Health Policy InsightEditorial Thursday 20 June 2013: Humpty Dumpty, J M Barrie and the art and the dirty little secret of the political cover-up
Humpty Dumpty sat on the wall,
Humpty Dumpty had a great fall.
All the King's horses and all the King's men
Couldn't put Humpty together again.
The CQC Morecambe Bay cover-up rumbles on, with Information Commissioner Chris Graham telling BBC Breakfast "so far as the Data Protection Act is concerned, we all have a right to the protection of our personal privacy - but if you are a senior official then there are issues about the point at which your privacy is set aside because of over-riding public interest. That's really the issue at stake here".
So the CQC's legal advice appears to be wrong, according to the Information Commissioner.
Well, that's the 'lawyers fairy' put onto the pile.
It's always interesting writing about the NHS and politics (the two being indivisible), and one of the things I discover as self-appointed NHS Chief Anthropologist (also self-appointed Chief Inspector Of Chief Inspectors) is the fascinating range of beliefs prevalent across the NHS cultures.
There are adherents of the aforementioned 'lawyers fairy', who believe that lawyers can resolve almost all problems, and the more expensive the lawyer, the better they are.
There are also devotees of the 'markets fairy', who believe all that is required in the NHS is one more push over the top towards full market mechanisms. Their opposing tribe worship the 'statist fairy', are dedicated worshippers of the one true state, 'uni et indivisible', as Papa Doc Duvalier said.
Another particular tribe worth studying is the believers in the 'cover-up fairy'.
This tribe is notable for its control-freakery. They appease The Gods Of Richmond House with burnt offerings of whistleblowers' careers, and silent rituals of compliance. They are believed to be descendants of the State Planning Committee teams in the USSR, who designed and implemented the wildly effective Five Year Plans.
The 'cover-up fairy' faithful imagine themselves to be skilful communicators and to proclaim often and in public that they "really know how the media works". (This is usually wildly wrong. I know some of the best communicators in the NHS, none of whom would make that claim. The first rule of good communication is not to tell people how good a communicator you are.)
The ancien regime mindset
It's not exactly a secret that the senior management cadre of the NHS in the post-Langlands era has been composed of the 'cover-up fairy' tribe. Bless, them, it was probably a product of their upbringings.
Comrade Sir David Nicholson And The Trent Mafia (doesn't it sound like the worst support band ever?) had particularly funny ways over this.
The mantra of the 'cover-up fairy' faithful is 'control and grip'. (I understand Charles Saatchi may do some PR for them once they shuffle off into their non-executive directorships.)
There is one small problem with control and grip: it is the shortest-term way of doing anything.
Yes, it seems to work - temporarily. It also over-centralises, suppresses creative and mobile talent - and it always, always blows up, because its architects are ultimately stupid and fail to design pressure valves into their systems.
So the system seems to work quietly (because noise embarrasses the minister tribe, who believe in 'the silence fairy'), so more pressure is loaded in.
This takes more control and grip (and probable illegality) to keep the system working silently, and the pressure builds up and up and up and up.
People in the system do protest, if they're very brave. Their careers become burnt offerings to The Gods Of Richmond House as mentioned, but if some are really courageous, they can win. It takes a long time and costs them a lot emotionally and financially - you could ask Kay Sheldon, Kim Holt, Stephen Bolsin, Gary Walker or various other people about that.
UPDATE: Sometimes, we miss their protests: Twitter furnished this link to a staggering 2010 letter to the Commons health select committee from P Twyman, a former under-secretary in various departments, warning about the CQC in very clear terms.
Mr Twyman's letter says "the CQC has adopted a pretty mindless, mechanistic approach to assessment. 'Mechanistic' is a polite word for 'box-ticking'.
"One has learned to read their reports with an extremely sceptical eye. All too often one can see that there are problems touched upon but discreetly pushed to one side, when any reasonable, competent inspector would have highlighted them as issues to be addressed.
"Worse still, if one talks to inspectors when their guard has been let down they reveal that they are unhappy with the methodology and - even worse still - the pressures they can be put under to moderate their criticisms. This is a problem which goes back to the time when inspections were carried out by County Councils themselves so that they ended up inspecting themselves: sadly the attitude still persists.
"Leaving aside inspection reports, dealing with the CQC - for example on Freedom of Information cases - is a classic case of marching through treacle with a costive, unhelpful bunch of bureaucrats, poorly supervised and badly managed.
"Whatever her strengths, Dame Jo Williams has presided over this organisation"
Nailed. In 2010. And we missed it.
Silly us.
The building pressure also affects a little-known tribe called patients and the public, when care deteriorates to a standard that would lead the RSPCA to prosecute if it were happening to a dog.
Patients and the public are like Victorian children to the control, grip and cover-up faithful: to be seen and not heard.
Sometimes, after years and years of unrewarded effort, patients and the public get their voices across. The cost to themselves and their relatives and loved ones is very hard to calculate - you could ask Julie Bailey, or James Titcombe, or many, many others about that.
And the pressure builds up and up and up and up.
And the control, and cover-ups, and grip build up and up and up and up, too.
And then somewhere, the system blows.
Somewhere like Mid-Staffs. Or Morecambe Bay. Or quite a few others.
And ministers get embarrassed.
The dirty little secret about cover-ups
Here is the dirty little secret of the 'cover-up fairy' faithful. They don't want you to know this, but we're all friends here.
Their dirty little secret is that cover-ups don't work, in the long run. Someone, somewhere always has an urge to talk. This might be because they are ashamed, or drunk, or get screwed over by a later control-and-grip exercise. It's human nature.
Cover-ups also only work if the hierarchy is the only conceivable way things can be. None of the clever, thoughtful people in the NHS - and there are very many - believe in the hierarchical approach.
Without exception, the people who are going to be part of the solution have realised that the network is going to beat the hierarchy every single time. They also tend to be naturals on social media, because they understand it's a network and not a hierarchy.
These people are remaking their organisations in that image, and building their networks. It's hard to do, and will take years to finish, but it's the only way to avoid the awful behaviours, centralisation and faith in wholly-discredited ideas like 'the cover-up fairy'.
Humpty Dumpty RIP. Died of exposure, 2013.
Sorry to any 'Peter Pan' fans out there (Kim Holt may smile wryly at the J M Barrie allusion), but don't believe in fairies.