- A spat with the Audit Commission
- Spoken from the heart
- Would you like to give a little of your time?
- Do targets kill people?
- Meanwhile out in our hospitals…
- And back at the factory…
- More snippets on factory costs
- While we put up with the rubbish services
- What happens to people when they become ministers?
- Something else that didn’t go quite right
- At last – a good decision
- Music to get it off your chest
A spat with the Audit Commission
Thanks to those of you who joined in the row following my article in the LGC on the need for the Audit Commission to be the first port of call for public-sector cuts. I wrote the article because I was incensed to hear the AC’s chief executive say that pay cuts for public-sector workers would be a ‘pain-free’ way to cut spending. He earns nearly £200K and with bonuses and pension entitlements Private Eye reckons his ‘pot’ to be worth over £900K. The people who would suffer would be those struggling on £20K.
But, worse than that, the Audit Commission has been coercing managers of public services to do the wrong things. Systems thinkers are fed up with trying to explain to the box-tickers that the things they want to see when inspecting have been learned to be dumb things to do. If we cut the Audit Commission we would save a fortune. I am arguing that we should cut out all the specifiers and radically change the method of inspection.
My article drew a response from the Audit Commission’s communications man, David Walker. He ignored my arguments and simply laid into me. Apparently, yours truly has incontinent judgment, makes bland assertions, is nonsensical, cavalier, an outsize critic, a prophet of lean (ugh and ugh), and a self-appointed scourge of the audit Commission with a religious mind set. He managed eleven insults in his short missive.
The upshot was rage amongst systems thinkers and all right-minded people. LGC reports that the noise on their site has never been greater. If you missed the debate you can catch up here: http://www.lgcplus.com/blogs/head-to-head/5004531.blog The LGC wants to know where to go with this next. If you have a view you can tell them on that blog.
Of all the postings on the LGC web site, I want to reproduce one. It is from the heart and sums up the feeling of many:
‘Most Local Government (LG) managers came into public service to provide good services and support the communities in which we live. The question that the Audit Commission (AC) should ask itself is ‘why do those very LG managers who have used both System Thinking and AC methodologies believe with such vigour that System Thinking helps us to do what we came into local government to do, whilst the AC does the opposite?’
I find it ironic that the AC can’t see that a major by-product of their well intentioned approach, results in managers, that should be concentrating on service users, to instead focus on paper, evidence manufacturing, and work that has little or no benefit to our service users. Indeed this actually diverts resources away from expenditure that benefits service users or society in general.
It is absolutely the case that the AC has resulted in a LG stance that may be summarised as ‘face to the AC, bottom (to be polite) to service users’. Those of us that actually provide or manage public services know that an unintended result of the AC is to push resources away from service users, and that this is endemic. Evidence? Every audit I have been subject to focuses on policies, strategies, surveys, golden threads … but not service users, telephone callers and contractors. The AC ‘reality checks’ should not be a small part of an audit – they should be the only part of an audit.
So is John Seddon correct that the Audit Commission should be abolished? The answer, in my view, is whether the AC achieves better outcomes for the public money spent on services for the public (not politicians) – what the AC was set up to do. Increasingly those of us that work in public services believe that it is now having the opposite effect.
Mr Walker, in its current direction, the AC is doomed. Without a change of direction, it is just a question of when – not if – the AC will be wound up. Your challenge isn’t to engage in personal attacks on those that increasingly recognise this, but to ask what can the organisation learn about alternative methods that deliver improvements in public service which are undreamed of by managers and politicians, and supported by front-line staff that are sick of arrangements that betray the reason they came into public service. So please put down your poison pen, pick up the phone, talk to John Seddon, and go and visit public services in which System Thinking has given staff their soul back, service users a dramatically improved service, and managers like me some sanity. Then decide.’
And if David Walker calls, I’d be pleased to show him.
The row showed how many people wanted to have a say. Would you like to give a little of your time to the cause? If you would, we’ll add you to a list and, now and again, we’ll inform you of opportunities to communicate and/or ask you to do things like provide evidence to help the cause. To join the list email firstname.lastname@example.org. You can do as much or as little as you want and your anonymity will be protected.
I think as the election approaches we have a window of opportunity, please consider giving it a bit of your time.
The piece in the last newsletter about NHS targets drew this defence from a reader:
‘It is sad to see that everybody has missed the point here. Prior to the introduction of the 4 hour target it was not unusual to hear of patients being left to wait for hours stuck on trolleys in A&E, this seemed to be accepted and be considered normal at the time. Even if this practice didn’t kill patients I’m sure it wouldn’t have made them any better. It is right that somebody has decided this must stop and patients need to be seen in a reasonable time, I doubt if many would consider 4 hours reasonable it is accident and emergency after all but that is different debate.
What is wrong is that there are two ways of achieving a target – the dumb one as per the example quoted i.e. keep a bad system and make it worse by forcing staff to do the wrong things in order to get the ‘right’ numbers or the clever one involving sorting the process, demand and capacity etc out. There are lots of A&E departments within the NHS who have taken the clever route and ensured prompt and efficient service for all patients.
Sadly within the NHS we are encouraged to be clever but allowed to be dumb just as long as the improving ‘numbers’ allows some minister somewhere to say the money spent hasn’t been wasted and services are improving.’
But that won’t do. The targets, ‘quality standards’, and all other specifications, with their associated mind-numbing and encyclopaedic guidance and instructions, have created a health service that is focused entirely on the wrong things. In our language, the centre is responsible for a series of system conditions that impede understanding and improvement. Just because one can use better measures and methods within this regime and beat the pants off targets, this could never be an argument for having them. Nor for having the regime.
Thanks to the readers who noticed these:
On 14th July the Telegraph reported evidence that targets are leading to patients being rushed through A&E, putting their lives at risk
The same reported in Bradford:
While in the East Midlands, the Department of Health is to launch an independent review into allegations of bullying and harassment against the strategic health authority following a row over targets that led to the departure of a hospital trust chair:
And bloggers take up the argument… Payment by Results (PbR) means Patients bring Revenue, so you foolishly manage activity:
And those are just a few from last month’s media. These are not aberrations, they are systemic consequences, ubiquitous and predictable. And none of the associated effort does anything to help us learn what measures and methods would lead to improvement.
The merger of specification and inspection bodies, the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission has led to £23m being spent on leases for empty offices and more than £700K being given as handouts to the departing executives. The new ‘Care Quality Commission’ inherits an IT system with ‘major malfunctions’, valued at £17.5m and promising to cost plenty more to fix it.
Some (annual) numbers: CSCI cost £99m, HC cost over £67m, MHAC cost over £5m. The new CQC is budgeted to cost nearly £167m; costs for transition are £38m and £22m is being spent on ‘capital investment’.
Those are the numbers we know. The bigger costs are associated with health services complying with their specifications. We intend to capture such data where we can. But the greatest costs are, as Deming would often point out, unknowable.
The Audit Commission announced a ‘modest’ increase in the audit fees of 1.5% I bet that went down well.
A report by PWC tells us each local authorities spend an average of £1.8m on reporting to central government each year. Imagine a regime where preparing for inspection is non-existent, where all evidence is available in the work.
And the Treasury Select Committee cast doubt on whether the efficiency savings claimed over the last few years ever materialized (they didn’t, costs went up). Such fears should put an urgent stop to coercing the public sector to do the wrong things. The priority ought to be getting evidence. There is plenty around, but it doesn’t fit the regime’s narrative.
Just one recent example: the Department for Transport’s ‘shared services’ initiative goes wrong. See: http://www.theregister.co.uk/2009/07/20/dft_shared_service/
And finally we are told that every government department is to have/has already, a ‘value for money minister’. That’ll do it!
Am I the only person thinking ‘what do the others do?’
A reader writes:
‘Latest bit of government systems thinking in action that I tripped over due to my book-keeper’s illness………you get a bit behind with paying your monthly Tax and NI bill. You realise that and pay it. A month later you get a shirty letter reminding you to pay. When you ring up to point out etc they say: ‘sorry what we do is send out blanket reminders to everyone without checking whether they have actually paid. Then we wait for you to ring up.’
The de-facto purpose of HMRC; create waste, create cost, worry taxpayers. I feel sorry for the managers who have been duped into creating factories by wrong-headed advisers.
To help vulnerable families stay in their homes the government launched a mortgage rescue scheme. The minister was reported as being excited about progress. During May the number of families helped by the scheme had trebled – from two to six. Yes, two to six!
‘The impact of the scheme is accelerating’, the minister said. You have to wonder how he could bring himself to say that. The scheme is costing us £200m. Inevitably reports say that the time it takes to access assistance is ‘extraordinary’. How did the minister become such a fool? Why can’t he say we got that wrong, why can’t he focus on understanding the problem rather than launching and then defending a dumb idea?
The Department of Energy and Climate Change set energy companies a target for carbon emissions (the Carbon Emissions Reduction Target). The most expedient way for companies to meet the obligations of the target is to send out lots of cheap energy-saving light bulbs. They are cheap because they are the old fashioned and ugly ‘stick-type’ CFLs, hated by many people, and they often have screw fittings that cannot be used in the bayonet sockets found in most homes.
About 200m unsolicited bulbs have so far been sent out. Over 140m were sent out under previous schemes. We learn that many people are not fitting them, some are storing them and many are expected to end up in land-fill, where they pose a pollution problem.
All shocking, I’m sure you’ll agree. But wait, something even more shocking: The Department won’t stop this happening right now because this would ‘unfairly penalise’ companies who had not yet taken advantage of the scheme.
You couldn’t make it up.
ICS has been dumped.
Hurrah! Baroness Morgan, the children’s minister, has told councils they will no longer be required to comply with the specifications for ICS (Integrated Children’s System). Reports published by the Social Work Task Force and Osfted found the same as readers have seen here. ICS ensures we have a disintegrated work system – in short, a demoralising, box-ticking world, full of waste; that puts children at risk.
Councils are now free to develop their own record-keeping systems, so a word of advice: Design a system that captures ONLY the data required to do the value work. This improves quality when doing the value work and minimises cost. People working with children who want to know more about what this means in practice should feel free to get in touch – advice from a Vanguard expert over the phone will be free. Systems thinkers know what it means and how to do it.
We should be grateful to the Baroness for giving us the scope to make a big difference to children’s services. Let’s hope it’s a sign of things to come.
Thanks to the reader who sent me the story of Dave Carroll, a little-known Canadian Country and Western singer. He had a problem with United’s baggage handlers trashing his guitar and then with their Customer Service people, who didn’t want to be of service. So he made up a song – ‘United Breaks Guitars’ and put it in You Tube. It made me laugh.
View it at: http://www.youtube.com/watch?v=5YGc4zOqozo
Anyone fancy writing a song about dealing with the Audit Commission?