Polly Toynbee asked the question why so few people speak out in The Guardian, as the departing head of NHS England, Sir David Nicholson, says the emphasis on competition has bogged down the NHS in competition law that is making millions for lawyers, while preventing cooperation, creating bureaucracy and stifling initiatives.
‘The view at the time was “better to be at the table influencing decisions than outside shouting objections through the window”’
It was a similar situation a few years ago when the previous government split social services into adult and children services, which effectively put child protection under the direction of education. They didn’t want this poisoned chalice. And the directors of social services did not ask for their departments to be divided and their roles downgraded.
The Association of Directors of Social Service, up until this point considered a strong and effective voice for social work, was in public very quiet. Yet privately directors saw it as an attack on the profession and an attempt to weaken a critic of many government policies.
As predicted, it has not proved a success and many local authorities have gone back to a combined service under one director.
Why the silence?
When I asked the chair of the new Association of Directors of Adult Social Services why so few of his predecessors spoke out, he said the view at the time was “better to be at the table influencing decisions than outside shouting objections through the window”.
Not only did this turn out to be a tactical error but senior people in the NHS appear to be repeating it, as he admitted to me once at a table where he found himself surrounded by government advisors and representatives of the private and voluntary sector, who effectively drowned out his voice.
So what does this tell us about leadership in the public sector? Clearly, to influence a government you must have access as well as trust and credibility; but one thing above all else that sets leaders apart is the courage to stand up for what you believe in – even if it won’t make you popular, do your career any good or get you in the New Year Honours list.