In the past 150 years, all sorts of human misery has been caused in the name of “efficiency”, and a lot more is coming as the ConDem’s attempt to hack our welfare state back to the bone; jobs and services are going to be cut, wages and benefits reduced, railway stations, hospital wards and schools closed.
All this has been and is going to be done as if it were self-evident what in any given situation it means to be “efficient”. But the concept of efficiency itself is entirely contingent; one man’s efficiency is another man’s shoddy workmanship and to use efficiency to justify an action is to tell us nothing of the real nature or motivations of the decisions being made.The Oxford Dictionary definition of “efficient” is, “achieving maximum productivity with minimum wasted effort or expense.”
But this in and of itself tells us very little because in any given situation we have to define what is productive and what types of effort or expense would be wasted. And despite what the technocrats and managerialists will try to tell you, these are not technical decisions based on objective calculations of “profit or loss” or “inputs versus outputs”, they are in fact value judgments – judgments about what methods and outcomes we value in any given situation.
Do we for example value increasing our profit margin more than we value a well-motivated workforce that feel they are being compensated fairly for a fair days work?
Do we value reducing costs more than we value a high quality university education in which students get the teaching hours and level of direct tutor contact time that fully develops their potential and represents real value for the fees they have to pay?
Do we value £150 in our pocket more than a television service that contributes to the quality and diversity of our national culture?
Do we value stable government more than a lively and open political discourse in which the views and opinions of ordinary citizens are heeded more than professional the views of politicians and so-called “experts”?
Do we value reduced taxes more than caring for those in our society who are unable to care for themselves?
Do we value obedience to the forces of law and order more than we value justice?
Do we value obedience to the dictates of management over an autonomous free-thinking workforce who can bring the benefit of their knowledge and experience to the organisation?
Politicians, business leaders and managers often try to disguise the true nature of these questions and defend their actions by an appeal to the concept of efficiency, and they are often very successful because it is very difficult to argue that we should deliberately choose to be inefficient. But often those who oppose so-called “efficiency savings” are not opposing efficiency per se, they are opposing the specific conception of efficiency being proposed.
The problem is, that by their nature, discussions of efficiency tend to concentrate on facile and easily measurable aspects of resource consumption and benefit accrual; most obviously the cash costs versus the cash income. While it is of course perfectly legitimate to take these issues into account, indeed absolutely crucial to any decision making process, these are not the only issues that need to be taken into account – especially when undertaking activities that are not business activities – and perhaps the pernicious intrusion of business values into all aspects of human endeavour is perhaps at the heart of the controversies that surround “efficiency savings”.
In a business whose sole legal function is to create profit for it’s owners, the emphasis on the most basic measures of efficiency may be desirable, even a legal obligation on the management, but in non-profit making organisations to concentrate on reducing costs and resource consumption ahead of all other values may be counter-productive. Often non-profit making organisations have been deliberately set up outside the business sector for this very reason. The NHS was just such an organisation, established so that all citizens, rich or poor, would have access to the highest quality health care – regardless of their ability to pay. We only have to look at the USA to see what a business based health service looks like, a country in which 40 million people are essentially excluded from access to any health care. The values and aims of the NHS, the public education system, the highways agency, welfare system etc, have nothing to do with a business conception of efficiency. This is not to suggest that such organisations should be allowed to “waste” tax payers money but it does mean that the criteria about what counts as wasteful are different from those that a business would adopt. For example everyone involved with the system of General Practice knows that patient satisfaction with the service and actual health outcomes are improved with longer GP/patient consultations. Indeed, some believe that any percieved benefits of complimentary medicine are simply down to the length of the consultations and the fact that alternative therapists have time to listen to patients. However, the New Labour managerialist approach to GP efficiency identified lengthy GP consultations as an inefficient use of GP time and targets were set to reduce GP consultations to less than 10 minutes. The effects of this move led to decreasing patient satisfaction and stressed and rushed GP’s and by Dec 2009 even the cautious and establishment BMA was calling for average consultations of 15 or even 20 minutes to be allowed/encouraged.
The aim of GP consultations is not to get as many people through the doors as quickly as possible, the aim is to help people stay healthy and to get well if they get sick. If to achieve this end we need more doctors because we need longer consultations then this is surely a decision we should be willing to make however inefficient a NHS manager or Department of Health Junior Minister thinks it is.
I Am Not A Number
Political and Philosophical Dispatches From An Individual Living In A Society