- The Leaders Summit
- Owen Buckwell wins leadership prize
- Health will get going in 2011
- But commissioning is a problem
- Consultation limited to doing the wrong thing righter
- Councils have been ‘set free’
- When ‘set free’ means sacked
- One review you must send evidence to
- If it looks like a duck…
- NHS inquiry looking into systemic issues
- D-I-Y Fundamentals
- Two events for the New Year
We had a huge turnout for the Leaders Summit last week – over 400 people came and by all accounts it was a great day. Portsmouth City Council and Plymouth NHS Trust were like bookends on the day’s presentations, the former has improved housing services and halved the cost, the latter stroke care… and halved the cost. If the same were done across all housing and health services we’d be wondering why we worried about the crunch.
Leaders from financial services (BNP Paribas Fortis and Aviva) showed how they had dismantled scale designs and achieved incredible economics through flow, leaders of local authorities talked about the amazing results they have achieved through applying the method to their services and, in particular, how ‘place’ is better understood and designed on the basis of demand. And Advice UK gave a powerful illustration of the way in which they have re-designed advice services to make them work for people in need (as well as it being pointed out for the umpteenth time that hundreds of millions is being spent mopping up failure demand from HMRC and DWP, why doesn’t that bother ministers?).
What was interesting is that while these organisations had applied the Vanguard Method across very different services, all found the same counterintuitive truths. They were stunning presentations, there were lots of questions, plenty of chat and lots friends and new people to meet; a great day. If you missed it Simon Caulkin is writing a summary of the day, it will be posted on the web site in a week or so.
Gary Hamel has created something called the Management Innovation Exchange (MIX), a site arguing for the need to re-think management. We posted Owen Buckwell’s story (‘Forget your people, act on the system’) in the Leadership category and it won! Read more here:
My prediction for the New Year is that health will get started on systems thinking. The results in Plymouth will stimulate interest as stroke is a major concern for many Trusts. We are also receiving many enquiries about what the Vanguard Method could do in health and the current change of regime provides an opportunity to do the right thing. The work in Plymouth showed how stable demand is; it is a profound revelation and means there is fantastic scope for improving services as costs are driven out. I am looking forward to it.
I gave evidence to the Health Select Committee a couple of days ago. I went to explain why commissioning as currently practised (and labelled World Class!) drives costs up. The committee was concerned about whether moving commissioning to GPs is going to work. It is interesting, there is a general consensus that it didn’t work too well when done in PCTs but, as ever, instead of learning about why, much of the evidence focused on peoples’ views and prejudices surrounding the impending move. It is, as Deming taught, a mistake to treat experience as knowledge. What we need is a better health system, not a move of a bad system.
I got the opportunity to explain how commissioning creates costs through its failure to absorb variety. The limited evidence we have currently suggest it may be inflating costs by as much as 100%. But the evidence so far is growing and it parallels the finding in housing where the schedule of rates does the same, and for the same reasons.
Will the committee pursue this issue? I doubt it, but at least the evidence is on the record. I know we’ll be pursuing it next year. We’ll have to if we want to design a system that will work.
The Cabinet Office and Treasury are conducting a consultation for the up-coming White Paper on public sector reform. Their call for evidence says, ‘In particular, if you would like to contribute your views, suggestions and expert knowledge on where these reforms could improve a specific public service based on your experience of running or managing a service, the Government wants to hear from you!’. Hurray! A great opportunity for systems thinkers to put forward their evidence?
But hold your horses and read on… ‘The Secretariat will delete from its records any responses that are ….not directly relevant to the questions being considered’. And the questions being considered? They are about the independent provision of public services, employee run services, external investment, ‘innovative’ payment by results commissioning (sic) and so on. Nothing asking whether these are the right things to do. Nothing asking for knowledge of what works.
They are asking for evidence to support their prejudices, it can only lead to doing the wrong thing righter. If systems thinkers respond with evidence of true public service reform, or evidence of how adherence to these models is driving up costs and worsening services their responses will be deleted.
That’s how the centre ‘listens’.
In a recent speech, the housing minister told councils they have been set free. No longer are they subject to tick-box targets. But the minister expressed his concerns about council managers exhibiting ‘Stockholm Syndrome’, the psychological attachment of the abused to their abuser. But in truth I think the current syndrome is more like schizophrenia, for while this minister issues no targets, he has ignored the evidence on some other major causes of costs, for example Choice-Based-Lettings, and continues to advocate it. In families with parents who say one thing and do another we find higher incidence of schizophrenia. You’re free unless, of course, you are not.
Local authority managers who run the housing benefits service have been told by the Department of Work and Pensions that their local benefits service will be no more when the new universal single benefit comes into effect in 2017. The idea is that the new benefit will be available on-line and via one national call centre. Local offices not required.
Systems thinkers who have developed extremely efficient and fast benefits services, saving millions, are up in arms. They not only provide a fast service, they provide a whole service, sorting out other things that need sorting, like bus-passes, school meals and housing issues, at the same time. They know that problems are not service-shaped but person-shaped. They also know that specialisation, back-offices and call centres merely create more demand with the benefits service.
I know some people have written to the minister to explain that the plans for the universal benefit are wrong-headed and will drive up costs. Will they get a good listening to or will they get the sack? If you know about benefits processing please add your voice by writing to the minister driving all this, Lord Freud. Get your lead members to understand what is going on, politicians talk to each other. We have to stop them wasting yet more of our money on these ideological and wrong-headed schemes.
The demise of the Audit Commission is raising concerns in some quarters (not here!). The Communities and Local Government Select Committee is conducting an inquiry into audit and inspection of local authorities.
I am submitting evidence on the following lines: Audit is not without value judgement. The idea of ‘best practice’ should be abandoned. The ‘value for money’ methodology used by the Audit Commission has little to do with value for money. ‘Better’ is a more constructive lodestar. Responsibility for innovation must be with the innovator. Inspection of performance should be limited to one question (I think you know the question) and citizen redress should be given teeth.
I think it would be helpful if people in the know sent evidence of the unreliability and lack of validity in Audit Commission inspections, how inspection has forced people to do things that make performance worse and evidence of how better services have been improved by not following Audit Commission / DCLG prescriptions.
My fear is that the committee will think re-inventing performance audit in some fashion will be a good idea. It is a very bad idea. You can find out how to submit evidence here:
Please do so. It can only help.
‘If it looks like a duck and quacks like a duck, then we have to consider the possibility that it is a duck’
So they say with the re-introduction of targets (as ‘not targets’) in health. The Department of Health wants unscheduled admissions down by 20%, A and E attendances down by 10% and length of stay in hospitals down by 25%. But, as usual, no idea about method. You can read the article here:
And the DoH wants call centres to deal with GP appointments. Imagine how much failure demand and cost they will create. How much is commissioning contributing to extended stays in hospital? Quite a lot. How much cost do the DoH initiatives and directives create?
It’s a duck for sure. A goal without a method. We should shoot it. Before it causes havoc.
The inquiry into the Staffordshire disaster is moving into the ways in which regulation has been central to the problems. It is one to watch. Go to:
Something NEW from Vanguard, exclusively for local authorities
To respond to increasing interest in the Vanguard Method amongst local authorities and to help local authority managers respond to the current financial challenges, we have developed a do-it-yourself Systems Fundamentals programme.
This three-day programme is an introduction to the Vanguard Method. It won’t give you all the help you may need to make significant changes to your services but it does serve as a powerful introduction and it works as a self-scoping exercise, participants will see the value they could get if they were to pursue the method. Some do so, on their own, and they do well; the only advantages in getting help from an expert are speed, less mistakes, and, generally, a bigger improvement. We advise avoiding help from pretenders, we have created a market for systems thinking, you’d be amazed at those who say they can do it.
The Fundamentals programme is an action-learning programme, participants get to follow the Model for Check for transactional services (like benefits, care services etc). Everything you need is provided; you just need to find a place to run it, the means to show a DVD which is the basis for most of the teaching content and a service that you want to study as part of the programme. It has been tested with a number of local authorities; hence we are confident that it works without the need for an expert in the room.
We are offering the Fundamentals D-I-Y programme for an introductory price of £1,500 plus VAT. It is designed for a group of up to 12 participants. Should you wish to re-use the programme we will charge you £100 plus VAT per delegate trained. These and other details of the programme logistics will be sent to you for you to understand more fully what is required to run the programme successfully.
We are planning to make further low-cost help available to local authorities next year.
If you would like to purchase the Fundamentals D-I-Y programme please nominate one person who will be responsible for delivering it and ask that person to get in touch with Maria Brunning (email@example.com), who will forward a detailed explanation and agreement.
Inquiries into police services and care services have taken notice of systems thinkers’ evidence. It is a good time to make available to others how you study these services as systems, what you learn when you do and the principles for better service design. If they interest you, watch out for news of the events in the New Year.