Doctor and activist

The Decline in Trust. 11/10/17


It is getting harder to trust people.  Once we trusted our teachers, our doctors, our bank managers and our politicians to lead us.  And people trusted that people could do their jobs.

But we became obsessed with competition instead of cooperation.  Everything had to make money. Everything was a commodity.  It was not enough to do something, it had to be done more cheaply. So it could not be done by the public sector. The private sector could lower wages ad do it cheaper.  Or they could casualise the workforce, so instead of paying someone for 35 hours when they only had 30 hours work, and chipping in the difference, they only paid them when they were there.

A disconnect arose between managers and employees. Managers had to supervise with Key Performance Indicators, which supposedly improved outcomes.   What got measured improved, but the right things were not always measured, and the job security and living wage of the employees was collateral damage.  And trust, as everyone was looking after themselves and cooperation was lessened.

There is an excellent book on the British National Health Service called, ‘The Political Economy of Health’ by Julian Tudor-Hart.  He describes the enthusiasm of staff when the NHS was started up.  There were no managers, as everyone cooperated in the great new enterprise of delivering universal services to the people who needed it.  When politicians and a new managerial class wanted to know what the cost of an individual procedure was, no one could tell them.  Figures were not kept. It would cost resources to collect them, and everyone knew that costs were kept as low as possible.  If a cost centre had a problem, it would ask for help in the self-managed system.  When the new managers wanted to compare what something should cost they asked the private sector, BUPA, who were happy to help and gave them a full schedule of their costs.  But where did BUPA’s cost schedule come from?  BUPA was a bit nonplussed by the question and traced it within their organisation.  The answer was that they had got charges from the US, which were far more than they could possibly have charged in the UK, so they divided them by four and found that they could charge that and survive quite nicely.  Eventually the NHS collected the figures and put in managers to check on these things.  But each change that put in more managers increased their overheads. From 2% when it was self managed it rose inexorably with every management change.

Managers are now a huge overhead, another unwanted side-effect of the loss of trust.

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