Resisting a NCS power grab

In last week’s MJ, principal consultant Aidan Rave proposed a new approach to the long-mooted plans for a National Care Service

We are what we repeatedly do, an observation made over two millennia ago by the Greek philosopher Aristotle, is one of the most succinct and accurate descriptions in the notoriously ambiguous study of organisational culture.

Culture matters, especially in relation to the long-mooted plans for the introduction of a National Care Service. After all, the working relationship between central and local government has been so often defined not by the poetic rhetoric of incoming administrations, but by the harsh prose of governing reality. To draw on another well-used maxim by the management guru Peter Drucker “culture eats strategy for breakfast” and when it comes to the culture underpinning the distribution of power between local and central government in the UK, it leads to many deep seated and well-founded suspicions.

As we have seen recently in Scotland, the creation of a National Care Service is far from a straightforward proposition and despite the emollient tone of the Labour Party in opposition over the last decade and a half, it has not featured prominently in their early priorities for government. Perhaps one of the reasons for this is that the enthusiasm for localism and devolution, evidenced by early and high-profile courting of the regional mayors and of local leaders, is incongruous with a move which could be seen to degrade local influence over care services. After all, in the minds of many local leaders, the difference between what central government ‘says’ and what it ‘does’ are poles apart and despite much reassurance, it’s difficult not to conclude that this will be seen as yet another power grab.

The problem is that when it comes to the culture between central and local government what we repeatedly do and have done for much of the 20^th century does not give us a great platform to build from. Nonetheless, the case for a National Care Services is not without merit and given that the current status quo is already of variable quality, financially unsustainable and far from future-proof, it demands consideration.

However, to avoid simply falling into the same old routine of civil servants drafting a bill for ministers who then consult with local government – amongst others – on its content before finally arriving at a messy compromise that ends up pleasing no one, perhaps a more radical approach is needed?

Instead of the civil service drafting the bill, why not have ministers commission the development of either legislative proposals or a white paper from a consortium of local government, third sector, private sector and civil service representatives – each with equal say and representation. Such an approach, though not without risk, would have three immediate advantages.

1. It would go some way to redressing the perceived cultural balance of power between central government, local government and other partners, signalling trust and confidence in the capacity of local leadership and avoiding the paternalistic tendencies that tend to characterise traditional approaches to law-making.
2. It would promote the incorporation of practical insight at the design stage from those who are living with the challenges of the existing care system. This should drive innovation and enable new ideas to shape progress.
3. It would gently but purposefully force all parties to assume greater ownership of both the design process and any final recommendations that are made. It would reduce opportunities for obfuscation or game playing and encourage the development of mature and sustainable relationships.

Once the final proposals are agreed, these could then be drafted into suitable legislative prose and placed for the consideration of lawmakers.

Maybe that approach is too radical, but there has to be some challenge to the notion that all policy must be first invented in Whitehall if we are ever to address the supplicant and donor mentality that has come to characterise the relationship between the centre and local leaders.

Either way, it is hard to see how a nationally designed solution can be successfully implemented at local level if local leaders feel no ownership of the proposed solution and this is too important an issue affecting too many people for it to be perennially delayed by what we repeatedly do.