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Death in Stafford

The shocking news of patient neglect and avoidable mortality in Stafford caused many readers to write. There was an eloquent exposition, by an ex NHS chief executive, explaining how targets are at the centre of the problem. But what do we hear from the ministers? They blame the managers. One reader sent me his blog:
http://viewfromthewolds.blogspot.com/2009/03/mid-staffs-scandal-being-there.html

As the blog points out, the problems would have been easy to see if leaders were looking in the right place, but leaders of our hospitals look up, for they are in fear of the regime. What is even more frightening is the fact that some leaders are fully aware of the impact of complying with the regime’s requirements on patient care but, nevertheless, chase their star-ratings. The regime is creating moral turpitude. How do these people sleep?

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More on Baby P

Lord Laming, the man who started the tragedy that has developed in children’s services following the Climbie affair, has been reviewing his own review. He declares that children are being put at risk because of management’s obsession with targets; he observed that the hike in court fees (from £150 to £4,000) is discouraging local authorities from seeking court orders; he laments the high turnover of social workers (but does not consider the causes) and his solutions? A national agency to drive in his ‘reforms’, more training and qualifications for social workers, inspectors to have child protection experience and so on. No understanding of the problems and big boots stamping down the wrong ‘solutions’.

The most telling example of the noble Lord’s failure to understand was his assertion that ‘anyone who knows me knows I am not a fan of computers’ in defence of peoples’ claims that the new computer system (ICS) was at the heart of the problem and a direct result of his first review (see newsletters passim).

The minister (Ed Balls) waded in, as ministers do, by blaming the managers. How wrong he is.

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Why doesn’t your doctor listen?

Heard on Broadcasting House (Radio 4 Sundays): A retiring GP who was sick of the system said: ‘I know the patient’s age, size, weight, smoking habits, blood pressure, pulse rate, BMI etc but I can’t for the life of me remember what’s wrong with him. The system is so geared to collecting data that you forget you’re there to treat people’.

The reader who sent me that also wrote:
‘I’ve just been in for a check up and they found my blood pressure to be a bit high. I said I want to sort it out by doing things myself and they said no – you get the pills. I’m sure I’m just another statistic – ‘condition spotted, recorded and treated – tick’.’

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Why can’t your hospital do the right thing?

A reader writes:

‘A colleague was due to have his leg amputated (cancer). He applied for the aids he thought he’d need in his home afterwards. He was told he qualified for them. And, being a logical thinking kind of person, he thought maybe it would be easier for him to DiY them while he still had two legs than when he was hopping around on one. So he drove round to the depot to collect them. You know what they said to him don’t you.

Yes, it really happened.’

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Targets in schools


A reader writes:



‘I have just heard a classic example of the folly of target setting. My wife who is a teacher in came home and told me that her head of department had been in a panic today. The government have apparently announced a new target where children must show an improvement of 2 steps in a given period of time. Previously it was 1.5. When the marks were examined it turned out only about 1% had met this standard! So before the ‘County` inspectors called to examine the figures the data was massaged to bring it up to 30%!! Honest marking goes out the window marking to endless criteria must now be done with targets in mind.’



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Partners ‘shaft’



I have often pointed out how ‘partnerships’ in the public sector will get you a tick from the audit commission while they worsen service and drive up costs. A reader from the private sector writes:



‘We were totally put off the partnership word by a very senior guy in one of our top 4 supermarkets, who said they used the German word for partnerships: partnershaft. At the time, this was a better descriptor of what they actually did to suppliers.’



And knowing a supplier to supermarkets I can tell you they still do. 



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Final score or end of the game?



The Audit Commission has put out a report entitled: ‘Final Score: The impact of the Comprehensive Performance Assessment of local government’. As many readers pointed out it is a self-serving pat on the back for the Audit Commission, crowing about ‘improvement’ on the basis of CPA scores which, as many of us know, are neither either valid nor reliable. Should we audit the auditors or just close them down?



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Hats off to the Kiwis



Central Otago District Council in New Zealand, the first organisation to adopt Systems Thinking in New Zealand, has been castigated by Audit New Zealand for having a ‘flawed’ long-term community plan. The auditor said the council’s plan was not good enough and did not follow best practices adopted by other councils. Of course it wouldn’t. By ‘best practice’ he means ‘normal’ practice. And just as we have learned in the UK, much of the work that goes into documents for the regime is of no value other than preventing unwanted attention. 



The auditor was also quoted as saying: ‘The major failing was it didn’t tell you exactly what they were doing, why they were doing it and how you could measure whether they’d done it or whether it was achieving its purpose.’ And I am confident that cannot be true. What is more likely is that the things Central Otago has in its plan don’t look familiar to the auditor. 

The leaders in Central Otago are standing up to the auditor.

The Mayor, Malcolm Macpherson was reported as saying it was a ‘badge of honour’ not to fit the national template. ‘I am more than happy to front up and explain why the adverse opinion is not a problem for us. We do a better job that the rest of the sector and Systems Thinking sets us above the common herd,’ he said. 



Hats off to him!

In Central Otago they know that ‘better’ is better than ‘best’. 



Read the article at: 
http://www.stuff.co.nz/southland-times/news/2302889/CODC-slammed-for-flawed-plan



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More ‘best’ nonsense



A reader writes:



‘You might enjoy this example of ‘Best Practice’ from an assessment of the [local council] Help Point Network for the Government’s Customer Service Excellence Award (certification was granted). Under the heading, ‘Areas of Good Practice’ is the item:



‘Your staff chase back office to ensure that service requests are undertaken in a timely manner and feedback is made to the customer with updates when required. The ‘ownership’ of the service request is excellent and is essential in building customer confidence.”



Ha! Assessors rate waste as worthy! He goes on:

‘The report goes on to praise a piece of research done on NI14 for the partnership which, when I tried to read it, made me so cross I had to hurl it into the bin in disgust. It suggests that it should be recommended to the Cabinet Office as an example of ‘Transformational Practice’.

‘

As you say, you couldn’t make it up!’



For those who don’t know (new readers I guess), my critique of NI 14 is available at: https://www.vanguard-method.com/v1_lib.php?current=674

I was saddened to see the Cabinet Office is now putting on seminars on NI14. I think some systems thinkers should turn up to ask them questions they cannot answer.



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Off shoring and failure demand



One of the causes of failure demand in both the private and, more recently, the public sector is off shoring. A reader alerted me to an article on the rising costs of off-shoring, Compass claim that off-shoring providers win work by pricing it at 18% below UK costs for the same work, then surprise surprise, by the end of the third year of the contract costs are as much as three times equivalent UK costs. And these are not the true costs. These calculations are based on transaction costs and as all systems thinkers know the true costs of operations are in flow, so the real escalation of costs associated with off-shoring include the failure demand created by fragmenting the work in this way. Much bigger numbers.



The article is posted at: http://www.management-issues.com/2007/6/27/research/offshore-call-centres-fail-to-deliver.asp



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Seddon speaks in Scotland



On May 12th I shall be giving a master class in Glasgow on Systems Thinking and the public sector. One of our Scottish clients will be there too – Glasgow Housing Association, the largest RSL in Europe, and the minister for Enterprise, Jim Mather, is coming along to support (in Scotland ministers do care about what works and are not surrounded by children spouting ideology). For information and booking go to: http://www.centreforconfidence.co.uk/events.php?p=cGlkPTE2NSZpZD02NTc=



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Deming Forum – I recommend it



This year’s Deming Forum looks set to be a corker. For information and a booking form go to: http://www.systemsthinking.co.uk/events.asp#3 May see you there!