- Dave’s promise
- NHS ‘production line’
- Whose idea is this?
- And what about IT?
- Can’t get out of the doo
- Educashun’s germ
- From accountability to responsibility
- How to change the system
- You don’t get it
- Better care costs less
David Cameron, our Prime Minister, said in his New Year message:
‘I am determined to do the bold things it will take to sort out public services, too. Too often our schools aren’t up to scratch, our hospitals aren’t always clean enough and our police don’t catch criminals. Brilliant and committed people work in public services – but somehow the system stops them doing their job. So we’ll change it.’
Nice words Dave, but do you know what to do? Do you know what you’ve done?
Perhaps, Dave, you should consider the health service. Recent news reports tell us that lots of people discharged from hospital are readmitted, within a month, as emergencies; and the numbers are increasing. Oblivious to their role in creating this shocking state of affairs, your ministers blame the hospitals for treating patients ‘like parts on a production line’.
But who built the system Dave? Who mandated ‘payment by results’, commissioning, protocols and targets? Do you know, Dave, how these things create the churn of patients?
Read the news report here:
Dave, you have paved the way for private-sector contractors to get their slice of the shared services bonanza by changing the VAT rules, and now the first such provider has been signed up by the Cabinet Office. It means that government departments are now able to purchase shared services without having the pain (and it is a pain) of going through procurement.
Dave, don’t you know how many of these private-sector-supplied industrialised shared services are failing, costing millions, and delivering worse services to boot? Do you know what it’s been like for the poor blighters on the ground who have trouble getting a service from these alienating, form-obsessed, target-driven, insensitive factories? And what about the other poor blighters, the suppliers, who have trouble getting paid? And what, Dave, do you know about the ways in which ‘professional procurement’ is driving up costs as well as being the bane of public-sector managers’ lives?
Dave, you must read ‘Dangerous Enthusiasms’ by Gauld and Goldfinch. It’s all about the fact that most large-scale IT systems fail. I guess you have a copy of Private Eye in the small room, I do. Did you see their piece on the Rural Payments Agency? A few years ago, to implement the Single Farm Payment, the RPA bought an IT system for £32m. It didn’t work. The IT costs have now gone up to £217m! On top of that, Dave, they have spent £300m on temporary staff to deal with all the rework, caused by mucking the service up, and have been fined £327m by the EU for failing to pay the farmers properly.
Dave, they are only paying 106,000 farmers! If they managed just to do that within their budget of £181m it would be costing them close to £2,000 to pay each and every farmer – blimey! Do the maths Dave, the costs of failure are more than four times the budget!
So why, Dave, do we see more large-scale IT systems coming along?
And Dave, please pop down to Somerset, where local councillors, who had been good people and done as they were told by getting the private-sector involved in a big shared services deal, now want to get out of it – but can’t! Dumping the whole scheme (the right answer, Dave) is just not affordable. So taxpayers will have to pick up the tab.
If your people didn’t brief you on this, as it doesn’t fit the policy narrative, see the news story here: http://www.youtube.com/watch?v=vKzSHxz14YI&feature=related
And when you’re next chatting with Julia from Australia, get her to tell you about the costs of getting out of shared services in Western Australia. Having blown 0m on getting nowhere, the Aussies have now got to cough up another m just to get out of the doo. See the news report here:
So why, Dave, is shared services the current big idea? And why are the Aussies open about the costs of failure while we hush them up?
And Dave, what have you done for education? You have carried on with Tony’s system, building a specifications, testing, inspection and league-table bureaucracy ensuring that teachers’ attention is everywhere but with the students. And now you are privatising schools, so people can make a profit from education.
Go to school in Finland Dave. They are top of the class with their results in education and they got there by doing the exact opposite. No privatisation, no testing, no creepy inspectors trying to put one over on teachers, and no ‘accountability’ as they don’t have a word for it in Finnish! But as one commentator says: ‘accountability is something that is left when responsibility has been subtracted’.
Read about the Finnish success and, of greater importance for you, Dave, how people ignore evidence when it doesn’t fit their ‘narrative’:
Pasi Sahlberg, who has written a book about the Finnish experience, calls your approach ‘the GERM’! The Global Education Reform Movement. To quote a head teacher who suffers from being subjected to these ‘reforms’: ‘The features of the GERM are: standardizing teaching and learning with common criteria for measurement and data; increased focus on core subjects, particularly literacy and numeracy; teaching a prescribed curriculum; transfer of models of administration from the corporate world; high stakes accountability policies – control through testing, inspection, division between schools and an ethos of punishment (for educators).’ You think this works Dave; but it doesn’t. This is how to drive a system away from its purpose.
See the teacher’s blog here:
Get Sahlberg’s book here:
And that, Dave is what you have done; taken away responsibility. You’ve done it in education, health, local authorities, housing, in fact everywhere. I wrote about this problem in my 2008 book. Your people told me they read it while you were in opposition, but thought it went too far. Well they would Dave, if we actually returned responsibility to people who delivered services there wouldn’t be much for your army of Whitehall ideas-people to do.
Dave, if you really want to change the system you can. You have first to unlearn. You and your predecessors have taken the heart out of public services by industrialising them. These ideas have also driven up the costs. You have to learn how and why. When you know, you’ll be a champion, stopping ministers raining down their ill-judged ideas. Stopping doing the wrong thing is in itself a wonderfully healthy thing to do.
As for learning to do the right thing, I’m sorry to say I didn’t invite you to a meeting of Vanguard people last week. We had a get-together for people to see what’s new in our public-sector work. You’d have seen profound improvement in healthcare, higher education, community-based services, policing and food safety.
You’d have been astonished at how studying these services revealed how the systems didn’t only ‘get in the way’ as you put it, they made the service costly, shocking and often inhuman. The worst example of inhumanity being health care where the system has fragmented the relationship with those in need, hence fails to understand need and provides services that don’t solve problems, creating greater demand and thus cost into the system. The case examples would have made you wonder if we lived in a civilised state. The redesigned services would have made you weep for their simplicity, humanness and inherent social value. And your jaw would have dropped at the consequences for costs. Yes, it is cheaper to provide services that work – lots cheaper.
Then you’d have been beset by panic. Everything you’d have seen represents a fundamental challenge to your narrative. These jaw-dropping results are only achieved by going against the grain of policy – yes, disobedience to your system. And I know you’d have quizzed my people on what you could do to make more of this happen and I know they’d have said to you: ‘just stop doing the wrong thing’.
If you’d like me to bring these presentations to Number 10, just let me know.
But as I put this newsletter to bed Dave, it is apparent that you just don’t know how much your actions actually make things worse. You have just announced that nurses will be obliged to have regular ward rounds and inspections will be conducted by patients and their relatives.
As I often say, Dave, you couldn’t make it up. You clearly have no idea.
But Dave, I’m not giving up. Why don’t you pop up to Newcastle on 31st January. At an event organised by the North of England Transformation Network, Lesley Kragt will show you how a care service has been massively improved by getting rid of the tick-boxes, dumping all ‘accountability’ paraphernalia and, instead, designing the care services around the needs of users – improving service and driving out costs.
To book your place contact: firstname.lastname@example.org
Go for it Dave… change the system