Thursday, September 22, 2011

The politics of "top-down"

Top-down is very unfashionable these days. David Cameron, the British Prime Minster, talks about "ending the old big-government, top-down way of running public services, releasing the grip of state control and putting power in people's hands" (Cameron promises 'people power' in public services plan BBC News 11 July 2011).

"Top-down" is associated with centralized (Whitehall) control, which is assumed to be driven by dogma and ideology. Whereas "bottom-up" is liberated and local - the new citizen-led democracy. (Mark Easton calls this Upside-Down Accountability - see his piece Introducing Cameronism BBC News 11 July 2011.)

"Top-down is also associated with a mismatch between supply and demand. In Scotland, a Commission on the Future Delivery of Public Services, chaired by Campbell Christie, sets out a mid-term vision of an entirely different culture in public provision: prevention rather than cure, community-based rather than top-down, acknowledging that the objective is to reduce demand, lest the twin pressures of budgetary restraint and demographic changes would "overwhelm" the entire system. (Brian Taylor, Sympathetic ear for 'flawed' social report BBC News 29 June 2011.)

In Britain, most of the topical examples come from the health service, but it is not difficult to find examples in other domains. Here is a small selection.

NHS Reorganization

In opposition David Cameron had promised to protect Chase Farm hospital from what he said was an "unjustified" top-down reorganisation. But there is a growing consensus within the health service and among independent experts that the NHS has too many hospitals (Ministers agree to controversial hospital shake-up, BBC News, 12 September 2011). And is it ever possible for a prime minister to intervene in such a dispute without acting top-down? 

Andrew Lansley has said he wanted to put an end to "top-down reconfigurations of NHS services, imposed from Whitehall rather than led by the local NHS". Now he will have to decide whether to back the local NHS even when it wants to make controversial changes. Chase Farm is the first high-profile case. (Why Chase Farm matters BBC News 12 September 2011)

Whenever possible, Andrew Lansley blames the Labour government. "Labour's IT programme ... wasted taxpayers' money by imposing a top-down IT system … " (NHS to overhaul £11bn IT project, BBC News 22 September 2011). Not surprisingly Labour disagrees: for Andy Burnham, it is the present government that is "subjecting the NHS to a reckless top-down reorganisation". (Archbishop of Canterbury criticises coalition policies BBC News 9 June 2011)

Dr Hamish Meldrum, Head of the BMA, also associates "top-down" with ideology. "There is a huge difference between adapt and change and slash and burn, between carefully planned reorganisations and knee-jerk closures and redundancies, between partnership working among health professionals, managers and patients and imposed top-down, politically-motivated diktat." (NHS told to avoid 'slash and burn cuts' BBC News 27 June 2011)

Education Reforms

Scottish Liberal Democrat education spokesman Liam McArthur said: "It is hard to see how this top-down restructuring will improve the experience and opportunities for students, or morale amongst college staff." Scots universities could merge in education reform (BBC News, 14 September 2011).

Law and Order

Profesor Lorraine Gamman, director of the Design Against Crime research centre, argues that "top-down" initiatives generally fail when it comes to encouraging people to preserve and treasure works of art. Instead, she says, community-led initiatives are usually far more effective at ensuring that public art is protected by self-policing. (How do you graffiti-proof public art? BBC News 4 July 2011)

Arab Spring

In Yemen, the momentum behind the revolution quickly grew beyond the top-down control of the established opposition. (Ginny Hill, Yemen unrest: Saleh's rivals enter elite power struggle BBC News 27 May 2011)

See also What does "Top-Down" mean?

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