party try to appeal to those voters fed up with the Establishment of which it is so clearly a part? David Cameron can hardly start attacking himself, after all.

There is one thing that the Tories could do – and which their backbenchers are pushing for – which would at least undermine a sense that the party is tied up in the cosy Establishment. Unfortunately, it’s something the leadership is notably reluctant to do. The government could address accountability in the public sector, rather than letting those involved in poor quality services continue to rise through the ranks. That’s a long-winded way of saying that David Nicholson, NHS chief executive, should be held accountable for his involvement in the Mid-Staffs scandal.


Conservative MP Charlotte Leslie wrote about the Early Day Motion that she’s tabled which calls for just that on Coffee House on Friday. She said:

‘I have tabled an Early Day Motion calling for the man who was in charge of the Strategic Health Authority overseeing Mid Staffs and who was later running the NHS when the 2008 damning reports were buried, to be held to account – and support for it is building amongst MPs. If responsibility in the NHS is to mean anything at all, David Nicholson must go.

‘But just as it is false to claim that the problem is a one-off in Mid-Staffs, when it is an NHS-wide issue, it would also be a mistake to assume that calls for accountability are just about one man. It is not. The EDM is about making a stand against an entire culture, and calling to account all those — former Ministers, officials, medics and highly paid managers, who were negligent in their duty to protect patient safety.’

Ministers, including David Cameron himself, have repeatedly said they don’t want to seek scapegoats in this scandal. Fair enough: as Leslie says, this isn’t about laying the sins of an entire system on one man. But for no-one at the top to be held accountable at all smacks of a cosy relationship between government and the public sector that serves no-one well at all.

Nicholson was not a harried nurse caught up in the system who dropped his standards of care because everyone else seemed to be doing it. That in itself is shocking. But he had oversight of the hospital itself, with all the generous remuneration and comfortable career prospects that these positions afford. The flipside is that if someone’s performance clearly does not merit such comfortable perks, then they must lose them.

Yes, do blame the system by all means. But systems are made up of and checked by people at the top. And when those people at the top don’t have sufficient insight into how badly wrong that system is going, then they are failing. They are not taking on the sins of others, like the scapegoats of the Old Testament, but falling on their own swords. And covering for those who should be taking responsibility makes politicians part of that cosy Establishment. Michael Gove hinted at the problems this causes on Friday when, referring to Mid-Staffs, he said ‘there’s a sense there that the establishment, however you describe it or however constituted, has let folk down’. If Cameron wants to suggest that the Tories aren’t wrapped up in the sort of politics that rightly upsets voters so much, then he should start with accountability in the NHS.

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  • Iain Hill

    Accountability? Could we start with the private sector?

    Hester has just given us his regular clownish defence of the need to pay him more than the average traffic warden. Could he become our Gtillo?

    If we are not to be forever hostage to these people, we need a campaign of skilled, concerted shareholder action, to progressively sell arge blocks of shares in selected companies, until their executives get the point.

    This need not necessarily be RBS, but one or two carefully selected, high visibility targets should be enough to establish the principle, and to “encourager les autres”.

  • Smithersjones2013

    If Cameron wants to suggest that the Tories aren’t wrapped up in the
    sort of politics that rightly upsets voters so much, then he should
    start with accountability in the NHS.

    Here Here!

  • harold

    Public Sector bodies have a statutory duty to promote the employment of disabled people. Given the success of ATOS in making disabled people available for work, why are so few employed by the NHS? Another accountable issue.

    • Dave Pleb Murphy

      ATOS are making disabled people available for work by reclassifying them as not disabled and therefore not eligible for positive discrimination …

  • lgrundy

    “David Nicholson, NHS chief executive”

    What you should have written Isabel is “former communist David Nicholson, NHS chief executive”

    The ideological roots of those running Britain’s public services need to be exposed at every opportunity.

    • Colonel Mustard

      Indeed. Had he been a member of a “far-right” party, even in his youth, this fact would be mentioned every time he is named, especially by the BBC.

  • Russell

    And what about the labour Ministers of Health who were meant to be in charge at the time all these murders of patients was taking place Isabel?
    Labour seem to be very silent about this matter, and the press, including this article, does not bother asking them about labours responsibility and accountability when they were in charge of the public services sector (MP’s and government Ministers are after all employees in the public sector)

    • Colonel Mustard

      Compare and contrast had this happened on the Tory watch. We would have had a public enquiry by now.

  • Anthony Makara

    The ideological war waged against the public sector will eventually exhaust itself, it will run out of steam and its foot soldiers will have to accept that there is no alternative to the public sector, because the alternatives, are only alternatives, if they can make a profit, otherwise they are not interested in caring for the elderly, disabled or the sick. Public Services, that is, those on the front line dealing with people of need, cannot be vessels for profit but have to be institutions for the public good, even if that does tax the public purse. The ideological right, which for the last 30 years has hijacked Conservative thinking, is incapable of understanding that some services are outside of the private/profit remit and must exist through and be supported by the state. Public sector services are too big and too important to be dismantled or ‘sold off’ and cannot be turned over for profit as there is little or no profit to be made from sectors where demand itself is based on human need.

    • Rhoda Klapp

      You don’t appear to address the issue of accountability. What is supposed to happen, in your ideology, when the public service in question is no good? When they kill people through negligence?

      • Anthony Makara

        Accountability has to be undertaken at the level of the individual, whether that is in management or those engaged in minor auxiliary roles within the organization. To collectively brand the NHS as failing, when the bad performances of certain individuals is at fault, is unfair. Still, that suits the agenda of those ideologues who believe the market must deliver absolutely everything. As we know the market can work, if profit can be made and if the customer can afford the service. Yet neither of those two conditions can be relied on. The term used, ‘People who kill’, implies intent, which again is unfair and misleading and doesn’t help us to focus on the actual causes of failure with the NHS.

        • Tom Tom

          That is to misunderstand the structure of the NHS. ALL management is UPWARDS with Repressive Control being implemented DOWNWARDS. It is a typical Stalinist Bureaucracy where sycophancy upwards is matched by contempt downwards. You cannot make Individuals accountablle at the sharp end if they are subjected to Management-By-Terror and Mushroom-Management, and as you know Tony…..MbT is when you given people responsibility for matters they have no control over or lack resurces to carry out their task

        • Rhoda Klapp

          When I write negligence I think you should assume that is what I mean and that it does not imply intent. But if you are the dead one or their family there isn’t much difference. Although responsibilty does indeed devolve to the level of the individual it can’t be shrugged off by those in charge. Do they ask for a reduced salary because they are not responsible? You ducked the question.

          Oh, and you can be as left-wing and caring as you like, but the market still applies. It can no more be switched off than gravity.

        • Colonel Mustard

          Absolute poppycock. There is no intent in manslaughter but one might conceive “malice aforethought” in a system of so-called ‘nursing’ that permits, within an organised infrastructure and hierarchy supposedly governed by both a regulatory and performance framework, old and ill patients to lie and die in their own faeces. I remain astounded that no-one has so far been prosecuted for criminal negligence causing death and that there has been no public enquiry into nursing.

          It is almost a contradiction in terms to suffer in that manner in a modern hospital, going against not just basic humanity but hundreds of years of proper nursing and compassion, even in eras of medical and scientific ignorance. Those poor people would have received better and more compassionate care in a mediaeval pilgrim’s hospice, or in Nightingale’s Scutari hospital (she must be turning in her grave to see what nursing in Britain has become), so please don’t try to defend the indefensible with a load of management waffle and mumbo-jumbo. Care is not just about medicine or medical status. But it is the missing element in New Labour’s Brave New NHS World.

    • Chris Morriss

      Yes, but which services should be “outside of the private/profit remit”? Possibly only the military, the police force, and the high-court judges?

      • Anthony Makara

        Areas such as health and education must, in the national interest, be available to all and that can’t happen if profit and affordability determine who provides and who has access to the services. These are areas where the patient and pupil is a passive participant in the process, their involvement is based on need and not consumer choice. So, the state must provide these basic services to protect access for all.

        • Rhoda Klapp

          Daft. Ignorant. Unobservant.

        • Forester126

          Are you not aware that most of the Health Service is already privatised, GP’s and Surgery’s are private and contract to the NHS. As are dentists, opticians, chiropodists, etc. All medicines come from private companies as does the equipment, even the laundry is outsourced. The only part that is nationalised are Hospitals themselves, and that is where the problems are.

          If the manufacturer of equipment used in a Hospital fell down on the job and someone died because of it they can be prosecuted under Heath and safety regulations, and the directors could be charged with manslaughter and yet all these people died and nobody has been held responsible. In fact whistle blowers have been paid off and asked to sign a confidentiality agreement so the public don’t find out. Now does that not ring some alarm bells for you?

          • Tom Tom

            “The only part that is nationalised are Hospitals themselves” which were seized from Local Authorities in many cases in 1948 just as Municipal Electricity and Gas Supply was seized by Whitehall in 1948………in 1972 Water was seized by Whitehall from Local Government

        • Colonel Mustard

          Health and education has been available to all for most of my lifetime which I dare say is longer than yours. Not even foreigners are turned away so please spare us the lefty “creating an issue where there isn’t one” tripe.

      • Tom Tom

        Deputy High Court JUdges are Practising Barristers just as Deputy County Court Judges are Practising Solicitors

  • Tom Tom

    The personalities in the political establishment are loathed. It is personal. They have been engaged in repeated cover up whether selecting patsies like Dearing, Chilcot, Hutton etc to whitewash inquiries, or promoting deadbeats like Lin Homer and Nicholson because they are Apparatchiki. Then the complete overpaid incompetence at ALL levels of the System whether Osborne or Nicholson or Entwistle and Patten or Hall and his cronies Purnell etc. The System is so clearly corrupt and incompetent that nothing will save it from collapse. We are watching a slow-motion train wreck as the Elites has used QE to delay the inevitable Implosion to protect themselves by raiding the populace and expropriating its savings and its future. The Zombieworld they have created has left the yawning gaps caused by an era of thieving magpies to expose just how barren the future looks. No cosmetic changes can save this system. If Cameron thinks he can throw a few overboard to save his skin he has forgotten who put them in their positions or kept them there

  • Rhoda Klapp

    When all you’ve got is a hammer, everything looks like a nail.

    When all you’ve got is an electability problem, everything looks like a populist initiative designed to garner favourable headlines.

    Now this initiative is in fact well-intentioned, but the real problem is why did it not just happen? Why have we a culture of defending the incompetent? Covering up the unacceptable? Why was nobody sacked at the BBC and the report redacted? I want accountablity to be the rule, not a exception. The automatic rule, so that no chickenshit politician gets to decide whom will be fired and whom defended. Maybe we need an independent inspector-general’s department so that the public can apply and get an investigation outside of the establishment. And a department to investigate the inspector-general..

    • itdoesntaddup

      They’re scared of Sharon Shoesmith payouts.

      • telemachus

        Your point about the BBC is very real
        But then it is run by a Tory Chairman

  • Adrian Drummond

    “But how does the Conservative party try to appeal to those voters fed up with the Establishment of which it is so clearly a part?”

    How about promoting those established Conservative values that the country wants rather than those contrived values of the Establishment.

    • andagain

      Conservative values that the country wants

      The country has not voted for a Conservative majority in Parliament for more than twenty years.

      • Adrian Drummond

        Exactly. You illustrate my point.

        • andagain

          I’m not sure I understand your point. How do three Labour majorities and no Conservative ones demonstrate that the country is crying out for Conservative values? It looks to me more like the country cries out for Tony Blairs values.

          • Colonel Mustard

            Might have something to do with the fact that for 2.8% more share of the vote than the Tories Labour got 157 more seats (2005) while for 7% more share of the vote than Labour the Tories got only 48 more seats (2010).

            It’s not about values but about a gerrymandered constituency system that gives Labour an unfair advantage (even before they imported 3 million extra voters and nobbled the BBC).

            • andagain

              You don’t think it has anything to do with the fact that Labour polled more votes than the Tories in three of the last four elections?

              And the combined Labour/LibDem vote has been far larger than the Conservative vote at every single election in which there was a Liberal Democrat Party.

              How does this demonstrate that the country is crying out for Conservative values?

              • Colonel Mustard

                But they didn’t poll more votes in the last election. And the last time I looked the government was not predicated on best of four, or even best of three. I do wish socialists would stop re-constructing to create a false narrative based on nothing more than anti-Tory hatred, that somehow because there is a coalition government Labour really won the last election, or that Lab-Lib votes are somehow as one, or that because Labour won three of the last four elections they somehow reflect the values of a majority of people. If you people really believe a Lab-Lib vote represents consensus then you should re-combine the two socialist parties into one.

                All you people represent is a very vociferous, very assured, very determined minority, with a disproportionate amount of clout in civil power, better propaganda and the national broadcaster in your pocket. As if that were not enough you also have an advantage in the electoral system as demonstrated above.

                And what it also shows, as we all know, reinforced by your ridiculous comment, is that you people have an assured belief in your right to rule and that any other outcome must be contested, hindered and undermined until you get what you want. That sinister Blairism that Labour represents the “political wing of nothing less than the British people as a whole” now being re-gurgitated in Miliband’s resurrected national socialist zombie as “one nation”. You don’t even know what conservative values are, for if you did you would not demonise and characterise them in the trite manner of telemachus. You people really are an appalling affront to democracy and fairness, to honesty and plurality in politics and to diversity of thought.

  • anyfool

    Well lets think about this,.in 2008 a report underlining the things that were going wrong in the NHS relating to outcomes like N/Staffs with thousands dying around the country.
    The then Labour government shelved it or pushed it out of sight, nothing was done and thousands died, these people died because of the actions of the Labour government, the health secretary at the time should be on manslaughter charges along with his civil servants and advisers.
    Cameron was opposition leader at the time, he must have known about the report, why if he did, not have something to say.
    This is the biggest disgrace in recent British history and nothing is being done, you have that other useless public sector organisation the police arresting people for calling a horse gay and they have not got the nous to batter a few doors down in a case of mass manslaughter.
    That type of thing is not something the likes of Cameron or Miliband have the strength of character to do, he had his chance to do something really needed but declined in case it was seen as scapegoating, pathetic.

    • Tom Tom

      Did you note where Cameron’s father was treated prior to being sent to an NHS hospital to die ?

      • alabenn

        That will explain why one saturday night police sitting in a van opposite the bus station watched three youths give another a good kicking, not only did they not assist, the lazy/cowardly tossers walk over and ask what the trouble was as though they had just arrived on the scene.

  • Swiss Bob

    “Ministers, including David Cameron himself, have repeatedly said they don’t want to seek scapegoats in this scandal.”

    Any other business Nicholson and the management of Mid Staffs would be up on manslaughter charges, and so they should be.

    a harried nurse caught up in the system who dropped his standards of care because everyone else seemed to be doing it.

    Isn’t this the Nuremberg defence?

    My Father has had excellent treatment for a couple of cancers but the care has been atrocious, beds covered in faeces (probably why he acquired C-Diff and nearly died), dirty, poorly maintained hospitals and lazy nursing staff that do not give a damn about the patients.

    • Tom Tom

      Don’t ask for Hospital Notes or you will be stunned by inaccurate recording of dates and events and omissions

    • telemachus

      I decry your lambasting of harried nurses not given the resources to cope
      Cameron promised to protect the NHS from cuts and instead wasted billions on another doctrinaire top down reorganisation
      Now Head Prefect Hunt fails to get a grip
      Oh sorry, he asked for the police to be called in

      • Colonel Mustard

        This happened under Labour, you dissembling little creep. I decry your constant lying here.

  • Hexhamgeezer

    Making the public sector accountable is a huge task.

    PR dillettantes like cameron are not up to it.

    • telemachus

      But Ed Balls at the Treasury is committed to ensure this accountability
      Problem at present is that ministers by and large and particularly the Treasury pair are not up to controlling the civil service

      • HJ777

        If people were held responsible in the public sector, Balls would never be heard of again after the criminal mess of our economy and finances he helped to create.

  • Hang the Bastards

    Brilliant idea; people are sick of the establishment so exercise leadership by… putting the blame on the executive. Sheer genius.

    • andagain

      If the management at Mid-Staffs was not to blame, who was?

      • Hang the Bastards

        Who was responsible for the whole cost cutting, targets and processes context?

        • andagain

          Are you trying to suggest that the management at mid-Staffs were not responsible for their actions becuase they were only following management incentives?

          If not, why were they not responsible?

          • Hang the Bastards

            They were following a management regime set by Government. Government has a share of the responsibility. But in any case you are missing the point; which is that our leaders should act like leaders rather than score points by shifting the blame.

            • andagain

              So the Mid-Staffs management of the day should get blamed after all. As well as the Labour Government that was in power at the time and covered the whole thing up?

              • Colonel Mustard

                It might be a start.

                • andagain

                  You insist that I am a Labour Party member, as you keep saying everytime I say something you dislike. Why are you agreeing with me?

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