Over the last couple of years, as the true lunacy of NHS “reforms” is revealed to an increasingly astonished medical profession, many of us have wondered whether there really was some sort of deranged madman driving the agenda. Surely no sane person could have devised this mayhem. Well, astonishingly, it seems that these dark suspicions have more than a grain of truth in them.
Much of the drivel peddled at vast expense by the management gurus of which the Department of Health seem so fond, and whose wisdom is lapped up so enthusiastically by ministers, stems from a theory known as “performance management”. Performance management is a big number; type it into Google and you get 350,000,000 hits. Performance management is the basis of the application of targets to health care and of the introduction of competitive forces to health care providers; it also lies behind MMC and MTAS.
Performance management is the product of a shadowy organization called the RAND Corporation, an American think-tank funded by the US military. It is an important body; among those who have worked for it are Condoleezza Rice, Donald Rumsfeld and Lewis “scooter” Libby (Dick Cheney’s former senior adviser recently sentenced to 25 years in prison). One of the RAND corporation’s brainwaves was the application of performance management to the Vietnam War; when things were going badly it was suggested that commanders in the field should be given weekly killing targets. Not wanting to upset their political masters, soldiers started either systematically lying about their kills, or shooting random innocents to achieve their targets.(sounds horribly familiar to some of our targets in the NHS).
The RAND Corporation has also done extensive research into the organization of health care., although as an aside I note the current mayhem in the American military’s own organization and today’s sacking of the US Surgeon-General
And where, pray, did the RAND corporation get its own ideas from? Much of its work was derived from the mathematical modelling and games theory of John Forbes Nash, a mathematical genius with paranoid schizophrenia of such severity that he spent 10years in a mental hospital, and who worked at the RAND Corporation..
(Author’s footnote : before anyone points it out, mental illness in general and schizophrenia in particular are not funny.)