Complex Systems and Why They Go Wrong Complex Systems in Government

Subsequent reporting began to widen the story, suggesting that whatever the failings of the panels, they needed to be considered alongside other aspects of the structure of the building, for example the gaps through which smoke and flames might move swiftly through a tower block. [...] For many years policy makers have been encouraged to start from a clear understanding of the environment; to analyse the evidence on what works (from the perspective of users, Ministers, providers etc); to look at recent changes to the policy and study the lessons to be learned from previous change, and so on. [...] In the case of the building regulations, both the building standards themselves and the organisation and independence of the inspectors and regulators have been subject to continuing change, mostly with the aim of deregulation. [...] The Guardian’s coverage of the report referred to a “devastating 586-page report, published amid apologies from the government and dismay from families of the lost men, [which] suggests the aircraft was doomed years earlier by lamentable and systemic failings on the part of senior individuals and leading corporations, compounded by the MoD sacrificing safety to cut costs”. [...] The regulatory regime for medicines, introduced in the 1970s in the wake of the Thalidomide scandal, rests on a thorough and expensive regime of testing and authorisation, paid for by the sector.