The definition of madness

Governments need to stop making the same incredibly expensive mistake over and over again

One of the many issues with the Whitehall model of policymaking is that thematic failures are often missed. The focus is on solving specific sectoral challenges within departments so there is no one, bar a few overworked firefighters in number 10 and the Treasury, to spot similar screw-ups happening across different policy areas.

Over the last few months I’ve written several posts that feature one of these thematic failures: attempts to squash demand for state support in one place that have led to a big increase in demand elsewhere that’s a lot more expensive.

Take last month’s post about GP appointments. The fall in the number of appointments relative to population and need, plus reduced continuity of care, has led to a big jump in A&E attendances and emergency hospital admissions for preventable conditions.

Dealing with this is much more costly that it would have been to increase GP numbers and has also helped clog up the hospital system. A&E wait times are still rising – 11% of people last month waited more than 12 hours to be seen and there were over 130,000 more attendances than in the same month last year. The growing number of emergency admissions is also hampering efforts to reduce elective waiting lists.

When you shift demand from one place to another like this it’s hard to reverse. As the government is now having to find billions more to cope with the mess in hospitals there’s not enough available to add the amount of GP capacity necessary to get back to where we were (even if we could find enough GPs). Plus once people learn new habits it’s hard to get them to change back even if it’s in their interests.

It's the same with the rising costs of the special educational needs system – that I wrote about a few weeks ago. Here we saw changes in funding and legislation that reduced support for children in mainstream education with less serious special needs. That led to a surge in applications for much more expensive Education and Health Care Plans (EHCPs) from schools and parents, and a big increase in demand for specialist school places. The state wasn’t able to respond quickly enough and so private equity firms are now making big profits from super-expensive independent specialist provision funded by the taxpayer.

The cost of the system has trebled (in cash terms) in a decade putting local authorities in serious financial difficulty. Due to these cost pressures many young people who badly need support are not being given it, or are seeing lengthy delays in approving their plans. Again any money that can be found – like the extra £1 billion announced in the recent spending review – has to go to propping up the overloaded system rather than restoring the support in mainstream schools that would prevent it from being required.

In the rest of this post I’m going to explore another – even more costly – version of this same problem, and identify some general features, before concluding with some suggestions about how governments can avoid making the same mistake in the future, while cleaning up the messes that have already been made.