- Minister dumps targets
- NHS Direct
- A sure sign of madness
- No idea
- More nonsense in education
- Shall we save the monster?
- Next month SIX SIGMA: the beginning of the end
Minister dumps targets
This month the minister for health announced he is going to drop all the targets because they ‘have done their job’. He must think we will believe he means ‘done something useful’ but we are not so stupid.
It occurs to me something must happen to people when they become ministers that leaves them believing they are experts in management, what can it be?
A reader writes:
“My brother in law is a General Practitioner. He says that NHS Direct is set up by people who have no idea what they are doing – so where’s the surprise? Apparently the service is staffed mostly by nurses (very highly qualified nurses!) who are paid better than their colleagues engaged in direct patient care in hospitals and GP practices – the government has to offer better money to lure them away from the job they should REALLY be doing. That’s the first mad bit!
The nurses typically deal with 12 to 14 patients over the phone in a 7 or 8 hour shift – yes only 12 to 14. That’s 35 minutes per call which sounds OK, doesn’t it? At least they could take their time to find out what’s really wrong and do something of some use! But (this is the second mad bit) they use a computerised diagnostic tool which has so many safety nets built into it that three things happen (typically):
1. Calls don’t take that long
2. Nurses don’t use their expertise (a huge waste when you consider that it could/should be put to better use in direct patient care) and are told by the computer to a) send them to a pharmacist, b) refer to the GP or c) get them to go to Accident and Emergency. Which option do you think no one uses? You guessed it, a). People are scared to make any kind of mistake so they use the safety nets – why wouldn’t they?
3. Callers are mostly told that everything should be OK but you’d better
check with your GP
As a consequence, (here’s the third mad bit), GP practices are being clogged up with patients who have nothing really wrong with them but are told to go to their GP by NHS Direct. My brother in law has seen his waiting room filling up more and more and waiting times for appointments at his practice becoming longer and longer since the service (?) was introduced. He regularly sees patients who say that they have talked to NHS Direct and they don’t know what’s really wrong with them, if anything at all. The GPs in his practice (and those he knows in the region) are getting a bit hacked off with it! But they have no way to do anything about it. Now that’s progress!”
The man running NHS Direct is now on the conference circuit doing a show on how good it all is. If you see the show ask him what he knows about demand – why people call – and outcome – whether and how effectively they get their problem solved. I have been amazed to learn the NHS knows nothing about demand and outcome; it is no wonder the system is not improving.
Just like command and control managers running call centres in the private sector this man can tell you all about the volumes of calls he takes, how long they take to be handled and so on, but he can tell you nothing about the things you need to know about to improve the system. If he did he would see the folly of using computer-aided decision-making. It wouldn’t matter so much if it wasn’t our money he is spending and our problems he is not solving.
A report on UK government efficiency by Sir Peter Gershon, has been leaked to the Financial Times. Apparently it will include proposals to make online transactions with government compulsory for everyone who is 'e-capable'. For citizens who don't have access to new technology, the report will recommend an expansion of telephone and contact centre services.
Sir Peter ought to go study what is happening right now in local authority services that have complied with ministers’ instructions to ‘e-enable’. He will find higher costs and poorer services – assuming he knows how to look.
Either he knows something I don’t or he is about to encourage government to do more of the same and expect a different result.
A reader writes:
“Thought you might be interested to see a piece of work the IDeA is touting around performance improvement. They don't seem to have discovered Chapter 8 of your latest book yet!”
The IdeA is supposed to be helping local authorities improve. The document he refers to compares and contrasts the junk that gets me going – ISO 9000, the Excellence Model, IiP, Charter Mark and so on. As he indicates I ripped into the problems with theory and practice with these in chapter eight of my book.
Let’s have a bit of fun. The author of this junk is one Amanda Davies. Please send her an e-mail suggesting she would be wise to read chapter eight of Freedom from Command and Control and then tear up he report entitled Review of Performance Management Models and Improvement Tools as there are big questions as to whether they ‘bake bread’.
Go on, amuse me. Her e-mail address is: email@example.com
A reader sent me this:
“Form teachers found sealed envelopes with instructions to hand them out to pupils to be taken home to parents. Teachers knew nothing about its purpose(!). Naturally some decided to open the letters up to see what it was all about, teachers expect to know about communication to pupils and parents.
On opening the letters they found questionnaires asking parents for their ‘opinions' on the teaching standards in the school. Standard marketing type questions ‘how would you rate?’ and giving the five box answer template. One of my favourite questions was 'what subjects do you think we should be
concentrating on/not concentrating on?' Of course many parents would not really know how to answer this question.
After much uproar the 'senior' management at the school decided to send home another note stating that the exercise has been cancelled, the damage in terms of both parents and teaching perception and morale as ever is incalculable…..the fact that the headmaster is to become a OFSTED inspector next year may have something to do with it.”
I guess this is another example of government fondness for ‘involving consumers’. It is dumb and wasteful to ask people what they’d like. But it seems you have to do dumb and wasteful things to get on. It really is time ministers got out of management.
You might not believe this but there is now a petition to save ISO 9000. The blurb put out by one Christopher Paris tells us the worldwide growth of ISO 9001 certificates is at its all-time lowest rate ever.
Wonderful. It won’t surprise you to know Mr Paris is an ISO 9000 consultant. I guess thousands like him will be wondering where their livelihoods are going. I’m just delighted this nasty disease is coming to an end. Without market-place coercion (you comply or we won’t buy) it would have ground to a halt long ago.
The April Newsletter will be a SPECIAL ISSUE, concentrating on the failings of Six Sigma.