Archive for March, 2009

Privacy

News this morning about the government’s ‘illegal’ databases: http://www.guardian.co.uk/politics/2009/mar/23/dna-database-idcards-children-index and http://news.bbc.co.uk/1/hi/uk/7955205.stm.  I suspect the story is not quite as exciting as the headlines have suggested.  But two things come to mind.  One of the examples used to illustrate the problems caused by the misuse of data is that mothers suffering from post natal depression might be reluctant to go to their doctor for fear of the information being passed to social workers.  Only a few weeks ago, we were being told, in connection with the Baby P case, that doctors and social workers need to talk to each other more and share data.  Which way do we want the government to be pulled next week?

But the second thing is slightly more comical.  If you heard the minister being interviewed on the Today programme on Radio 4 this morning, it was almost a classic episode of Yes Minister.  I am thinking of the episode, ‘The Greasy Pole’, in which the minister undermines scientific advice by following Sir Humphrey’s checklist.  All reports can be criticised on the following lines:

  1. it leaves important questions unanswered;
  2. the evidence is inconclusive;
  3. figures are open to other interpretations;
  4. certain findings are contradictory; and
  5. some of the main conclusions have been questionned.

This is almost exactly what was done this morning.  And to finish it off, the minister also ‘played the man and not the ball’ – he questionned the author’s ability to speak on legal matters when he has no legal qualifications.

Further proof, if any were needed, that Yes Minister has much to teach us about Whitehall.

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Canada shows the way

Hats off to the Canadian spokesperson who called George Galloway MP an ‘infandous street-corner Cromwell’.  First, because it is a beautiful encapsulation of the man.  Second, because of the use of the word infandous.  So often, public servants are criticised for using opaque language.  In this case, all the news coverage had to give a definition of the word – ‘too odious to be expressed or mentioned’.  It is nice (almost unheard of?) to learn something useful from government spokespersons.  And this is one word I will certainly try to use more often!

Mid-Staffs and the management of health services

News yesterday of the report into the standards at Mid-Staffordshire NHS Foundation Trust: http://www.healthcarecommission.org.uk/newsandevents/mediacentre/pressreleases.cfm?cit_id=1640&FAArea1=customWidgets.content_view_1&usecache=false.  Much of the media coverage seems to have decided to direct questions at politicians for the regime of targets and incentives put in place and the management responses to these incentives.  Most prominently, the Trust received Foundation status recently, giving it more autonomy from central controls.

But can the series of failings be blamed on management’s drive to achieve their targets and Foundation status?  To some degree, this will have been an issue.  Certainly, financial constraints and 4-hour waiting times in Accident and Emergency feature as a focus of attention.  But some of the standards are so unacceptable that they do not represent reasonable managerial responses to any target or pressure.  What hospital would seriously decide to fail to respond to calls from patients or fail to provide trained staff to make clinical decisions?  At that point, have you not ceased to be a hospital that anyone would recognise?  To that degree, the failings are not the fault of the performance regime but of the management.

Some organisations do lose sight of their purpose – this is the case in the public, private and not-for-profit sectors.  The Healthcare Commission suggests that Trust Board meetings in this instance focused on finances and targets, not on care (though I would suggest that this is the case for many Trust board meetings – certainly those I have seen).  Perhaps more importantly, they failed to pay attention to the consequences of their decisions.  For me, this is the key.  Management decision-making can look all very reasonable and rational at a meeting or in a report.  But we have to understand the consequences for the service they provide – particularly in a health care setting.

Baby P and child protection

Lord Laming’s second report into child protection procedures in England was published yesterday.  The conclusions are not the subject of banner headlines this morning in the national press.  Weeks ago, we were treated to headlines condemning social workers – how could they not have known, etc…  This from a media that is normally more comfortable criticising the interference of the ‘nanny state’.

Laming’s second report (available at: http://publications.everychildmatters.gov.uk/eOrderingDownload/HC-330.pdf) gets straight to the heart of some difficult issues.  The processes are there on paper – the problem is implementation.  And the failure of implementation is not simply incompetence, idleness or malice, as too many easy headlines might suggest.  Instead, it is about people in a system that is creaking at the seams.  And, at the best of times, the role of social worker is not an easy one.  Laming puts it well in the introduction: ‘Frontline staff in each of the key services have a demanding task.  Their work requires not only knowledge and skill but also determination, courage, and an ability to cope with sometimes intense conflict.’  Recognising the complexity of the role and consciously developing staff to make judgements and to act on those judgements is key.

But Laming spots the other big problem – the commitment of senior managers.  The two issues are closely linked.  Managers need to know that their child protection staff are well trained and that their judgements can be trusted.  Social workers need to know that their managers will support those judgements.

Once again, it is people and their relationships within and between organisations that determines how effective a policy is.

The civil service – fit for purpose?

The think tank, Reform, published a provocative report last week reviewing the civil service.  Drawing upon the recent Capability Reviews in Whitehall (see previous posts on this issue), the report suggests the need for significant changes to deliver effective policy advice, management and accountability.  While some of the recommendations are nothing new, it does raise again the question, often avoided, about the competence of the civil service to deliver.

The report is available at: http://www.reform.co.uk/fitforpurpose_217.php