Towards a people-centred language of demand management

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Gavin Jones

I’m regularly asked to make presentations to groups of people (the last one being to 22 Deputy Lord Lieutenants!) to set out the issues and opportunities facing local government in the light of increasingly painful budget cuts. Of the pictorial slides I use to tell the story, the one guaranteed to have the greatest impact and make people hold their heads in their hands and mutter depressing words of despair is my ‘motivational’ slide that alarmingly shows demand outstripping resources at a frightening pace – often known as the ‘’ or ‘Map of Misery’.

I’ve often thought that the word demand in this context seems very impersonal and almost dehumanising, whereas what lies behind much of this demand are real people, many of whom are vulnerable and in need of our help. When I am in need (and it is possible my time will come) will I simply be an input to someone’s demand curve? An unhelpful driver of financial pressure? Or instead could I be seen and valued as a human being with capabilities but also in need of some help and support? This, I believe, is the danger of expressing difficult financial circumstances in impersonal corporate speak. Too often the emotionless language of costs and reducing budgets facilitates a culture that ignores or forgets that at the heart of this technically phrased conundrum are human beings – increasing numbers of whom find themselves at the heart of diminishing resources.

This use of de-personalised language, with the current issues often only framed as a financial problem, creates enormous and unnecessary organisational conflict which puts the bureaucrats (tasked with the corporate objective of cutting spend) at odds with the service professionals. One sees it as a financial problem, the other a social one. A dangerous knock-on effect of this is the internal friction that is caused with the resentment of other Council departments that see themselves as financial victims of ‘uncontrolled’ spend by the demand-led services.

I’m not for a minute suggesting that bureaucrats (financial or otherwise) are any less caring or empathetic towards the plight of vulnerable people, but a more intelligent use of language and a considered framing for tackling the issue of rising demand and reducing resources, is more likely to build a sense of organisational collaboration to tackle real issues of how public services can continue to help people to cope with vulnerability with more dignity and independence.

Doesn’t it feel better to talk about the need for organisational change in terms of how a smaller state can be more creative in helping people to age well and to retain their dignity and capability, rather than with a negative rhetoric of cuts and declining spend? I think the former is so much more engaging and invites us to think creatively and positively as opposed to the more defeatist approach of reducing spend and squashing demand.

At the end of the day, using a more people-centred language and approach to ‘managing demand’ is far more likely to result in the design of collaborative sustainability solution to support an ageing population that ‘how do we get the money out and fast?’!

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Gavin joined Swindon Borough Council (SBC) in 2004, having previously worked in a variety of private sector organisations and market sectors and has been Chief Executive since 2006. Gavin was listed as one of the top 50 New Radicals in the Sunday Observer’s national campaign for Britain’s most innovative leaders and voted one of the most influential leaders in Local Government. Gavin is a Board Member of the national think tank the New Local Government Network, (NLGN), a Trustee of the Prospect Hospice, a Board Director of Forward Swindon Ltd and a Board Director of SOLACE Enterprises,.

Under what conditions are decisions best made? Football managers and the public sector

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Ian Briggs

I am not much of a football follower, but I am becoming increasingly bemused by the fascination for premiership clubs in becoming so closely associated with their managers. You can hardly fail to notice that the headlines stories on the back pages of newspapers concentrate a great deal on the relative merits of the approaches taken by the current crop of managers. Am I alone in thinking that they get more attention now than the players?

Their very personalities are so great that they now appear to be at least as important as the club itself. Success or failure on the pitch is often put down to the decisions of the manager and less on the relative performance of the players. Sir Alex Ferguson leaving Manchester United and Jose Mourinho becoming so much intertwined with Chelsea has got me thinking about our assumption that consensual decision-making is an absolute necessity within the public services – when compared to the unilateral decisions made by football club managers that are viewed as key factors in match results.

The committee system that we have lived within in local government for so many years, albeit often under a charismatic chairperson, is the very embodiment of consensual decision-making. A problem is placed within the political arena and through open discussion and challenge a decision is arrived at that is seen to be within some level of agreement and indeed consensus to be an appropriate means of doing business. For quite some time we have concentrated upon inter-agency partnership working where bringing together expertise from a range of organisations implies that the benefits of consensual decision-making are a necessity to cope with the complexity of delivering public services.

So, whilst on the one hand we have an acceptance of bringing together a group to concentrate on an issue of public interest either within management teams, committees or a partnership, on the other hand we are experimenting with non-consensual decision-making of certain prominent leaders in public life. Witness the debate over the relative merits of executive Mayors in local government (at best an unresolved argument) and the singular independent role of Police and Crime Commissioners as examples.

When things go wrong we may want to have a ‘head to roll’; if a football club is not winning then the supporters call for the sacking of the manager – even in some cases hiring aeroplanes to fly over the football ground with messages flapping from their tails to that effect. How different is this to occasional lurid tabloid newspaper headlines calling for the removal of a senior manager or politician if there is perceived poor performance in a public sector organisation. In some cases they could perhaps do the honourable thin and fall on their swords if the consequence of a bad decision (even if it is a decision they have merely endorsed rather than made themselves) has challenging or inappropriate and unintended consequences. All this leads to a gradual shift towards the public needing to have a strong, singular individual making decisions – eschewing consensus.

So under what conditions are decisions best made? In open, consensual arenas (even if committees often operate behind closed doors) or through a singular, individual focal point around a decision as in the case of football club managers?

Since Rittel and Webber formally described wicked problems in the early 1970s, we have debated what they mean for those who are in public management and leadership and are facing issues where there is little agreement over the exact nature of the problem. This has opened up much debate on the benefit of bringing together a wide range of stakeholders to focus their attention upon complex problems – and let’s face it, the list of these things seems to be growing! Is it because we see more and more ‘wicked’ issues and we have a relative lack of success in solving them that we are now becoming drawn towards a less consensual form of decision-making?

In his highly provocative book If Mayors Rules the World, Benjamin R. Barber offers the view that large nation-states with complex democratic consensual decision-making processes are poorly placed to deal with the complex and wicked issues faced today. If we were to place decision-making and leadership into the hands of one individual then the scope for clear direction setting and making brave and original decisions may increase and therefore be favourable to placing decisions in the hands of committees and stakeholder groups which often lead to stasis, mass avoidance and confusion. The subtext here is that we need to place a higher value on charismatic and visionary leadership; however, have not some of the most dangerous individuals in history conformed to this typology? As I am no student of football neither am I a student of history, but when Europe was a collection of small nation and city states this did seem to lead to war and violent competition!

To complicate matters a little further we might have degrees of consensuality in decision-making. Last week after the second reading of the hybrid bill for HS2, Parliament endorse the decision to press ahead with the project. Having all party agreement is important on a problem that has wicked characteristics such as this one. The next stage could be to ‘sell’ the decision to the public and the wider stakeholder community on the basis that it is a better decision because it has this degree of consensus. HS2 could be seen as valid in the public eye as it has this right level of political and stakeholder consensus, while it we had a football club style manager making the decision alone on HS2 there would be uproar.

So where does this leave us? Are we exploring the limits of consensual decision-making? The advent of new governance arrangements in health is perhaps a good current example of where through bringing together groups of stakeholders an assumption is made that the consensual approach to decision-making is most appropriate. However, the dynamics of bringing together multiple parties has disadvantages as well as assumed benefits. Successive studies suggest that when things get complicated (for this read ‘wicked’) and more and more perspectives and opinions are introduced into groups, then the more likely it is that an incidence of ‘multiple-uncertainty’ will occur. In short, there are too many holes in the process of deciding for any potential solution to fall into and be subsequently forgotten.

To avoid this inefficiency, decisions could be placed in the hands of one responsible and accountable person. The football team has not lost because the specialist coach who deals with the players in attacking roles has not done their job properly, nor is it because the players on the opposing side were better on the day. It is because the one individual at the top of the pecking order has failed to apply the correct strategy and not motivated the players well enough to win. In the post-match review, conducted usually in the full glare of the media spotlight, it is the manager who gets it in the neck because his (and remember it usually is a ‘his’) decisions were not deployed effectively during the game. On the specific issue of gender, it is worth noting that there are multiple studies which suggest that most women will be more effective than men in complex situation as they display a preference for consensual decision-making.

So, should we be concerned about whether decisions are best made in consensual or non-consensual arenas? Are we right to assume that the most effective way of leading through wicked decision is through strong individualised leadership that downplays where other stakeholders have differing ideas and preferences for solutions? In the end it may not matter and ultimately be down purely to contingency and circumstances – in some circumstances we must take others with us and in differing circumstances we need to have stand out leadership that prospers or fails on the basis that they deploy non-consensual decision-making and have the robustness and capacity to live with the public ridicule and criticism that this can bring. But we do seem to have conflicting approaches: local democracy was founded upon an add mixture of the checks and balances of consensual devision-making, yet we seem to be seeking new heroes and heroines. The committee was the place for shared and distributed responsibility, but remember that even a committee has a chairperson – their role might not be to just endorse the decision the majority comes to but also to create the conditions that are required to make a good decision.

I am a little shocked that as someone who has only a passing interest in football at best, I can now rattle off the names of managers and the clubs they lead. If top class football is a place where non-consensual decision-making is being played out with some success then we should step back and think about our approaches to open consensual decision-making in the world of public services. Would we be better served if we did have less of this and more of the singular, individualist decision-making here as well? My discomfort with this though of the potential benefits of the hero and heroine decision-makers who dismiss consensual mechanisms is equally by my bemusement at why I am interested in football after years of boredom with the game. But it seems that the football managers of today are at least asking questions of our understanding of the best approaches to decision-making in complex situation. Fancy a new job, Sir Alex?

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Ian Briggs is a Senior Fellow at INLOGOV, and sits on a rural Parish Council in Warwickshire. He has research interests in the development and assessment of leadership, performance coaching, organisational development and change, and the establishment of shared service provision.

Gerrymandering in Northern Ireland local government? Surely not.

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Chris Game

It seemed obvious from the outset that Gerry Adams’ arrest in connection with the 1972 murder of Jean McConville was a momentous event with potentially massive implications: long-term, short-term, north and south of the border. So I was slightly surprised the following morning to hear a Sinn Fein spokesperson, protesting about the timing of the arrest, highlight its impact specifically on the Northern Ireland local elections. Still, with the subject having been raised, I couldn’t help recalling the gerrymandering – or even Gerrymandering – controversies that were the chief reason why these elections on 22nd May for 11 new, larger and somewhat strengthened councils hadn’t taken place, as planned, in 2011.

The postponement was regrettable, given that the process of replacing the 1973 structure of 26 emasculated district councils had already been going on for years. The NI Executive had started a comprehensive review of NI public administration in 2002, shortly before its longest period of suspension. In 2005 Secretary of State Peter Hain announced a scheme for seven politically balanced ‘super-councils’ – three nationalist-controlled, three unionist, with Belfast and its politically mixed electorate swinging between the two – which did succeed in uniting most of the parties, except Sinn Fein, but unfortunately only in opposition to the whole idea.

In 2008 the restored Executive split the difference between Sinn Fein and the unionists’ generally preferred 15-council structure by opting for 11, with a significant transfer of powers from central to local government, and the additional virtue of recognizable, if convoluted, place names, instead of vapid compass points: Armagh, Banbridge & Craigavon rather than ‘South’, and so on. The first elections would take place in May 2011 – or should have done, had it not been for the arguments over boundaries.

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Traditional NI political wisdom has it that, if you want more than about, say, seven areas with roughly equal populations, no matter what number you choose, slightly more than half will have a unionist majority, and virtually all the remainder a nationalist majority. Changing demography is challenging this axiom, as may well be demonstrated in the compositions of the new councils. But, if the last elections to the old councils in 2011 had been contested on the new district boundaries, the best guesstimates are that the DUP would have been the largest party on six councils – those in the north and east, with the exceptions of Belfast and Newry, Mourne & Down – and Sinn Fein the largest party on the other five.

In one sense, these things have mattered less than might be supposed, partly because of councils’ limited powers, but also because a majority of them have long operated under similar responsibility- or power-sharing principles as the NI Assembly in, for example, their proportional allocation and rotation of committee places and chairmanships. No amount of responsibility-sharing, though, was able in 2012-13 to defuse the incendiary issue of flying the Union flag on town halls. Nor, as the details of the new districts emerged in 2008-09, did it prevent heated disputes about the proposed boundaries – particularly in, though certainly not confined to, Belfast, with its sheer size, centrality, and changing religious and political make-up.

Over the years the city’s electorate has shrunk and, like NI as a whole, has become steadily more nationalist. As a result, the once strongly Protestant council has become politically more balanced – the current make-up being 24 nationalists (Sinn Fein + SDLP), 21 unionists (Democratic, Ulster and Progressive), and 6 Alliance – although the unreformed ward structure means that it took roughly 1,700 votes to elect each nationalist member, against 1,500 for each unionist.

Almost any proposed configuration of larger reformed councils, therefore, would have been likely to produce a more nationalist Belfast.  Predictably enough, though, when it appeared actually to do, so too did the headline accusations of gerrymandering, particularly over the extension of the city’s southern boundaries.

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In fairness to the relevant sub-editors, at least they were using the provocative term in more or less its correct sense – manipulating electoral boundaries for partisan advantage – even though, as the map shows, no new improbably shaped districts, resembling salamanders or any other tetrapods, were involved. In fact, the map is possibly slightly misleading, for the main added areas – parts of Lisburn in the west and of Castlereagh in the east – are mostly quite densely populated and represent an increased population of over 50,000 or nearly one-fifth, bringing the city’s total to 334,000. There was undoubtedly an argument, on the basis of the existing built-up area, for pushing the boundaries significantly further in both directions and possibly also in the north – but not one with anything like enough political traction to gain it serious consideration.

With the religious affiliation of all the city’s wards and electoral areas being available down to decimal places – from 94%+ Protestant along the Shankhill and Crumlin Roads to 97%+ Catholic in the Upper and Lower Falls, perhaps the easiest way of describing the significance of the city’s actual expansion is in the same terms. The three wards that revert from Lisburn to Belfast – Poleglass, Twinbrook and Dunmurry – are between 80 and 95% Catholic and are also larger than the two transferred wards from Castlereagh – Gilnahirk and Tullycarnet – which are 81 to 86% Protestant. These two wards are situated due south of the Stormont Parliament (see the red star on the second map) and are part of the Belfast East Parliamentary constituency – as, a little further east along Upper Newtownards Road, are Dundonald and the Ballybeen housing estate. The 8,500 Ballybeen residents, however, who constitute three wards on their own, all overwhelmingly Protestant, are not being transferred.

The gerrymandering accusations, though, that contributed most to the three-year postponement of the introduction of the new councils were made across the other side of the city, in respect of the village of Dunmurry and the multi-hatted Edwin Poots: DUP Member of the NI Assembly, Minister (in 2009) for the Environment and responsible therefore for local government, and a longstanding member of Lisburn City Council.

In a nutshell, Councillor Poots claimed the administration of which Minister Poots was a member was ‘Gerrymandering’ to the advantage of Sinn Fein in Belfast. He proposed that said Minister Poots use his authority to make what Councillor Poots claimed would be a “modest adjustment” to the recommendations of the independent Local Government Boundary Commissioner and allow Dunmurry residents to remain within what would become a comfortably unionist Lisburn & Castlereagh – a proposal that, not surprisingly, some commentators also saw as gerrymandering.

Dunmurry was not the only boundary dispute, and boundaries were not the only matters of contention. But it was key sticking point. For, until Poots and his unionist colleagues eventually backed down, there could be no final settlement of district boundaries, and no progression to the determination of ward boundaries or, unique to NI because of the requirements of proportional representation, to the grouping of wards into District Electoral Areas. In the end it seemed to come as no great surprise when in June 2010 it was announced that the 2011 local elections would be to the existing authorities – which is perhaps itself unsurprising in a state whose very existence, many would say, is a product of gerrymandering.

Chris Game - pic

 

Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

 

Public data: saleable asset or national resource?

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Tom Barrance

Recent announcements by two government agencies, the HMRC and the Health and Social Care Information Centre (HSCIC), regarding the sale of information has thrown a spotlight upon government information and the attendant debates of privacy verses exploitation. What is the ownership of information collected by the state? Held in trust for the citizen, or seen as assets like 3/4G mobile phone licences to be sold by government to the highest bidder? Or should all government data be treated as open data that is made freely available to all?

Government information is gathered in a number of ways, by legal requirement and from its nodal position within networks. Data, then, may not be provided willingly. The willing provision of information is governed by the concepts of notice and consent. Consent is given by the citizen having the right to know why information is collected and for what purpose, and is supported by the right to withhold agreement.  Without this procedural fairness, the use, and sale, of data can fatally undermine trust in the data collector.

The sale of public data is not a new phenomenon brought about by the clamour for “Big Data” or the development of database services like Hadoop; indeed the trend for the sale of public data may be seen with the sale of the edited electoral register under the terms laid down by the Representation of the People Act 2000. The sale of personal address data, for those who have not opted out (and the sale of all data to Credit Reference Agencies), is now well established and has fuelled the direct marketing industry, allowing large numbers of companies to purchase and exploit information. Consent is assumed with a default opt-in, the citizen having to actively request that their information is not sold. The principle established then is that data accumulated by the state is an asset of the state, and may be disposed of as such.

Turning to the recent examples of the proposal to sell some HMRC tax data,  described by Conservative MP David Davies as “borderline insane” and the currently suspended care.data plan under which the HSCIC will make data available to a range of organisations, or customers in the language used by the HSCIC, meeting the wide ranging description of  “academics and universities, healthcare commissioners and providers, third sector organisations, information intermediaries and commercial organisations including life science companies”. These groups can purchase, and a detailed cost schedule is provided for, what is described as “De-identified data for limited disclosure or access – data that has been through a process of pseudonymisation, however there remains a risk of individuals being identified”.

The question turns to who owns personal data; that is the data likely to infringe privacy, and is this still considered to be a state asset? At first glance medical, social care and financial information would appear to be central to the definition of the private realm, especially when combined with name and address. However does this still hold when the information is pseudonymised? How secure is a pseudonym, could the data still make the individual identifiable; for example how many individuals with Crohn’s disease and one child live within a given postcode?  The exact nature of the information and the ability to cross-correlate data can lead to individual identification.

In all of these examples, it can be seen that government treats the information at its disposal as an asset which it owns outright and can sell within the bounds of data protection legislation, if it so chooses. In taking this step, the government assumes the best use of this data is to sell it to a small number of selected users, rather than releasing the information wholesale.

The voluntary sharing of what would otherwise be considered sensitive or personal data has been commonplace since the introduction of store “loyalty” cards. These cards act as a method of exchange for personal details, for example basic demographic information (including name and address) together with a detailed transaction history allowing the store to determine the spending habits of the individual and of a cohort of similar individuals; (Rust, et al., 2010).  People are happy to voluntarily part with some personal data as part of a transparent process, where there is an obvious reward and where they may consider themselves to be in control.

The Government approach is somewhat different; it appears to take the view that information its asset to be disposed of as it sees appropriate, in what is perceived as the national best interest. This is a case of acting without procedural fairness, which as can be seen from press coverage, results in a fatal loss of trust.

So, where does this leave the question of the sale of information? The issue that government must address is the conditions and terms for the release of data; and it must take the public with it on this journey. A keystone in this debate, government must determine whether it sees public information as a saleable asset or as a national resource. Transparency regarding the state’s attitude to information that it holds is crucial to popular support for either open data initiatives or the treatment of information as an asset. This transparency must include an understanding of the value of the information.

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Tom Barrance is a part time Doctoral Researcher looking at Gov 2.0 in UK Local Government, and a full time Business Analyst/Project Manager at the London Borough of Hackney. He has worked in the public sector for the past 13 years, at a number of different local councils in a range of roles in Economic Development, business change and delivering ICT solutions.

The 2014 local elections – a preview

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Chris Game

Two EU countries this May will hold local elections that coincide with their European parliamentary elections: Greece and ourselves. On Sunday 25 May Greeks vote in the second, ‘run-off’ round of elections to all their 13 regions and 325 municipalities. England, though nearly five times as populous as Greece, also has 325 lower-tier and unitary authorities. We, however, will elect mostly only fractions of fewer than half of our councils, yet still it takes seven lines of a table to summarise the 161 authorities whose voters on Thursday 22 May will probably have both a local and Euro vote. We bemoan our disappointing local turnouts, but we don’t make the system exactly voter-friendly.

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Inevitably, the Euro elections will dominate the campaign, and the all-out London borough elections will dominate the local results. In this preview too – though less so in the longer INLOGOV Briefing Paper – all-out elections are accorded priority.

May 2010, when most of this year’s retiring councillors were elected, was Labour’s second worst parliamentary election performance in 80 years. Given a different context, though, its local and particularly its London election performance would have been justifiably celebrated – three boroughs won directly from the Conservatives (Ealing, Enfield and Harrow), seven more from No Overall Control (NOC), and more London seats than the Tories for the first time since 1998.

There’s no mystery about the national-local discrepancy – just two big reasons: the four-year electoral cycle and the General Election-boosted turnout.  The seats up in 2010 were those contested in 2006, when Labour’s estimated 26% of the national vote barely topped the Lib Dems’ 25% and was way adrift of the Conservatives’ 39%. By 2010 that 13% national vote gap had halved, bringing big Labour gains in both votes and councils – thanks partly also to hugely increased turnouts of over 60%, benefiting the large parties, especially Labour, at the expense of minor ones.

Of nearly 1,600 minor party and independent candidates in London, just 23 were elected: 2 Greens, down from 12 in 2006 (Camden, Lewisham); 1 Respect, down from 15 (Tower Hamlets – now 2); no BNP, and no UKIP – though the party has since reached double figures, mainly through Tory defections. This year turnouts will be down again, and minor party representation – including, but not only, that of UKIP – equally certainly up.

London is not a UKIP priority, and its best prospects may be in those boroughs where it already has defectors – Hounslow, Merton and Havering (from the Conservatives), Barking & Dagenham (from Labour). But UKIP influence – countrywide but particularly in London, where electors have potentially three local votes – will also be more subtly felt through vote-splitting, helping Labour to gain control, or possibly the Lib Dems to retain it, where they might not otherwise have done so.

With its long-term opinion poll lead, though, it is again Labour that will be expecting to win councils as well as seats. Back in early January, Sadiq Khan, Shadow Minister for London, announced the party’s ‘suburban mindset’ strategy, and its five Outer London ‘battleground boroughs’ – Conservative-controlled Barnet and Croydon, and the currently hung Harrow, Merton and Redbridge.

The latter are the proverbial low-hanging fruit. In HARROW Labour actually won a majority in 2010, but then, as described in a blog at the time, lost it through splits and defections, handing control to the current Conservative minority administration.  In MERTON it took minority control, strengthened it through Conservative defections to UKIP, and achieved a good result in last summer’s Colliers Green by-election.  In REDBRIDGE the Conservatives and Lib Dems signed a partnership agreement just as their leaders were doing the same at Westminster. In all three boroughs Labour will be aiming for majority control, in Redbridge for the first time ever.

In CROYDON the Conservatives narrowly retained a 4-seat majority through an electoral system rewarding nearly 19% of Lib Dem voters with no councillors at all. Here too a modest swing would give Labour an equally workable majority, and more than justify the party’s decision to employ a full-time agent.

BARNET, though, seems an altogether tougher proposition. Numerous issues have incensed residents – from the ‘One Barnet’ mass privatisation of council services, through the closures of libraries and children’s centres and the scrapping of sheltered housing wardens, to the ever-contentious increased parking charges.  But Labour has never won more seats than the Tories, and to do so would require a nearly 10% swing plus the Lib Dems clinging on to their three very marginal Childs Hill seats.

Labour’s last listed London target is the TOWER HAMLETS mayoralty, held by the controversial Independent and Labour expellee, Luftur Rahman.  Opponents have accused him of everything, from dubiously selling off and granting planning permission for the hotel conversion of the listed Poplar Town Hall to trying to buy his own re-election, but little of the mud really seems to stick and it may, if anything, boost his support. Panorama recently had a go, following which Eric Pickles sent in his inspectors – though not to report back until well after the May elections.

The other four mayoral contests all involve incumbents who were elected in 2002 and are now seeking their fourth consecutive terms: Jules Pipe (Hackney), Steve Bullock (Lewisham) and Robin Wales (Newham), all Labour, plus the Lib Dem Dorothy Thornhill in WATFORD. All four have their policy initiatives and successes, but only Thornhill can claim in addition to have totally recast the politics of her town and council.  Watford in 2002 was an apparently permanently Labour-run town. Yet its voters chose as their mayor a Lib Dem councillor and assistant head teacher, whose party coattails have since transformed the council chamber to the extent that two-thirds of members today are Lib Dems.

Returning to London, with the Lib Dems’ local election performance having collapsed almost as grimly as its national poll ratings, the party’s two majority-controlled London boroughs are bound to be under scrutiny. SUTTON they’ve held since 1990 and, although they lost one councillor to Labour, arithmetically at least they look safe for another term. In KINGSTON UPON THAMES, though, with one councillor resigning to sit as an Independent, plus a lost by-election following their disgraced leader’s imprisonment, their 2010 six-seat majority now hangs on a single seat – and on the hope that UKIP may take votes from the Conservatives in the right places.

The other all-out elections are those caused by boundary reviews, two resulting in slightly enlarged unitary councils and two in smaller district councils. MILTON KEYNES has been run in the recent past by all three major parties, and since 2011 by a minority Conservative administration.  Labour will be aiming to become at least the largest party on the new, enlarged council.  SLOUGH, it is totally safe to say, will continue to be Labour. In THREE RIVERS the Lib Dems will seek to maintain the majority control they’ve held since 1999; and in HART Labour will be wistfully recalling when it last won even a ward – in 1976.

Of the 36 metropolitan boroughs, Labour already controls 29 and so has little need of a target list here. Of the two Conservative councils, TRAFFORD looked the more vulnerable even before the recent shock resignation of Matt Colledge as both council leader and councillor. Having reduced the Tories’ majority to 3 in a recent by-election, Labour will hope to win its own for the first time since 2003. The SOLIHULL Conservatives look securer, partly because their principal challengers, the Lib Dems (now 9), have been defecting to the Greens (now 7), who will be seeking to supplant them as the official opposition.

The West Yorkshire trio of Bradford, Calderdale and Kirklees have all been hung since at least 2000, but this could be about to change.  In BRADFORD Labour’s 2012 hopes of turning its minority control into a majority were thwarted by the coattails effect of George Galloway’s parliamentary by-election victory for Respect. The coattail councillors all resigned last October to become Independents, and Labour should make it this time.

KIRKLEES and CALDERDALE travel in parallel. Five years ago, both boroughs were run by Conservative minorities, which were replaced by Labour-Lib Dem coalitions, which were succeeded in turn by Labour minority administrations. In both boroughs all three main parties have groups numbering at least double figures – a measure of the difficulty any one party has in trying to win an overall majority. Arithmetically Kirklees looks the more attainable for Labour, but the party would probably have to take seats from the Conservatives, Lib Dems and Greens. In Calderdale, in the wards being defended that require swings of less than 10% to change hands, Labour is unlikely to be the chief beneficiary, having finished in second place in 2010 in just three to the Conservatives’ ten.

In STOCKPORT, the Lib Dems now have only minority control of their metropolitan flagship, and are defending 12 of their 29 seats. Labour is the leading opposition, but, having finished second in only two of them in 2010, its gains may be limited. Already the largest party in WALSALL, its chances should be better. If it won the same wards as in 2012, but without this time losing a couple of others to Independents, the party could gain majority control for the first time this century.

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Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

The Great NHS Robbery – and the great fraud headline con

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Chris Game

Some social phenomena are exceptionally tricky to measure: the black economy, white-collar crime, illegal immigration.  So when someone claims to have done so, no matter how flaky their findings, they attract huge, and largely uncritical, media attention. Like last week’s excitement about the scale of NHS fraud.

The catalyst was a Panorama programme – The Great NHS Robbery – that needed some pre-transmission headlines. The programme consisted mainly of specific cases of GPs, dentists, pharmacists, private contractors and suppliers who’d been found guilty of defrauding the NHS. It alleged that the Government’s official NHS fraud figure of £229 million p.a. is a huge under-count or under-estimate, and suggested that, having cut the staffing and budgets of NHS Protect and other fraud investigators, the Government was turning a proverbial blind eye to the scale of the problem, especially by comparison with the increased resources it allocated to the detection of the much smaller quantum of benefit fraud.

Old cases and political sniping, however, don’t make major headlines. What Panorama needed were some seriously big and scary figures, and fortunately there were some to hand – just down the M3 at the University of Portsmouth’s Centre for Counter Fraud Studies (CCFS). By happy coincidence, the CCFS was about to co-publish, on the very same day as the first showing of The Great NHS Robbery, a report analysing, as the programme put it, “the most rigorous data on health care fraud in the world”, and containing some “staggering” findings for the NHS.

The BBC had its headlines – “NHS fraud and error costing the UK £7 billion a year” – and Panorama had its audience. Other contemporaneous media headlines were all apparently taken either from the BBC’s plug story or the programme itself. Some were fractionally more cautious, like The Guardian’s “NHS fraud could be as high as £5 billion a year, says former health service official”; others less, like the Nursing Times’ “Fraud costs NHS £7 billion – enough to pay for 250,000 nurses”.

None of the authors, it seemed, went to the CCFS report to check how the loss figures were arrived at and what they represented – possibly imagining that a global report on such a complex and technical topic, representing the product of several years’ research, would be vast, probably undownloadable, and incomprehensible to the average reader.

Interestingly, though, it’s none of these things. The Financial Cost of Healthcare Fraud 2014: What data from around the world shows runs to just 16 pages, including the two covers. The rest comprises: Contents, Foreword, three prefaces, three pages about the authors and publishers, a full-page picture, a blank page … and a 4½-page ‘report’. There are no “data from around the world”, so, even with the glossy pictures, you could, if you wished, download it in about a second.

However, to save you having to plough through all 4½ pages yourselves, let me take you through the methodology step by step.

1.  Do a literature review of the 92 studies of healthcare fraud and error losses that you’re  able to find that have been undertaken since 1997 – not ‘globally’, but in languages you can understand: the UK, US, France, Belgium, the Netherlands and New Zealand;

2.  Don’t worry about the studies being in numerous completely different areas of health care, but average out the quoted financial loss figures in all 92 studies and cite that average with real authoritative precision – i.e. not 7%, but 6.99% – because, remember, these have to look like “the most rigorous data on health care fraud in the world”;

3.  Globalise your ‘research’ by finding a figure for global healthcare expenditure for some recent year (no, not ‘global’ as in your six countries, but really global) – say, $6.97 trillion for 2011 (or £4.48 trillion) – and again don’t worry about whether they’re US or International $$ or what the figure actually represents, for this is one of those footnote- and reference-free reports;

4.  Divide (3) by (2), and again state the sum with great precision: that this shows that £313 billion is being lost by the world’s healthcare services each year – or 25% more than when you last did the sum in 2008;

5.  Guess – because you’ve apparently no evidence one way or the other – that the financial integrity of the NHS is probably about average for the six countries you’ve studied, and assert that it is therefore losing 7% of expenditure each year – or £7 billion out of its roughly £100 billion total – in ‘fraud and error’, making sure, of course, that you emphasise the fraud bit.

6.  Add a little diagram, as shown below with the addition of my clarification of where the UK figure comes from.

game graph

I must confess at this point to having misled you a little. I mentioned that the report contains no “data from around the world”, and indeed there are no figures for the UK or any other individual country.  The £7 billion came in the Panorama programme, from one of the report’s two principal authors, Jim Gee. Gee is the former health service official referred to The Guardian’s headline: former CEO of the NHS Counter Fraud Service and now Director of Counter Fraud Services at BDO LLP – not, sadly, the British Darts Organisation, but Binder, Dijker, Otte and Co., an accountancy firm specialising in anti-fraud services – and Chair of the CCFS at the University of Portsmouth. Gee left it to the programme’s presenter to add that “he puts more than £5 billion of that £7 billion down to fraud, rather than financial error” – which explains the other part of The Guardian’s headline.

Though certainly not on the same scale as its undercover filming of LSE students in North Korea, Panorama’s decision to rest the central argument of this programme on such flaky statistics, produced at least in part to further the interests of a self-promoting business services company, seems to me another clear editorial misjudgement. Certainly it irritated me when I pieced together the above account and realised that in effect I’d been conned.

Much more importantly, though, it must in anything other than the short term undermine, rather than substantiate, the key points the programme was seeking to make: that the way the Department of Health currently measures and estimates NHS fraud is grossly inadequate and damagingly misleading; that governments, and this Government in particular, see it in their interests to under-record the scale of fraud (and financial error, for that matter); and that more, rather than less, funding should be being invested in fraud detection and inspection services.

The sad truth is that Panorama seized on CCFS/BDO’s £5 to £7 billion because there was nothing better or more accurate available. Jim Gee’s ‘methodology’ suggests to me that he’s probably underestimating global healthcare financial losses and overestimating those of the NHS, but neither I nor the Government have any way of officially demonstrating it. Nor is there any likelihood of the Government, since it is substantially in denial, embarking on a programme to reduce the losses by up to the 40% within 12 months that Gee, wearing his BDO hat, considers feasible. I doubt if many others agree, but, to adapt the proverb: in the land of the dataless, the one-figure man is king.

game

Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.