A symptom of decreasing community participation in public service planning and management is the increasing size of public service organisations. It has now reached a stage where there is no effective public participation, just consultation and not much of that.
This is not a new phenomenon; it has been going on in UK local government for over 40 years. In 1974, the small rural and urban district councils and the city councils were taken over by larger district councils and county councils, and the city councils such as Southampton became district councils. Further reorganisations in 1986, 1992 and 2000 followed the same path, albeit with a few contrary politically inspired hiccups.
Unitary authorities now rule the roost, with some odd results such as Hereford City Council retaining its name and becoming a parish council.
The current situation is of all-powerful local authorities, whose bureaucratic culture and management is beyond the ken of their service users, and barely understood by the local politicians confronted with endless bureaucratic tomes.
In the NHS it is going on, with NHS trusts joining up with like-minded trusts and with local authority social services departments. Again there is little awareness or understanding amongst those being served. This time, the process of increasing bigness seems to be faster than in the past and from below more difficult to understand, even if you are aware it is happening.
Don’t try and understand the following example of what is happening around here, because hardly any of us can and most are unaware of what seems like endless muddling.
In 2011, the Wye Valley NHS Trust was established by merging Hereford Hospitals NHS Trust with Herefordshire Primary Care Community Trust and Herefordshire Council’s Adult Social Care Services. In November 2016, it was announced that the Wye Valley NHS Trust was to set up an “alliance” with South Warwickshire NHS Foundation Trust. Then in September 2017, it was announced that two NHS trusts which serve Gloucestershire and Herefordshire will merge, and the 2gether NHS Foundation Trust and Gloucestershire Care Services NHS Trust will join together.
These are all clips from the local newspaper. I’m not sure if I have got it right, but that is how things are when you don’t understand!
Why would NHS Trusts in Herefordshire and Warwickshire have an “alliance” when they don’t even adjoin each other? At least one of the trusts provides services funded by both the NHS and the local authority. Lots of liaison meetings there methinks.
As these organisations become bigger, they become increasingly remote from those they claim to serve. England is run by an all-powerful bureaucratic system. It is a system which is impossible to dismantle, because of the array of those with vested interests in keeping the current system. Vested interests not only within the public sector but also outside, as a result of outsourcing to private sector organisations, which are themselves getting bigger.
This is nothing to do with left, right or centre. It is how things become when political control is lost.
Can it ever end?
There is a tiny hint of things to come, maybe. Our red telephone box is now a library filled with books and run by local residents. Apparently there are more than 4,000 phone boxes across the UK which have been taken over by local people running all kinds of enterprises wanted locally. Local participation free of all consultation from above. Bravo!