The article nicely poses the question of cost cutting versus the unintended effects of those cuts. Councillor Jane Potter is quoted as saying, “I welcome the fact we are planning to spend our limited resources more effectively by focusing on services for young people rather than buildings to achieve better outcomes.”

But Charlotte Toomer, chair of Redditch Student Council, said the decision was wrong and would force young people with nowhere else to go out onto the streets.
“We haven’t been listened to. They are forever moaning about young people on the streets but by doing this the situation is going to get worse. Taking the youth house away will lead to more kids on the streets and more crime,” she said.

The question is whether the young people will in fact use the other facilities and so see no loss of service or whether as Toomer says, things will get worse.

My guess is that cuts that are driven by balance sheets will, in the end lead to more costs in the long run. I don’t know if anyone stopped to ask the users of the centre themselves what they wanted or needed to improve the service. I’d bet they would have some pretty good ideas of how to improve the service and cut costs as a consequence.

If only users of a service got listened to.

Best,

Rob

The Hospital Guide shows that patients are less likely to get treated promptly and more likely to die if they are admitted to hospital at the weekend. The chances of survival are better in hospitals that have more senior doctors on site. But some hospitals with A&E departments have few senior doctors in hospital at weekends or overnight. The guide identifies trusts with low levels of staffing and high mortality.

The reality is that the public don’t live their lives Monday to Friday. That means that we may very well need care on the weekends. If hospitals are not staffing their A&E departments and wards to match the needs of patients then they need to change how they organise themselves.

It is not a complicated exercise to track admissions and care patterns to see when staff are required.

If an organisation is not matching resource to need it will be performing below optimal levels which in the case of the NHS can mean an increase in mortality and longer times to access care. This is something that is operationally simple to change and however culturally difficult, needs to be done for the good of patients.

Best,

Rob

The reason that I highlight this situation is because the cruelty comes along with stupidity.

In the article, Ros Altmann, director general of the over-50s group Saga, is quoted as saying,

Cuts like this are incredibly short-sighted, because the less that is spent on someone with moderate needs now means more will have to be spent when their needs become substantial.

Focusing on cost cutting means costs go up in the long run.

Not complicated.

And the most annoying thing is that you could reduce costs and at the same time provide better care which keeps people in their own home for longer. Which is what everybody wants.

Best,

Rob

However in reading an article on the BBC website: NHS: Crackdown on ‘hidden waiting’ ordered by ministers there was one paragraph that seemed to stand out from the crowd. The text was this:

Ministers believe there is not enough incentive for these patients to be treated, meaning some are left “languishing” unnecessarily.

Let’s let that sit there and percolate a little while we stand back and recall what the NHS is for.

The NHS was set up as a form of national health insurance. Collectively we pay tax and national insurance and if ever we need health care in our lives in the UK it was to be delivered free at the point of charge. The NHS was designed to give the public peace of mind that even if they fell on hard times that in regards to their health they would always have access to care.

So the reason for the existence of the NHS is to provide health care to the British public.

In my book, “Beat the Cuts – How to Improve Public Services and Easily Cut Costs” I argue that the real motivation to do good work comes from within. This motivation stems from wanting to do something meaningful, wanting to work as a team, wanting to take pride in your own work and wanting to do something for others. The last of those is particularly prevalent in the public sector. That list contrasts with extrinsic motivators such as money, prestige, power and praise.

When ministers are quoted as saying that there “is not enough incentive” I think they must be thinking of the list of extrinsic drivers. My experience in all parts of the public sector is that its staff really do want to serve and provide for the public. This is very strongly true in the NHS.

So I don’t believe that there is not enough incentive. There is. The problem is that too many people only think of motivation from outside and forget the internal motivations. The consequence of that serious oversight is that they further pile on the extrinsic motivations which actually sap the internal drivers. In addition they forget to foster intrinsic motivation in the systems of management that are set up. The irony is that their statement eventually will become true. The extrinsic motivators will cease to be effective and their over application will have crushed any intrinsic motivation so there really will be not enough incentive to care for patients.

However, I am confident that we are not there yet. But we need to be careful not to ignore pride in work or the need to help others any more.

Best,

Rob

As Lansley squats in front of the idol created by the Labour tribe, the danger he has faced melts from his thoughts as he is calmed by the simplicity of the creation that sits quietly before him.

He is still.

But Lansley knows that he is not out of danger yet. He steadies himself and mentally weighs the golden object before him. He takes a bag in his right hand and measures the policy ideas it contains. He looks again at the idol and back to the bag. He takes a fistful of directives from the bag and drops them to the stone floor. He glances back at the statue and then discards a few more diktats from the bag. He is ready. His right hand holds the bag as close as possible to the idol, his left hand poised on the other side.

One more breath.

As the last wisp of air leaves his lungs he smartly tips the idol off the plinth, simultaneously rolling the sandbag into its place with a gap that could never be noticed. Or so he hopes.

Lansley pauses. Waits. Listens. His body still taut.

Nothing.

His shoulders drop a fraction and he allows a small smile of relief and victory to creep across his face. He starts to stand to leave with his prize. For a fleeting moment he has done it. He has removed the Golden Idol of the NHS 18-Week Treatment Target. No one thought he could do it. Even he wasn’t sure. He knew it was the right thing to do. But has he forgotten something from the ancient legends?

Lansley tenses. A deep, distant rumble. In a moment the roof of the cavern is crashing down. The floor cracks beneath his feet. The altar explodes in his face. He must run.

As he dodges more darts and nearly loses his Fedora to spear flying out of a wall beside him, his mind rushes back to the warnings of the old man in the village. The sage said that you can’t just remove a target and replace it with sand. “It is right,” said the man, “to remove the 18-week target. The Labour tribe wouldn’t listen when it was said they shouldn’t create the evil target idol in the first place. The problem is that targets appear to magically work even if they are really dysfunctional. But if it is to be removed it needs to be replaced with a proper method. So if you take it away, as you must, you need to leave in its place a sustainable way to treat patients well. Only the timely and appropriate delivery of treatment in the NHS will stop the whole thing collapsing. Only then will the 18-week target not be required, and it can be beaten in in ways no one could imagine.”

All at once, Lansley screeches to a halt amid all the chaos and dashes back through the flying debris. Swinging the 18-week target high he brings it crashing down onto the splintered remains of the altar. “Come on!!” he shouts. Surely putting the 18-week target idol back will stop the pandemonium and collapse? Nothing changes. In fact the disintegration of the NHS seems to hasten.

Indiana Lansley rushes for the fast dropping door. If he doesn’t make it he will be crushed by the rubble of the NHS, never to be seen again. As he runs he can feel the glow of the 18-week idol behind him. Its power burning into his spine as he flees. The door falls ever faster.

He has always got there in time before…

This is a classic case where plumping directly for cost-cutting measures in the short term has caused costs to go up in the medium to long term.

If we are to avoid more of this kind of occurrence happening across the public sector we need to realise that the only sustainable way to cut costs is to improve services.

Delaying the delivery of defence equipment won’t save money because there is a cost to changing the course of procurement and production, then the cost of interim measures and finally the cost of restarting the delayed projects. Add to that the cost of getting ever more out of date equipment and materials and the loss of value in addition to the obvious loss of funds is clear.

Finding better ways to deliver the equipment our armed forces need would be a much more fruitful endeavour. Procurement exercises that were tasked with giving just what was needed, when it was required with much shorter turnaround times between identifying the need and the arrival of new capability on the battlefield is the way to cut budgets. And we shouldn’t get sidetracked that this is a procurement problem. More procurement with more checks, “better” specifications and tighter controls will only make things worse. Instead, it is the value that is brought to our defensive capability by what we obtain and how to shorten the time to bring it into service which will lead to less money being spent.

Best,

Rob

They are Ikea and the process is selling a kitchen to be delivered. It starts out promisingly. You can use an online, 3D design program to position your desired cabinets, drawers and appliances with the doors and handles that you want. You can whirl the 3D image around and print top and side views with dimensions on.

But when you go into the store to order the kitchen you designed it starts to unravel. The assistant in the kitchen department spent time with us so we could check that we hadn’t missed anything obvious and she did pick up that we had picked a waste sorting cabinet that wasn’t being used with a sink meaning she could change the drawers to be much deeper. But then she had to manually add text lines in the order that was generated from our design in order that we could see which group of five parts related to which cabinet. After this protracted process we collected the cabinet legs and other little bits from the warehouse and went to pay.

After paying we queued at the Home Delivery desk, where to our shock a very nimble fingered man took the printed order sheet that we got from the kitchen department and proceeded to re-key all the stock numbers and quantities for each one of the 45 individual parts needed to put together our kitchen into the picking and delivery system. Why the kitchen systems and the delivery system don’t talk to each other is amazing to me.

He was a bit put out when I asked to check his duplicate entry, but I knew that five minutes to spot a mistake was better than weeks to try and get Ikea to send the correct part. In fact it was all correct – this time – but I wonder how may orders get copied over incorrectly given the number of kitchens Ikea must deliver every year in all their stores.

To top it off we couldn’t choose a day for delivery. We ordered on Sunday so they pick the next day and deliver the day after that. So it was Tuesday or we wait three weeks. The reason given was that they don’t like to pick an order then have it lying around waiting for delivery. That I understand, but I see no reason that they can’t put our order on the Thursday pick schedule so they deliver to us on the Friday that is most convenient.

I wonder if any of their senior staff has walked through the process as a customer like I had to do this weekend? I’ll wager that they can’t have, since if they did they would want to change it quicker than I could say, “We’re missing half our kitchen.”

Best,

Rob

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I like the film ‘Firefox’. I recognise that it is not a great film but it has Clint Eastwood and I like that kind of watchable, post-cold war thriller.

The basic plot is that Mr Eastwood plays Mitchell Gant, an elite ex-fighter pilot who is brought out of retirement because his mother was a native Russian speaker. His mission is to go deep into Soviet territory to steal the latest high-tech Russian MiG fighter – code named Firefox – which has a thought-controlled weapons system.

After many adventures Gant is hidden by the very scientist, played by Nigel Hawthorne, who designed the thought-controlled weapons system that the Americans want to get their hands on. Hawthorne tells Gant that in order to operate the weapons system that he, “must think in Russian”.

Cut to Gant flying over the Ural mountains in the stolen Firefox with another MiG fighter on his tail thinking, in English, “Fire the rearward missiles. Fire the rearward missiles.” Obviously nothing happens until Nigel Hawthorne’s floaty, accented voice is heard saying (of course) “You must think in Russian.” Quick as a flash, Gant repeats his thought but in Russian and the rearward missiles fire, destroying the dastardly Soviet foe who is on this tail. America wins again!

(Nearly there with the relevant bit…)

When I was taking my final exams at university I knew that not only did I need to answer the questions correctly but I also needed to think like the examiner in order to get maximum marks. Given that these were mathematics exams that meant showing lots of clear working and getting the maths jargon in that they liked. So just before the invigilator would say, “You may now start,” I would repeat, under my breath, “You must think in Russian,” to remind myself think about what the examiner wanted.

What has this to do with public services? Well if we are to save services from the cuts, we must think in the right way. That right way is to think like our customer thinks. Thinking like ministers, accountants or even public sector staff won’t do it. In fact that could very well make things worse. We must understand what our customer thinks of when using our service and design the service to maximise that. Forget internal customers, forget auditors, forget management whims, focus on the customer to deliver fast, error free services which in turn will remove waste and cut costs.

Anytime we are thinking of making a change, pause (but not long enough to let the following MiG shoot you down) and listen for Nigel telling you that, “You must think like your customer.”

“You must think in Russian.”

Best,

Rob

However, the problem is deeper than cuts to budgets. The problem is that the government, the Labour party and the unions are still stuck in the model that says cuts to budgets means cuts to services which in turn leads to negotiations or strikes to fight those cuts.

We need to step back and challenge the assumption that cuts in budget require cuts in services. In fact the opposite is true. Improving services is the only true, reliable and sustainable way to reduce budgets.

Many services are full of waste, delay and errors. It is not because staff aren’t trying hard. As W. Edwards Deming said, “We are being ruined by best efforts.” The problem is that we don’t manage services as systems so trying hard to optimise one corner of the public sector will sub-optimise the service to the public as a whole.

In place of negotiating or striking about this cut or that cut, unions, management, staff and government need to work first on improving services to remove the costs that litter processes. This will bring them together to work on the problem of providing better value to the public instead of fighting about how to remove value altogether.

Best,

Rob

The Guardian reports a spat between a health insurer and the consultant surgeons that are operating on its clients knees. We can’t know who is right, all we can say is this is the kind of thing that happens when you mix economic and service incentives.

People paying out money will always want to reduce it and those being paid will always want to maximise it. Of course the vast majority of surgeons want to give just the right care to their patients, but you can see how some might have their heads turned. You can also see how a health company would rush to protect its business model by trying to cut costs.

In the middle is the patient wanting the right treatment for their knee. With all the money floating around no wonder they get forgotten sometimes.

I just hope these kind of spats don’t get more common as the health landscape changes in the next few years.

Best,

Rob