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Probably we all think we know what a decision is? But not everyone knows that the word ‘decision’ means one thing to the man and woman in the street and quite another to a bureaucrat? Read on to learn what consequences this can have.

My last report on this website, entitled NHS in Cornwall poised to close Minor Injury Units, drew a stern response from the chief officer of NHS Kernow, the Clinical Commissioning Group. She said:

Absolutely no decisions have been made about the number and future locations of urgent treatment centres … and any other community alternatives to the emergency department. … No decision will be made before [the public consultation] process has ended and the evidence collected during any consultation has been examined.

So here’s a question:

What exactly does she mean by a ‘decision’?

We should be aware that the word ‘decision’ is used in one way in ordinary life and in a quite different way in British bureaucracies.

In ordinary life, a decision is a choice. When we decide what to buy for dinner or what to watch on TV, we are making a choice, a choice between alternatives.

But in British bureaucracies, like the NHS, a decision is a formal step in a policy-making or administrative process. Once the decision is taken, the body concerned has permission to go on to the next step in the process.

Moreover, it is the usual thing in British bureaucracies that, when a public consultation stage is reached, only one proposal is put forward. There is no choice offered. The public are not offered alternatives to choose between.

And this is precisely what we can expect from NHS Kernow. Their Outline Business Case for the Cornwall & Isles of Scilly Sustainability and Transformation Plan (STP), said:

We propose to replace the current Minor Injury Units with a new model of strategically located Urgent Care Centres across the spine of Cornwall. The Centres will provide enhanced, consistent and resilient clinical cover to meet the urgent care needs of all residents and visitors.

As we see, there is no mention here of alternative models – like the one adopted in Devon, for example.

And just over a month ago, NHS Kernow’s chief officer reminded her governing body:

Cornwall’s Shaping our Future STP plans include a commitment to replace Minor Injury Units with fewer strategically placed Urgent Treatment Centres.

If we take these statements at face value it is crystal clear that no work is being done to explore ways of upgrading or modifying Minor Injury Units. Consequently we can be absolutely certain that at the public consultation stage such a possibility will not voluntarily be put forward as an alternative for the public to choose.

Just like concrete steps, failure to do something can close off alternatives. Pursuing one course of action to the exclusion of others creates a fait accompli before a formal consultation stage is ever reached. As a former Head of the Civil Service put it:

The experience of anyone who has worked in Whitehall is that there is an early stage in any project when things are fluid; when, if you are in touch with those concerned and get hold of the facts it is fairly easy to influence decisions. But after a scheme has been worked on for weeks and months, and has hardened into a particular shape, and come up for formal decisions, then it is often very difficult to do anything except either approve it or throw it overboard.

He might have added that there is invariably a considerable penalty attached to throwing it overboard at that point.

There is of course one thing that NHS Kernow’s chief officer could do to reassure the public. She could give an undertaking that when the public consultation stage is reached there will be more than one possible plan up for discussion. The alternatives should be genuine and should include one that involves keeping on Minor Injury Units in one form or another, so the public can make a choice and say which of the alternatives they prefer.

Will she give that undertaking?

 

[For references, please see posts dated September 12, 2017 and January 3, 2018]