Five years ago a fresh-faced leader of the opposition stood on the stage at a TED conference in London speaking to a gathering of technologists and entrepreneurs. His promise was to deliver the next age of government. David Cameron’s talk did not feature the words “austerity”, “immigration”, or “long-term economic plan”, but instead an optimistic vision of family, community, and smarter digital governance built on a technological revolution. Three months later Cameron was prime minister.
The speech was a key part of the Conservative party’s 2010 pre-election strategy to define a new form of politics for a post-bureaucratic age. This was a fashionable management concept in US business schools in the 1990s during an aggressive period of merger and acquisition activity and a de-layering of private sector middle management. But the two decades of academic research which followed gave underwhelming conclusions that bureaucracy and direct managerial supervision had not, in fact, disappeared in firms or public sector agencies beyond anything other than bureaucracy-lite.
Since at least the 1960s, bureaucracy has been an infamous idea in business and politics. In the political narrative, it has become an economic disease. The pathogen is the faceless “bureaucrat”; the pen pusher, jobsworth and pedant. A bean counter either drafting petty rules and regulations in a desperate attempt to hold power, or idling in committee meetings eating biscuits and drinking tea.
But in a service economy, where few people work in agriculture or heavy industry, discerning the difference between diseased-ridden bureaucracy and healthy bureaucracy is a significant challenge. The vast majority of the British public work within bureaucratic organisations.
Cameron’s TED talk from 2010.
In his 2010 TED talk, Cameron suggested we were now able to live in that post-bureaucratic age thanks to an information revolution which had wrestled power away from central government and placed it in the hands of local people. But as soon as he became prime minister his message hardened into something more aggressive. In the 2011 Conservative spring forum, the first post-election opportunity to set out a concrete political philosophy, Cameron announced:
We are going to be taking on the enemies of enterprise, the bureaucrats in government departments who concoct those ridiculous rules and regulations that make life impossible.
The “enemies of enterprise” speech, which some described as an evidence-averse Thatcherite ideological crusade, has been the consistent message. The optimistic idea of the post-bureaucratic age has disappeared completely and the ambiguous bureaucratic enemy has resurfaced. In the recent leader debates on April 2, Cameron gave a vigorous response to probing about a wasteful top-down reorganisation of the NHS:
Let me tell Ed Miliband what we did. We took 20,000 bureaucrats out of the NHS and put 9,000 doctors and 7,000 nurses in. Now he opposes those reforms, presumably he would like to rehire the bureaucrats, I want doctors with stethoscopes not bureaucrats with clipboards.
NHS tackled during the April 2 Leaders Debate.
Recent NHS Workforce statistics do suggest that the abolishing of primary care trusts and related restructuring after 2010 led to a reduction of staff classified as “managers” or “senior managers” by around 20,000 across NHS England by 2014. However, this amounted to less than 2% of the NHS workforce.
The NHS is an extremely complex professional bureaucracy attempting to deliver some of the most challenging services in society. By some estimates the NHS is the seventh largest employer in the world, with a workforce of 1.3m structured around a division of labour of 350 different occupational roles. Less than 3% of the workforce is classified as managers.
Little fat to trim
Attempts to remove non-professional (non-clinical) employees, including managers, administrators and support staff, is not very easy, or necessarily desirable in professional bureaucracies like the NHS. More careful examination of recent NHS workforce data suggests that the Conservative reforms attempted to remove non-clinical “bureaucrats” from other areas, such as clerical and administrators work, but after cuts were made in 2010 these had already sprung back by 2014. The pattern is very similar for other management roles, such as nurse managers. Research suggests that an increasing level of administration is being pushed on practitioner-managers, largely nurses and doctors, who have strain from higher roles and less time for clinical care.
Moreover, the number of non-clinical managers is also creeping back up, with a full-time equivalent measure of management and senior management growing at a faster rate between 2013-14 than either doctors or nurses. As I write, there are more “manager” jobs available on the NHS Jobs website (based on a simple keyword search) than “doctor” clinical roles, suggesting that management bureaucrats will continue to rise.
Wrestling with the NHS
With the NHS being considered by the public to be the most important issue facing Britain going into the 2015 election campaign it is important that voters question the rhetoric about the management of public services. Both Labour and Conservative governments have attempted to reorganise vital public services, through mechanisms such as restructuring pay scales or experimenting with privately-run units. The only proven remedy for meeting growing service pressures, as pointed out by Liberal Democrat leader Nick Clegg at the recent leader debate, is “hard cash”. Recently, the Conservatives have finally stopped talking about attacking the bureaucrats and have promised an extra £8 billion for the NHS by 2020. But in order to do this, and carry out their long-term economic plan of austerity, the attack on bureaucrats will need to move to other parts of the public sector.
There is little convincing evidence that we are moving to a post-bureaucratic age. The knowledge, rules, processes and relationships embedded within bureaucracies enable firms and public agencies to deliver reliable and consistent services; and this often leads to unavoidable inertia in organisational structures. Still, most people would prefer a health service that privileges safety and reliability over enterprise and profit. The memory of G4S' attempts to manage security during the London Olympics will be fresh in people’s minds. And when Ian Duncan Smith announced the plan for “pension freedom day” recently he was quick to reassure the public that a substantial bureaucracy of pension advisers would be there to offer support to the public.
Cameron’s attack on the bureaucratic disease has a strange irony during an election campaign which is centred more on the “visible hand” of cautious economic management than an “invisible hand” of exuberant market forces. The political ideology of the right might not like the idea of faceless bureaucrats, but like them or not, the bureaucrats are here to stay.
Mark Gatenby in the past has received funding from National Institute for Health Research SDO programme.
Authors: The Conversation