Government ministers live on Planet Whitehall while the rest of us live on Planet Earth. The two places are, as the songs have it, worlds apart. Thus on Planet Whitehall earlier this week, Andy Burnham, Health Secretary, said: " As the National Health Service strives to move from good to great and becomes more people-centred and preventative, the (NHS) Constitution will ensure that all the improvements it makes can be safeguarded for generations to come."
A day later, back here on Planet Earth, the Nursing Times, revealed that nurses are being asked to treat patients in store rooms, mop cupboards, wards that are already full and, in one case, a kitchen area. In a Nursing Times survey to which more than 900 nurses responded, nearly two thirds said patients at their hospitals were being treated in areas not designed for clinical care.
They highlighted "threats to safety including patients having no access to call bells, water and suction facilities, missing emergency equipment, risk of infection and fire exits being blocked." The privacy and dignity of patients is often compromised.
Up there on Planet Whitehall, Mr Burnham, I have no doubt, is a talented operator. Still only 40 years old, he has been in Parliament scarcely a decade and yet is now holding his second Cabinet post. However, it is some years since he last lived on Planet Earth. Since the age of 24 he has been, successively, a Labour Party researcher, a trades union official and special adviser to a minister and then, finally, a MP. With apparently no experience of running anything, of meeting the needs of customers, of being responsible for staff or of having to lead by example, he presides over a National Health Service that employs 1.5 million people, a number exceeded only by the Chinese People's Liberation Army, Walmart and the Indian Railways.
This is how the British system of government works and I shouldn't mind it provided that ministers did their jobs in partnership with talented civil servants who could make up for their deficiencies. (I have addressed this question in depth on my social networking site brokengovernment.ning.com). Unfortunately, this way of working doesn't commend itself to governments that feel bound to engage in marketing themselves to the electorate from the day after an election victory until their next appointment with voters. So instead they set eye-catching targets for the delivery of public services and attempt to enforce them with such severity that bullying has become commonplace across government.
On Planet Whitehall, Mr Burnham thinks what a good idea it would be to give constitutional backing to targets for hospitals. He has announced, therefore, a revised NHS Constitution that sets time limits for the provision of various types of treatment. In the circles in which he moves, this seems a very reasonable thing to do, backed up as it has been by a consultation in which some 8,000 people have taken part.
Down here on Planet Earth, however, the nurses who have been complaining to their managers about dangerous over-crowding have rarely been heard. They were commonly told that all other space was full, accident and emergency was under pressure, the move was authorised by senior managers, or the A&E waiting time target was at risk. One nurse told the Nursing Times: "I carried out a risk assessment on my ward which showed this was a very dangerous and high-risk practice, but it still continues as I am told there are just no other beds available and the instruction has come from the chief executive."
There are two things to notice here. One reason given was the imperative of meeting a target. Second, the instruction came from the chief executive, who is unlikely to have any medical knowledge.
In fact setting numerical targets may easily do more harm than good. John Seddon and Peter Middleton have done a lot of work on examining the impact of targets. Mr Seddon runs a consultancy specialising in organisational change and is a visiting Professor at Cardiff and Derby Universities. Mr Middleton is a senior lecturer at Queen's University, Belfast. They have just published six case studies taken from the public sector (Delivering public services that work).
The problem with targets, they say, is that they are set by people separate from the work and with no knowledge of how the work is carried out. This would be true of most government ministers. In a target-driven process, instead of engaging the employees, "a premium is placed on their compliance and how they perform against target. This channels their ingenuity away from serving their customers to achieving their targets. Staff constantly look upwards for direction rather than outwards to their customers."
One case study describes the handling of housing benefit for 10,000 households by East Devon District Council. In place was a system of command and control such as the NHS practices. East Devon had split the work into small pieces to increase efficiency. No individual member of staff owned a claim because it was believed that would be less stressful and more efficient. Fraudulent information was actively hunted down. Average processing time for each new claim was 36 days.
Yet when East Devon managers asked their customers what they wanted they discovered modest demands: a kind, caring person to help them out; a quick decision; to be kept informed; to have forms and processes that are clear and easy to understand; and to be asked only once for all the necessary information. East Devon District Council reorganised its operations to meet these expectations. It found that the creativity unleashed was "remarkable" and the average processing time for new claims improved to 17 days.
So ministers should come back to earth. I would like them to be seconded in turn to run small businesses for, say, six months. They would encounter real customers and have to manage staff on a face-to-face basis. Who would offer Mr Burnham a post? Don't hesitate for, with practice, he might be as good at business as he is at politics. But when he got back to Whitehall, he would never again make statements as silly as the ones quoted above.
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