Counting beans

Every organisation needs a bean counter - someone who knows the price of everything, writes it all down beautifully neatly, and hassles people to spend less. An absolutely vital function - if nobody is doing this, you go broke.

But you can have too much of a good thing. You should never, ever put the bean counters in charge, because although they know what everything costs down to the last penny, they only understand value in terms of numbers.

A good example of this are the civil servants who run the British National Health Service. The NHS guarantees free medical care for all, spending absolutely phenomenal amounts of money, as you might expect, and it gets more expensive with every passing year, as more and more treatments are discovered. So the bean counters are always trying to rein in the costs. The trouble is, they come up with numbers-based solutions, with no thought for the human cost. Yes, it probably is cheaper on paper to have larger, more specialised hospitals spaced further apart, rather than smaller local ones, but it kills people. Have a heart attack in Canterbury ten years ago and in five minutes you would be in the local hospital's A&E department. Have the same heart attack there now, and you'd better hope you can hold on while they drive you to Ashford, because they closed down Canterbury's A&E department. So if you are in Canterbury, make sure you don't have your heart attack during the rush hour.

The irony of this is that it probably isn't really cheaper overall in money terms - the true costs just get shunted over into someone else's budget, the ambulance service for example (hospitals further apart = more and longer trips = more staff, petrol and vehicles + longer stays in hospital as a knock-on effect. Not to mention the extra deaths). A famous example of this is hospital "bed-blocking", where an elderly person is taken into hospital for, say, pneumonia, cured of that, but can't be discharged because they need social care, which the local council can't provide, so they stay in hospital for months. The social services bean counters have successfully shifted the cost of that elderly person's treatment off their balance sheet, saving money for the council ta-daa!, but more taxpayer's money is spent overall, because the care the hospital is providing costs more than the social care the patient actually needs.

That's an example of over-mighty bean counters playing tricks on each other, but they also play dirty tricks on the public. A couple of years ago the British government instructed the NHS to cut waiting lists for medical treatment. After a decent interval the bean counters reported a glorious victory and produced lots of stats about how few people were now on the waiting lists compared to last year. Only they cheated. They started operating a sort of secret second tier of waiting lists, where you had to wait to get onto the waiting list, and often couldn't get on to it at all. Never mind the people living every day in pain because they can't get the treatment they need, they made the numbers look much better! The government only found out what they'd done during the next election campaign, the only time they listen to ordinary people, when they were presented with numerous case histories. As far as I know no civil servants were disciplined for this, though it amounts to fraud and criminal negligence in my book.

Another thing they do scares me. They are always trying to make hospitals "more efficient", by which they mean having as many of the beds occupied as possible at all times. If people took it in strict turns to get ill that would be fine, but life's not like that. Hey Mr Bean-Counter, get your head out of the spreadsheet for a minute and ask a doctor to explain the word "epidemic" to you! In any sane health service you _have_ to have spare capacity, or people suffer and die. If bird flu does become an epidemic, or something else does, where will you put all the extra patients?

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