- Vanguard opens in Ireland
- Audit Commission chairman declares regulation as waste
- A letter to the Health Secretary
- Government busted
- Vanguard Standards now available in Spanish
We are proud to announce Vanguard is now established in Ireland. Our man on the ground is Niall Connolly (email@example.com). On September 16th, in conjunction with the Call Centre Association for Ireland we are running a one day workshop on Lean Service. For information contact the CCA: 1850 927827 OR CCMA@ECOMINTERACTION.COM
Writing in The Times on May 6th, James Strachan, the new chair of the Audit Commission said some things that should give those in the public sector a little heart:
“Centralist command and control supported by a plethora of targets is as counterproductive as it was in the former Soviet bloc…. The NHS [National Health Service] is not so much over-managed as destructively over-bureaucratised”
And he maintains we need people who are: “less obsessed by the selfish comfort of an audit trail and who understand that the man who makes no mistakes makes nothing”. But it is not clear whether he means the auditors or the audited.
As the article goes on there is less to give us heart. Strachan uses the article to promote “strategic regulation”. What does this mean? It means those public services that have got the ‘gongs’ (passed previous inspections and registered to various ‘standards’) will have less attention paid to them. But did the gongs make a difference? Is “strategic regulation” not just the same game with another tune? Having opened the debate on regulation as waste, Strachan fails to tackle the big question: Can specification and inspection lead to improvement?
I have written to Mr Strachan. He has not replied.
I also had occasion to write to Alan Milburn, the Health Secretary. I wrote:
“Recently in an interview with BBC you said: ‘It is completely unacceptable in a public service to be deliberately fiddling the figures in the way that a small minority of senior NHS managers and NHS trusts have done.”
One day you will learn that ‘fiddling’ is ubiquitous and systemic; it a consequence of the targeting regime, for targets are, by their nature, arbitrary. You will also discover the targeting regime has an associated bureaucracy that bears no positive relation to the way the work works – it is all waste; but it is there to serve you.
You also said: ‘Where that has happened swift action has been taken. We are not going to have a situation in the NHS where a few bad apples are spoiling the reputation of the overwhelming majority.”
If you carry on like this you will be sacking a lot of people – at least as many as you can find, for people become ingenious at ‘cheating’.
And you said: ‘Most organisations have targets, they are part of the currency of modern management,”
Not so, they are part of the culture of old management, the kind that led to industrial strife in the last century. Obviously you are unaware that the same deleterious phenomena occur in private sector organisations; in the case of the older ones they have institutional ways of minimising dysfunctional consequences; in some of the younger ones – and the Cable Companies are a good example – targets have been the cause of poor service and high costs. While claiming to take the health service forward you are taking it backwards.
You say: “We should be unapologetic about setting demanding targets on waiting times in particular because waiting is the public’s number one concern about the NHS.’
When you discover for yourself the dysfunctional nature of the impact of targets on performance and morale, let alone patient service, you will change your ways. Until then you, albeit unintentionally, are worsening health services.
He has not replied either.
This month the Guardian reported how a man running a Drug Action Team – whose purpose is to deal with the drug problem – quit because he could no longer stand the waste and bureaucracy: 44 different funding streams, each with its own detailed guidance and micro targets from the centre, each one with its own demand for a detailed business plan and quarterly reports back to the centre; the endless service agreements he had to sign with every local provider with their own micro targets and a demand for quarterly reports back to him so he could collate them and pass them back to the centre; over 68 pages and nine planning grids with 82 objectives; the funding announced too late for planning and then handed over too late to be spent and finally spent for spending’s sake to prevent it being reclaimed by the centre; the staff hired and trained and then suddenly sacked when funding or targets were switched by the centre, (or just quitting because they couldn’t stand it any more). He reckoned he and his staff spent only 40% of their time organisation services for drug users – the rest of their time was consumed by producing paper plans and paper reports for Whitehall.
Talking about the Government, he said: “They don’t know very much about drugs but they do know about management and monitoring and data collection. So that’s what they do.”
Actually they know nothing about management. If they did they would know that their actions undermine rather than foster understanding and improvement.
Over and over again this man found a problem was confronted not with a solution but with a bureaucratic process. Just one example:
Problem: there are not enough rehab places. Solution: pay for some more. What the DAT had to do: audit and review existing rehab places; join a regional review of rehab places; hand over £5,000 from their treatment budget, along with all the other local DATs, to fund a regional office to take over central purchasing of rehab; set up an enquiry into the need for special rehab places for black, Asian and women users – and, of course, all of this had to be recorded on planning grids, most of which then had to be rewritten to improve its performance score. Outcome: no change yet. And so it was for a series of other problems he sought to fix.
He wrote a resignation memo for a colleague with the heading ‘Ravings of a burned-out mind’. He described the culture of control in Whitehall, their ‘monitoring fetish’ and their short-term thinking, and he wrote: ‘Monitoring has become almost religious in its status, as has centralised control … The demand for quick hits and early wins is driven by a central desire analogous to the instant ratification demands made by drug users…
If you have examples like this, send them to me; I’m collecting the evidence 😉
Ahead of the publication of “The Case Against ISO 9000” in Spanish, the translator has translated The Vanguard Standards into Spanish. So if you work in Spanish-speaking territories and you are being coerced into registration to ISO 9000 (why else would you do it), do it the Vanguard way.