Examination of Witnesses(Questions 520-537)
MR JAN
FILOCHOWSKI, COUNCILLOR
JOHN BEES,
MR CAREW
REYNELL AND
MR JONATHAN
HARRIS
TUESDAY 10 DECEMBER 2002
520. That is very lyrical!
(Mr Harris) I work in education.
Mr Brennan
521. You should work for the Tourist Board!
(Mr Harris) It has children often from a very deprived
background. Our schools achieve extremely well. 83 per cent of
our secondary schools achieve above and well beyond the comparative
figures for OFSTED and the remaining 17 per cent are as good as
any other school in the country. Our primary schools generally
speaking are very good as well. So our schools are good and if
you add the value-added data you will find that the schools achieve
very high value added. In terms of the overall achievements, we
are above national averages but we are not as high as some of
the more affluent areas in the country. That is why continuous
improvement is important for us rather than just absolute numbers.
Mr Prentice
522. Have other LEAs had this head-to-head with
the Department for refusing to accept the target, this process
of negotiation, and then had it all worked out at the time? We
know about Cornwall because you are here telling us but has it
happened anywhere else?
(Mr Harris) I do not think so. We are the only authority
that has not agreed that particular target with the Department
for Education and Skills. They have had negotiations with other
authorities but eventually they have agreed DfES targets. That
may reflect the fact that the targets in other places are more
realistic but in Cornwall's case we felt we could not accept the
target put upon us.
Sir Sydney Chapman
523. You have spelt out in graphic detail your
"negotiations" with the Department of Education. You
came to this point where they were not prepared to adjust the
target. All the evidence that I have heard on this visit to Bristol,
not just at this meeting now, is that the government departments
care damn all about local situations or local specialist needs
particularly in an inner city area and "what we say goes,
they are tablets of targets". Is that the case from the local
authority point of view?
(Mr Harris) Do you want me to answer that in education
first and pass it to the others? I am not sure I would necessarily
use the language you did but maybe on a bad day I might! It is
certainly the case that much of what is happening is formulaic
rather than based upon local knowledge. I think the second position
as far as we are concerned as an authority is that we are put
in a very difficult position because if the government comes along
to us with a target which they have calculated nationally and
says, "Agree and accept that", we can agree and accept
it with them but then we are put in an impossible position with
our schools. We have to go to them and disaggregate targets school
by school and they will say, "We cannot achieve this, it
is impossible." I would send out advisors and inspectors
to have negotiations with Headteachers when both of them know
negotiation is pointless. That is why I think that sort of target
setting is very demotivating and a waste of public resources and
we could use those resources much better. The Department for Education
and Skills have not handled this well. They have handled it in
a cavalier way and put local authorities in very difficult position
indeed, and it is better to avoid that by building targets that
are motivating for staff and motivating for the authority.
(Councillor Bees) We have had some difficulties when
we have been looking at our stretch targets, and I think that
tends to be more around which department we may be dealing with.
Some of them Carew alluded to earlier. Some departments have a
record of setting targets for longer. We have had some particular
difficulties around our transport targets where we have been engaged
in quite a lengthy discussion about what we thought might be an
extremely stretching target for us but we were told absolutely
we could not have that and would have to move to something else.
Carew, do you want to explain it more fully?
(Mr Reynell) The local authority engaged in a process
of supplementing the range of national targets that we work to
by entering into something called a Local Public Services Agreement
which agrees specific local targets for 12 performance indicators,
seven of which must be drawn from the national list of indicators,
five of which can be prepared on a local basis. As I said earlier,
the City Council has a long record of numerically-based performance
management so there are quite a lot of those local performance
indicators. That process involved parallel negotiations with a
number of government departments. I would simply say that there
were marked differences in the degree of willingness to engage
in open discussions about local issues and targets between government
departments. In some cases I think our view was that there was
a willingness to listen to local arguments. In other cases there
seemed to us to be a much more—choosing my words carefully—doctrinaire
clinging on to the national targets and unwillingness to deviate
to any extent. So I do not think our perception of the situation
is uniform of the sort that you characterised. Our understanding
is that this is a process of preparation of Local Public Service
Agreements between public and local authorities. One of the reasons
that the Local Government Association has been prompting this
has been to encourage dialogue between the civil servants involved
in setting targets for specific local authorities to keep the
civil servants up to what delivering the targets actually means
in local circumstances. That is very time-consuming and that has
to be juggled with all sorts of other measures. As we have said
before, it is something that a track record of engagement in detailed
discussion with authorities about targets equips civil servants
and particular departments to a greater extent than others.
524. Jan, if I can come to you. The Prime Minister
said in the House of Commons very recently words to the effect
that of course we must meet clinical need in the National Health
Service, that is the paramount thing, but that he had no intention
of getting rid, as he put it, of waiting lists and waiting times
because they are important to the patients. When he said waiting
lists and waiting times, of course we know the difference between
the two.
(Mr Filochowski) He had no intention of?
525. Of getting rid of waiting lists or waiting
times.
(Mr Filochowski) The targets rather than the actual
things. That would be great to get rid of waiting lists!
526. Because they were important to the patient,
to the public. I think he was speaking generically, he was talking
about targets as a whole. Again, all the evidence I have heard
suggests not this sweeping phrase that targets and clinical care
and clinical need are incompatible but that at least some targets
are totally incompatible with providing the clinical need of patients.
I would like you to comment on that.
(Mr Filochowski) Compatible or incompatible?
527. Incompatible.
(Mr Filochowski) I am sure I can think of one now
that is completely incompatible but I do not have to. I can think
of some targets that are compatible. Let me give you a target,
the Government's National Service Framework for cardiology, if
you come in A&E having had a heart attack and you need clot-busting
thrombolistic drugs and getting those into you very quickly is
the key to your survival, and on the basis of good clinical evidence
you should get that drug administered within 30 minutes of your
arrival at the door, the Government has set a target of 75 per
cent of patients with a door to needle time within 30 minutes.
Most hospitals are missing it by a mile. My hospital Bath when
I arrived were at 33 per cent. Last week we were at 82 per cent.
I think it is a pretty good target and the effort we have put
into achieving it is improving clinical care. It is possible to
have specific targets that work alongside rather than in contradiction
to clinical priorities. It is just a matter of using discrimination
and intelligence in selecting them.
528. The point I am trying to make is that some
targets damage or make impossible the clinical need of the patient.
(Mr Filochowski) We should get rid of those. Which
ones have you in mind?
529. We have heard evidence, and I only hesitate
to give it because I may get it slightly wrong. We had an eye
specialist saying that because they had to meet a certain target
there that the recall visits were delayed to meet another target
and some people were in danger of their glaucoma getting worse
and beyond repair, if that is the right clinical phrase.
(Mr Filochowski) I think there is an issue here. You
could set me an impossible target or I could set you an impossible
target. It is back to Jonathan's point about credible and achieveable
targets. Clearly if you squeeze too hard even the best run of
organisations will be unable to meet a target if you make it too
hard, so I think the skill and the knack is setting achievable
targets. I have heard of the stretch target terminology and there
is something about targets which are difficult but achieveable.
Clearly if they are not really achievable what you end up doing
is making the invidious choice between two very important things.
I think it is about getting the level of difficulty of the targets
right. It is not always right and it would be astonishing if it
always was, but I do believe in relation to access targets, after
a fairly bumpy start, that the targets are now much nearer to
being right—they are difficult but achievable. I think if
they are achievable withoug perverse consequences they will improve
patient care.
530. I must persist on this. I realise you have
been in Bath since July but you were in Medway before that.
(Mr Filochowski) And one or two other places including
Bristol.
531. Sure, but you must have come across a particular
target being set the effect of which was that clincial care would
be jeopardised. Surely, it would be your professional duty to
immediately get in touch with the Department of Health and say,
"Hey, this is endangering people's lives." The consequence
of that target innocently made, I am sure not intentionally, is
going to result in a few people dying because you have got to
meet something less important in another sphere of the hospital.
(Mr Filochowski) I think it is rarely as black and
white as that but certainly I believe that there are targets that
are set which are unhelpful and perverse, and within limits I
certainly say that. I do not write to the newspapers and say it,
I make a comment as a professional through the appropriate channels
in the NHS, and some targets get changed as a result of that.
They do not all get changed but I do not think there is a complete
blanket refusal to respond to criticisms of inappropriate targets.
532. So you feel the Department of Health is
receptive to any representations you make along those lines?
(Mr Filochowski) No, I do not think it is receptive
to any representations I make, it is receptive to some representations
some of the time. It is a matter of judment and I am not in a
position to make a judgemnt as to how effectively they respond
to representations but they do some of the time and they do change
targets. I am in little doubt that the move from measuring waiting
lists to waiting times was because of the pressure of the continuing
commentary by NHS managers and clinicians that waiting times is
a much better measure of need than numbers. That was their number
one flagship target.
Sir Sydney Chapman: Thank you.
Chairman
533. We will not keep you beyond 4 pm. We have
only got a couple of minutes left.
(Councillor Bees) Can we just say something about
the dificulty we have had with targets here in Bristol.
(Mr Reynell) To give a specific example about targets.
One of the targets of social services authorities is the proportion
of children to be kept beyond a certain period of time on the
child protection register and the objective in social services
authorities is to make arrangements that make it possible to take
children off the child protection register after not too long
a period has elapsed. Social services authorities are assessed
on a scale of nought to three stars. One of the critical determinants
of the star rating is performance on that particular indicator.
Bristol as a social services authority is currently a one-star
authority and would be a two-star authority were it not for its
performance on that particular indicator. There has been considerable
criticism locally and within the Department of Health about the
appropriateness of that as an indicator. Social workers have to
make judgments about whether it is appropriate for children to
stay on the child protection register. The existence of a threshold
on that target means that social services and social workers having
made judgments which are accepted by the authority has resulted
in the authority overall largely missing its targets on that,
ie there is a higher proportion of people staying on the child
protection register for more than 18 months, as a result of which
the authority is ranking as a one-star rather than a two-star
social services authority.
534. Would it be a good idea if we had some
kind of arbitration, brokerage, targets tribunal? It is a serious
question, that if the centre and organisations are in dispute
about the credibility or achievability of targets, Cornwall for
example with the Department of Education, you take your respective
cases somewhere and then have it adjudicated upon. Is that daft?
(Mr Harris) I am not sure that would be beneficial,
Chairman, because I think the danger is we will start going to
yet more bureaucratic time spent on discussing targets rather
than discussing what is going on on the ground and what is important
in schools, in my case, and in health and elsewhere. I would rather
have a discussion with the DfES ministers with flexibility on
their part and flexibility on mine. Over the last 12 months I
have not seen as much flexibility as I would have liked and perhaps
I have been used to over the years. I would rather have discussions
on that basis, rather than a tribunal. That is a personal opinion.
(Councillor Bees) In Bristol's case we would rather
protect the children than just meet the indicator and get an extra
star. We employ people in a professional capacity to try and make
judgments and we try to back those people.
535. Jan does not worry about it because he
meets the targets anyway!
(Mr Filochowski) He certainly does worry. A no-star
trust with three months' notice, I certainly worried about them
there. I am thinking really hard about your question because it
is quite a profound one. I think probably not on balance. I think
we should seek to make what representations we can where they
are wrong. I think there is some dynamism in the service over
time to get better ones and certainly in the NHS now ministers
are at least committed to giving the setting of targets to a quasi
independent body, the Commission for Health Audit and Inspection
that they are intending to set up, so they are trying to respond
to the criticism that they are subject to short-term political
gain. I think it is moderately impressive they are trying to do
that. The more important thing at the end of the day is how they
are used. If they are used merely as a stick to beat people with,
however good they are, I do not think they are going to fulfil
the right function. Equally, if they are ignored then they are
pointless. I think it is about using them to accept there is a
need to change performance hopefully in a not too threatening
way.
Chairman: We have brought our own bit of Somerset
with us and it is appropriate that Ian from Bridgewater should
ask the last question.
Mr Liddell-Grainger
536. Cornwall, I am rather intrigued. They always
say a good Cornish meeting is one where blood flows over the carpet
and out the door. When you came down to Cornwall how long did
it take you to convince the Council that there was something fundamentally
wrong here and we would have to take on the goverment to say this
is not right, and did you convince them all?
(Mr Harris) I am not Cornish but I have been in Cornwall
a long time and we have seen massive improvement in education
in Cornwall and our schools are some of the top performing in
the country, as judged by OFSTED, so we started from a position
of some strength. It did not take me any length of time at all
to convince the people who mattered. When I showed a number of
examples to both elected members and Headteachers, they said,
"I agree that what you are suggesting is right." I have
had total all-party support from Labour Conservative, Liberal
Democrats and Independent members—and the Independent group
in Cornwall is a big one and quite wide ranging. I have had total
support from Headteachers, primary and secondary. I have had a
number of letters from members of the public. If I wanted to make
myself really popular, it is a good way of doing it but it was
not done with that intention in mind. I have had no Headteacher,
no member, no member of the public saying, "What you are
doing is wrong." That is very interesting. Life is not normally
like that as a chief education officer!
537. That is fascinating. Can I ask finally,
why are you leaving?
(Mr Harris) I am going to join an outstanding organisation
in Hong Kong called the English Schools Foundation as Chief Executive
and I am looking forward to that in January.
Chairman: We are leaving because we have got
to catch a train. Can I thank you very much indeed for your time.
Can I thank first of all Bristol and the Bristol area for the
last two days. We have had a wonderful reception and learnt a
lot. Everybody here has helped us. We are particularly grateful
to you for coming along and giving your time this afternoon and
for the instructive way you have run our whole visit. I hope we
reflect some of the things you have told us in what we say to
the Government shortly. Thank you very much indeed.
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