Examination of Witness (Questions 660
- 679)
THURSDAY 13 DECEMBER 2001
DR WENDY
THOMSON
660. I ask that question because it is only
about five per cent of greasy spoon cafés in Blackpool
that get inspected by the environmental health people. I ask that
question because we are all horrified at what happened in Rotherham
with the adulterated meat and poor old Rotherham Council spent
about a million pounds tracking down these people that were passing
off adulterated meat meant for the pet food market into the human
food chain. I wondered whether there should be a national standard
on that.
(Dr Thomson) It is not an area I could claim any great
expertise in. I do know there is a Food Standards Agency which
I am sure will be looking at that and at what it considers to
be appropriate regulatory frameworks.
661. Are there instances where the Local Government
Association are coming to you saying that they should have national
standards for those particular services or is it all the other
way, that central government is saying to the local government
people where the national standards should apply? With national
standards must come resources. You cannot say we are going to
have the same standards in Cornwall, Somerset and Lancashire without
underwriting them.
(Dr Thomson) The flexibility on finance is increased
with the new White Paper with the recognition that councils need
to be able to serve their communities in flexible ways. Their
reliance on grant is not as complete as perhaps it has been, so
resources are important. My impression is that local government
wants clarity in standards. Like anyone, if you are going to be
assessed as good or bad, you want to know the basis on which that
judgement is to be made.
Chairman
662. Is there a single place where we can go
and find out about public service agreements, we have got this,
we have got that, we have got national standards? Is there a compendium
of all this so that we can go and turn them all up in one place?
(Dr Thomson) I believe the report of the spending
review on the public service agreements that are published at
the completion of the review is a pretty comprehensive statement
of the performance expected of public services.
663. That is the PSA system, but there are many
things now that are added on beyond that, are there not? It is
a question of how these things all fit together. It is purely
a factual question. If I want to see the whole gamut of targets,
standards, everything, can I go and turn it up somewhere? Is there
a book I can go and look at?
(Dr Thomson) I think they all do follow from the PSAs
that are at a high level and from there you can follow through.
I am not aware of a compendium that embraces every single service
across the country. I think it would be pretty thick and pretty
hard to digest if you looked at it across the board.
664. But is that not precisely one of the issues?
(Dr Thomson) What would make it complex is that if
you want local diversity some of those standards go down to a
very local level and that is as it should be, but we perhaps at
this level need to know those areas to which there is a clear
national commitment to a set of performance targets.
665. Does it matter that these consumers out
there have not got a clue who provides services any more or what
standards they are working to, and therefore who to punish if
things go wrong and who to reward if things go well?
(Dr Thomson) I think it does matter a great deal what
the public knows and does not know. One of the commitments in
the government's modernisation programme is that there should
be greater transparency to the public about what they are entitled
to and how they should access it. Certainly the local government
modernisation programme very much talks about dialogue with local
communities. I recognise too that the MORI polls on public understanding
of service delivery show that people are not always aware. That
is why a lot of public services are now placing more emphasis
on informing the public better. A better informed public will
make better use and access to services. If you look across government
there is a lot of priority being placed on this at the moment.
Mr Heyes
666. I want to follow on from the points that
Gordon Prentice was making about local authorities. I am still
a local authority councillor. I have not been a Member of Parliament
for very long; I am still doing both jobs. The local authority
that I am a member of was a best value pilot authority. We have
had very good best value reports consistently. We passed our local
authority Ofsted with flying colours, we have good SSI reports,
we have promoted a customer oriented culture. We have been okay
on all the performance indicators that we have been set to achieve.
We have attracted very large sums by way of bidding processes
all of which involved rigorous assessment of local authority capacity
to deliver along with their partners. It would seem that that
is an example of a well performing council. In fact it is Oldham
Council, which was declared early this week to be a prime example
of public service failure, where we had riots in the streets,
where we have ghettoisation in housing and education, and we are
a prime example of poor community leadership. There is a very
clear contradiction there which I would welcome your observations
on.
(Dr Thomson) I would agree with the thrust of your
point that community leadership must be the key aspect of how
we judge the performance of local government. Local government
is about places and how attractive and supportive those places
are for people to live in and no judgement we make about their
performance should ignore that.
667. The features of a well performing council
that were listed under the proposals in the Local Government White
Paper I guess would objectively rank Oldham Council as one that
should have relatively more freedom with the loosening of central
constraints that you talked about earlier, but the recommendations
of the Ritchie Report into Oldham were that because of these failures
of community leadership the response should be to send in mentors
from the centre, Audit Commission advisers, consultants from the
Improvement and Development Agency to give advice and help with
capacity building. In fact, the form of the advice and recommendations
are to do more of what Oldham has already done and apparently
done successfully over the years.
(Dr Thomson) I cannot comment on what advice has been
given to Oldham in recent weeks. I would say that the framework
on which local government will be assessed will include community
leadership and will include the features that you are saying are
important and that local communities will be judged upon.
668. But is it not just more tinkering with
managerial approaches, changing fashions? Best value was the fashion
a couple of years ago and we did all that was required under that,
and we are now being told that it was too prescriptive and that
we need to introduce other measures. The system rolls on and a
new fashion comes along and the local authority has to dance to
the new tune. The real issue is about resources, surely. That
is why local authorities like Oldham struggle. It is not about
community leadership failing to follow the fashionable prescription.
It is about resources. That is at the heart of it surely.
(Dr Thomson) Some people are of that view. I do not
think it is a matter of resources alone. Obviously resources are
part of the picture. I think we have seen that throwing money
at issues has not always solved the problems and there are good
examples of some of the more deprived communities that attest
to that. Best value requires authorities to be in touch with local
people and very much strengthen the role of community leadership.
I am certainly of the view that public services very often, because
they are for the public, because the public value them and recognise
them for what they mean, are serving their purpose.
Mr Heyes: I will not push it too far because
it is in danger of turning into a rant from me. I am quite edgy
about the position this week, as you can probably tell. On that
particular point, Oldham did a MORI poll on customer perception
of the services and it produced extremely good results. The perception
of community leadership was good. That is not a question; it is
just an observation.
Mr White
669. When you talk about being in touch with
people is the problem not that it is the same people who are prepared
to be involved with best value and you do not get to the people
whose services you actually get at the end? Are we not in danger
in what you are doing, change management, the whole thing, of
getting to the same people who threaten to do it again and the
chattering classes and so on without actually getting to the real
thing?
(Dr Thomson) I think everyone agrees that you need
to find a whole range of ways in which the community can get involved
with public services. It needs to be done at a local level and
you need a strategy beyond the public meeting because that is
a limited strategy for talking to people in the modern world.
MORI polls are a strand but again there is a whole range of ways
in which you can communicate with people in a modern world where
there are lots of opportunities from telethons to the Internet,
a whole range of modern ways of communicating.
Mr Lyons
670. I should like to ask a question on the
Health Service. If I were to go back to my local health board
and say to them that the view of central government is, "You
have to tailor and shape services for the public here", my
view is that they would have me sectioned within about 20 minutes
if they could. How can we change that? How can we make the reality
at local level meet the theoretical drive?
(Dr Thomson) I need to understand better what you
think would meet with such surprise at the local level where you
live.
671. Let me give you one example. If I said
to them, "We want local maternity services", they would
laugh in my face, they would think I was off my head, because
the drive all across the country—and I do not think it is
any different in Scotland—is to centralise maternity. How
do I deal with that?
(Dr Thomson) I understand your point now. The need
to serve the public is not inconsistent with mature and realistic
understanding of how services can best be provided. I do not think
it is impossible to meet what the customer wants at a local level
and also for the customer to be informed about what is possible.
My experience of dealing with local people around their expectations
of services is that they do understand the reality of what resources
are available, they like to be well informed about the best practice
and on things like maternity services and other specialist health
services, and I think the public always wants something local
and convenient. They can be informed and persuaded by the information
that demonstrates that better outcomes are to be had by providing
services in a different way. I guess what I think you would recognise
in the front line is that most people are trying to do a good
job for people who come through the door and what they are frustrated
by sometimes is that they do not have the systems or infrastructures
or the modern ways of working that would make it easier for them
to do that. I think there is always a wish for more resources
at the front line. It would be a recognition of some of what I
am describing, of it being important for excellent public services
as well as a recognition of how there are still a lot of shortcomings
to create the environments where people can work well and serve
customers well.
672. This is not just one example from where
I live. It is across Scotland just now and certainly in major
parts of England that people have had a local maternity service
for over 100 years and are perfectly happy with that service—good,
efficient, effective service, good medical service as well; no
problems. Why should we centralise it? Why should we not keep
it local when tens of thousands of people, the customers, say,
"We want that to continue"? Why should we deny them
that?
(Dr Thomson) I do not know enough about the policy
on National Health Service maternity provision.
Chairman
673. We are back to delivery again.
(Dr Thomson) Obviously there is a central theme here.
The public does not always find change easy, just like some members
of staff do not find change easy. Some of the challenge that we
are describing is both providing some leadership when there are
new and better ways of doing things, provided the leadership explain
when and how we need to advance in that way, as well as being
tuned into what people needing the service want. Balancing that
is the job of the public service.
674. So you are giving me the okay to say that
you are telling them in the department that we can keep it local?
(Dr Thomson) If you read, as I am sure you will, the
NHS Plan, its implementation produced a document called Shifting
the Balance of Power which was produced this summer, which
was very much about devolution. The recent Health Bill commits
the Government to devolving 75 per cent of NHS funding to primary
care level and that is quite a radical devolution for the Health
Service. It has not yet become a reality because, as we know from
making a commitment to delivering, it takes time but certainly
the intention is devolution.
675. I keep telling them things can only get
better but they do not seem convinced. My second point is this.
In this very room a few weeks ago I came along to a session organised
by the Royal College of Nursing. There were nurses from all over
England and Wales, lots of very excellent nurses, and I thought,
"I must speak to as many people as I can and get a feel for
what is happening in the Health Service in England". It was
a quite consistent story that hardly a week would pass when there
was some new arrangement, some change. I said to them, "What
is wrong? Do you not agree with it?" They said, "No.
Quite simply it prevents us from working and improving patient
care. We want change but we do not want it to be our work every
day, every week, every month. We want to look after the patient
and this is an obstacle to working with the patient. Can you as
a politician not do something about that?" I said, "I
wish I could." How do we square that, that on the ground
there is no real relationship, that change is slow and we are
trying to help people, motivate them, encourage them, and they
just see it as nothing other than an obstacle to them providing
improved health service to the patients? How do we get round that?
(Dr Thomson) Certainly we need to communicate what
the purpose of the changes is and how it is going to make the
service to the public improve. That sounds quite simple but it
is not an easy task, something that is a huge task for something
the scale of the NHS with its 1.2 million staff. There is, from
the conversation with your nursing colleagues, obviously still
a job to be done. It is part of the communication task that government
is recognising: the focus on delivery should not be about continual
initiatives. When you are committed enough to the proposals faced
in the ten-year plans there is a consistent commitment to delivering
those. That should provide a greater consistency and sense of
continuity than perhaps there has been in the past.
676. I should tell you that I have tried to
say to them to help them with that, "Look; the Government
are pumping millions into the Health Service", and all the
nurses want is leaders here to help them get on with their work.
Another point is this. You make a great deal of communication,
which is quite important in my view. But does that not also give
a responsibility to listen to what people have to say about the
service they provide?
(Dr Thomson) No, I think that does come with a responsibility
to listen.
677. So how do we listen to the people in the
Health Service? How do we do that structurally?
(Dr Thomson) I believe that most NHS organisations
will have arrangements for listening to their staff and also increasingly
for listening to patients' experiences as well. You need to listen
to both.
Chairman
678. Do you think there has been an initiative
overload?
(Dr Thomson) Many people working in public services
have complained of too many initiatives, but that reflects the
impatience and lack of commitment to change perhaps. This agenda
of delivery is trying to bring those two experiences together,
a commitment to deliver, primary objectives, but to do it in a
way which is more continuous, more consistent and not leading
to a feeling of being overwhelmed.
Annette Brooke
679. Is there not a danger that with this initiative
we have to remove shortages of teachers and nurses and so on,
this is a big bang effect rather than a gradual change and that
it could actually be that what we might have to go through might
just be too painful?
(Dr Thomson) The improvement and retention of key
staff is obviously important to successful services. The statistics
are sometimes saying a number of things at once. I think when
you see the concern about shortage of teachers that is also in
part because there has been a real increase in the number of teaching
positions because of the increased investment that there has been
in education and it is the same with nursing and GPs in the Health
Service. As you invest so you need to expand capacity and the
shortfall becomes more clear. Just this week the Education Department
announced a net increase of 10,000 teachers within the last three
years which was in advance of the target they set for themselves.
It is important that there are programmes in place to attract
people into the professions right across public services.
| 
