The Anatomy of Policy Scandals

Trying to identify the injustices ITV will be making dramas about in 2030

Beneath the day-to-day noise of politics this year has been the slow thrum of two of Britain’s longest-running policy scandals winding their way to a gradual conclusion.

Next Monday the Infected Blood Inquiry will release its report on the failures that led to more than 30,000 people being infected with deadly viruses, between 1970 and 1991, due to contaminated blood products. Attention will focus on how much NHS leaders and government officials knew about the risks being taken, as well as attempts to prevent families raising awareness of the issue.

But we already know, from reporting by the BBC and others, that risks were highlighted to government officials. Despite this it took until 2017 for the Inquiry to be launched. The government has said it will compensate all victims (some interim compensation was granted in 2022). It is likely to cost in the region of £10 billion.

On Wednesday former post office CEO Paula Vennells will give evidence to the Post Office Horizon IT Inquiry. She will be pressed on how much she knew about the faulty computer systems that led to hundreds of subpostmasters being falsely convinced of theft between 1999 and 2015. It is undoubtedly one of the worst miscarriages of justice in British history, and took years of diligent work from a handful of journalists before adequate attention was paid.

One of the oddities of both cases is that despite everyone agreeing they are terrible they don’t really “fit” into any contemporary political narrative: the key failures happened a long time ago, and across governments of both colours. Rishi Sunak can be criticised for not moving quickly enough to provide redress but he can hardly be blamed for things that happened when he was a teenager.

A troubling feature of these scandals – to which we can add other examples such as Hillsborough and Grenfell – is that by the time the full truth finally comes to light those who were responsible can no longer be held properly to account. It’s never the current minister, or official, or CEO’s fault.

And yet there are plenty of possible candidates for the next scandal that are happening right now, that we already know about, but are not receiving anything like the same amount of coverage. The question I want to explore in the rest of this post is why, and how can we speed things up?

Let’s start by narrowing the scope of what we mean by “policy scandal” to those which create an injustice against a specific group that was not deliberately intended. This excludes something like the Rwanda deportations which many will consider scandalous but which Parliament has agreed to in full knowledge of the consequences. It also excludes policy failures, like the HS2 debacle or lengthy NHS waiting lists, which affect everyone; possible financial scandals, as per the allegations around covid PPE or Teesworks; and constitutional scandals like the selling of honours which seems to have become entirely normalised.

Even with this narrowed definition there are plenty of candidates. So I’m going to break them down by the reasons I think they haven’t, as yet, got much attention.

The full risk still hasn’t been realised

This category covers cases where the government has chosen not to do something that would mitigate a known risk.

School buildings are a good example. Since the summer of 2021 the DfE corporate risk register has identified that there is a “critical and very likely” risk that building collapse or failure could cause death or injury. The National Audit Office published a report last year stating that the “DfE currently lacks comprehensive information on the extent and severity of these safety issues, which would allow it to develop a longer-term plan to address them.” The authors noted that 38% of all school buildings were beyond their design life and that the government had chosen to underinvest, against their own estimate of need, by £2 billion a year.

The risk was almost realised last summer when three ceilings made with so-called “bubbly concrete” (officially known as RAAC) collapsed. Luckily no one was in the rooms at the time, so no one was hurt, but it still caused a week of bad headlines for the government. They have subsequently identified other schools at risk from RAAC collapses, and funded repairs, but there are a much wider array of structural problems with old buildings and no money to fix them. Now imagine what will happen if a roof falls on an assembly full of kids. There will be outrage. But it does not seem right that a tragedy has to happen before action is taken.

The NHS has the same problem. A few weeks ago ceilings collapsed in the radiology department and critical care unit at Stepping Hill hospital in Stockport. Large parts of the hospital have already been closed due to it literally falling down. No funding has been made available to rebuild it. This is not unusual. The ceiling collapsed in the intensive care unit of Princess Alexandra Hospital in Harlow recently too.

Sooner or later the lack of investment in crumbling infrastructure will cause a major disaster and the government of the day will have to set up an inquiry into how the situation was allowed to get so bad.

The risk hasn’t been quantified or fully understood

This category covers issues where experts have flagged a potential risk but the extent or nature of it is not clear. There are a couple of good examples from the NHS as, given the need to drive down costs, several innovations have been introduced or ramped up that are making a lot of professionals very nervous. But in neither case is the impact yet clear.

Example one is the big increase in the number of physician and anaesthesia associates being recruited to work in hospitals and GP surgeries. These roles are designed for people with non-medical degrees – though ideally ones in biosciences. They do a two year training programme and can then provide support, but not fulfil all the roles performed by fully qualified doctors.

This is a way to boost staffing at lower cost but has led to a semi-revolt by doctors. As of last year there were around 3000 associates working in the NHS, with plans to increase this to 12,000 by the middle of next decade.

In the last few months we’ve seen a concerted pushback from doctors worried about the consequences. The flashpoint has been government proposals to have the General Medical Council regulate associates, but the core concerns are that patients will not appreciate that they are not seeing a proper doctor and that there is a heightened risk of them getting the wrong treatment. A recent BMA survey (not a representative poll) found that “87% of doctors…said the way AAs and PAs currently work in the NHS was always or sometimes a risk to patient safety.”

There was also a major bust-up at the Royal College of Physicians where the leadership, cautiously supportive of the shift, got caught presenting their own survey results in a misleading way, leading to resignations.

Now, of course, some of this might be self-interest. Doctors have a clear incentive to protect their professional status. Nonetheless this level of pushback against a policy should be seen as a red flag. But, as far as I know, there has not been any proper analysis of the risks by government. There has been a well-publicised case of a young actress, Emily Chesterton, dying unnecessarily after two appointments with a physician associate she thought was a GP, but not a systematic review of the risk.

The other NHS example also relates to a policy being expanded to reduce costs. Many people think hospital waiting lists are so high because of growing demand but the number of new patients joining the list per month has actually fallen 1.2% since 2019. This is despite a 17.5% increase in the number of GP appointments. If referrals from GPs had continued at the same rate hospitals would have been completely overwhelmed.

There are a few reasons why referrals have dropped, some of which are undoubtedly bad, like more getting lost in the system, but a big reason is that GPs have been directed and incentivised to push more patients down an “advise and guidance” route, where help is sought from a hospital doctor by phone or email but there is no full referral.

It is possible this is all working fine and, indeed, a genuine productivity improvement, but, again, we don’t have any systematic analysis of outcomes. A survey of GPs last year found two thirds felt it was blocking patients who really need a referral. Will we find at some point in the future it has led to avoidable tragedies?

The risk is known but has not coalesced into a campaign

Then are scandals that are already known to anyone paying attention, and have got some media coverage, but haven’t broken through to the point where government has had to change policy or launch an Inquiry.

The Single Justice Procedure is a perfect case study. This was introduced in 2015 – as an efficiency measure to speed up magistrate hearings – it means around 40,000 cases a month for minor offences like non-payment of TV licenses and not having a valid train ticket are dealt with by a single magistrate, without the defendant being present, and on a tight time schedule. We know this is leading to injustices, not because the government have done any kind of proper review, but because the journalist Tristran Kirk tweets out examples on an almost daily basis.

In the last few weeks alone he’s highlighted the case of a London pensioner, who owed £8.50 unpaid car tax, being given a criminal conviction despite being in hospital for mental health treatment at the time; a mother convicted for the same offence, after failing to pay in the few weeks after her 3 month old daughter had died; and a 17 year old convicted of driving without insurance when the procedure isn’t allowed to be used for people under 18. The sheer volume of cases being assessed - up to 150 a day per magistrate - inevitably means mistakes will be made and genuine mitigations missed. (Another 83 year old pensioner with dementia had his conviction overturned after Kirk highlighted it).  

A few months ago the Magistrates’ Association called for an overhaul, highlighting that significant numbers of their members feel they are not able to properly consider cases. They proposed not just more time, but also that prosecutors see all pleas and mitigations in advance, and that there is more data transparency. So far the government has refused to engage and many people are suffering serious harm as a result.

There are numerous examples of injustices within the welfare system that government has, similarly, chosen to ignore to date. One that’s got a bit of media attention recently is the long-running saga of overpayments for carers, who are eligible for an allowance if they look after someone on a qualifying disability benefit. It’s £81 a week, but if you earn more than £151 doing other work you can’t claim it. If you earn a penny more than this, but keep claiming, you are then liable for repaying the full amount claimed for the whole period.

In 2019, after the Guardian raised the issue, the NAO found most overpayments were accidental, not fraud, and were not identified quickly enough by the DWP, leaving people with life-changing debts. Five years later, the problem has not been resolved. The Guardian is back on the case, with a bit of help from the BBC, and has uncovered numerous cases of injustice like, Helen Jacks, carer for her elderly father, who breached the cap by £2 after her NHS employee changed policy on charging her for parking. She now has no allowance, and a £1,700 bill she can’t afford, giving her panic attacks. There are people with bills north of £40k. Despite coverage the government have not changed the policy.

There are dozens of long-standing issues like this – such as accidental overpayment of universal credit leading to severe hardship and in some cases suicides; or ongoing failures in the assessment processes for disability benefits. This got a lot of attention a decade ago when the contractor Atos were found to have ruled all sorts of desperately ill and dying people ineligible for benefits. They lost that contract (though have subsequently got other ones) and the coverage largely stopped. But many of the problems have continued.

A Work and Pensions Select Committee report last year found that “the system continues to let down some of the often vulnerable people who rely on it” giving multiple examples of claimants driven to suicide, though the DWP do not collect any data on this, and have repeatedly ignored requests from coroners to change processes. A 2020 NAO report looking into suicides across the benefits system identified 69 examples between 2015 and 2020 but also said that it was “highly unlikely that the 69 cases the Department has investigated represents the number of cases it could have investigated.”

The more marginalised the group reliant on any given system, the more common injustice will be, because it is harder to generate sympathy. I could write a whole other article on abuses within the immigration system, some of which are deliberately added in as a deterrent, but others of which are accidental. Perhaps the most outrageous recent example was the Home Office acknowledging, last year, that they had lost 200 unaccompanied child migrants, with a whistleblower claiming that some had been abducted from outside the hotel in Brighton where many were housed.

The treatment of prisoners, who garner no public sympathy at all, in some of the most overcrowded and understaffed prisons is so bleak that it’s almost unimaginable. In the year to June 2023 there were nearly 65,000 incidents of self-harm, up 21% on the previous year, and 92 suicides, up 24%.

Getting resolution faster

That there are plenty of candidates for the next big Inquiry is clear enough. But how do we avoid having to wait 20 years, or getting no resolution at all?

For the first two categories the challenge is around risk management. Either we know something is a critical risk (school buildings) or experts suspect it might be (physicians associates). Government does not want to highlight known risks, or investigate possible ones, because doing so would be embarrassing and probably cost a lot of money to resolve.

With a new government about to arrive there is an opportunity for a reset as airing all the problems the last one left will be very much in their interests. A proper, transparent, and high profile, cross-government risk register, with an assessment of which were the most serious would a way to highlight all these issues and ensure they are properly evaluated. (We do have a national risk register, but it’s not updated much and it’s only focused on external risk like floods and pandemic, not ones due to government action.)

Naturally this would degrade over time the longer a government stayed in power and the more it was responsible for problems that should be on it. But at least it would create a basis for discussion and accountability.

The other problem is that it’s getting increasingly difficult to do investigative journalism. There are, as I’ve shown, still good campaigning journalists, and a few publications, like Private Eye, that will still pay people to dig away at scandals. But it’s ever harder to fund, largely as a result of big changes to news media business models. The BBC’s decision to gut Newsnight, which will no longer be doing investigations, is indicative of the wider problem. It’s expensive and it doesn’t get clickbait engagement.

Many national newspapers don’t even have specialist correspondents any more for most social policy areas. I don’t have an obvious answer here, beyond the suggestions I made in a post a few months ago to boost local journalism (many scandals like Grenfell and Hillsborough are also local ones). If any very rich people want to chat about philanthropically funding an investigative journalism substack then do get in touch.

There is also a need to help those affected by injustices to campaign. There’s a reason Alan Bates was the focus of the ITV drama on the post office. It needed someone to organise the fightback. For many of the examples I’ve given where known scandals are ongoing the groups affected are highly marginalised and do not have the resources or contacts to campaign. There are plenty of charities working in these sectors but for scandals to get breakthrough national coverage, of the sort that embarrasses governments into action, there need to be visible and sympathetic victims. An organisation that brought together veterans of existing campaigns, like Hillsborough and the Infected Blood Scandal, to identify and support other victims could be very powerful.

Right now there simply aren’t the mechanisms out there to force the government to confront injustices soon enough. A new government could help create some; but we also need more powerful organisations in the media and beyond, to challenge power. Or in 2030 we’ll be watching another drama series about a foreseeable tragedy or horrendous injustice, wondering why it took so long to uncover.