Select Committee on Public Administration Minutes of Evidence


Examination of Witnesses(Questions 540-559)

THURSDAY 27 FEBRUARY 2003

PROFESSOR MICHAEL BARBER AND MR NICK MACPHERSON

  540. Is it not the job of the Delivery Unit to chase them up?
  (Professor Barber) That particular responsibility lay with the Treasury, but wherever we were meeting departments that needed chasing up we were happy to collaborate with them in doing that job.

Mr Lyons

  541. Can I turn to the question of these red lights flashing about A&E departments. You mentioned, Michael, that in January to July, Health and A&E has top priority.
  (Professor Barber) It is one of a number of priorities, yes.

  542. What is the analysis of the problems in A&E across the UK?
  (Professor Barber) If you are going to go into details about a particular department I think we are moving away from the subject of the inquiry, but I am happy to give you a broad outline of that. The target for Accident and Emergency is that nobody should wait more than four hours to be treated in A&E. That comes home to roost in December 2004 which is not very long away. At the moment the Health Service is some way short of achieving that; around 80 per cent are achieving that. There is a milestone which we hope it will hit in March or April of this year of 90 per cent and then it has to go through to 100 per cent. There are a number of factors that affect performance in A&E. One is how you deal with minor injuries and the best practice in that area is a process called "see and treat". In other words, when somebody comes with a minor injury, just to look at it and deal with it immediately. That approach is being spread across the country by the Modernisation Agency currently. The other aspect that generates problems in A&E is bed management within a hospital. Obviously, as emergencies come in which are more serious, that affects the use of beds in the hospital. The part of best practice that is currently being transferred round the health service is to do with the quality of bed management and the relationship between emergency admissions and elective admissions. The process of effective bed management is also being transferred round the Health Service. It is the implementation of that that Alan Milburn, with the Prime Minister, is tracking very carefully at the moment.

  543. We took evidence in Bath and there was a nice story of almost turning a hospital round in some ways. The colleague who came to give evidence said that really it is down to capacity. He has increased capacity and it frees up enormous changes in terms of bed management and so on. Is there any way of taking on board that type of example and, as you said, using it as best practice across other trusts?
  (Professor Barber) Absolutely. The very large sums of money coming from the Treasury to the Health Service are very much focused on an expanding capacity across the entire Health Service. That is happening. But neither Mr Filochowski nor anybody else believes it is solely a matter of capacity. It is also a matter of effective management—which he talked about very eloquently to the Committee—and it is the combination of effective management with expanding capacity that are going to help deliver the A&E target and some of the other waiting times targets in time.

  544. You mentioned earlier on in evidence that you were quite keen on this bottom-up target setting. When we took evidence from Unison and the Royal College of Nursing and others, they say it is almost non-existent. They agree with targets in general but wanted to have in input. So how can they do that?
  (Mr Macpherson) There are limits to what we can do sitting in the Treasury, but we will certainly be encouraging departments to consult early in the run up to the next spending review. We did suggest that they do that last time. I think many of them did, but maybe some organisations fell through the cracks and we will be re-enforcing that. The Chancellor of the Exchequer is particularly keen on this as part of the programme of devolving and de-centralising and actually engaging with the front line, and, as I said, that added impetus will be put into that.

  545. Like you I am very keen on that approach and would support it in any way I could. I am just slightly worried when I hear more and more evidence of the amount of bullying that is going on in the health service and also it has been reported elsewhere. How can staff feel quite free to come and make suggestions—or criticisms for that matter—and feel quite safe in that situation?
  (Mr Macpherson) It is important that they should have an input into this process. In many ways this ties in with the whole debate about the Public Service ethos and empowerment of public servants. It is something which, the evidence suggests, is important and will improve the chances of success and clearly we have to do all we can from the centre of government to re-enforce that message. It is also worth considering how the targets could evolve over time. For example, one particular model of targets which I have had very positive feedback from local authorities is around local public service agreements where central government and local government actually negotiate priorities—some are national, some are local—with rewards built in, so that if the local authority succeeds against those targets it either gets more resources or it is allowed further freedom. I do think, as we move forward, we need to consider issues like that. In a recent speech the Chancellor set out a possible way forward which could give a greater role for local communities. He made a speech on 3 February, "A modern agenda for prosperity and social reform", and towards the end of that speech there is an interesting section on how targets might evolve. As national standards are established, as the targets are met, where do we go from here?

  546. Going back to the 15 per cent improvement of productivity by 2005, what figure are you looking to be at by the end of 2003 and 2004 towards that?
  (Professor Barber) Which target are you quoting?

  547. The 15 per cent improvement in the NHS by 2005.
  (Professor Barber) I do not recognise the figure.

  548. This was related to the report which said that 15 per cent was needed.
  (Professor Barber) I am not sure what the figure is.

Chairman

  549. I think we are probably not going to go down this road, but I think it was in the context of what was said to be your observations on the difficulties of meeting the 2005 target, the productivity leap which would be required to achieve that. I think that is what John is referring to.
  (Professor Barber) I am neither accepting nor denying that figure because I am not sure what you are referring to, but clearly we have some view of the progress which we make year by year. In answer to Sir Sydney Chapman's questions, we have been anxious about the number of targets and I am certainly not going to set a number of additional interim targets now in answer to a question. We will see what kind of progress both Health and the other departments are making against the targets. Announcing them publicly just adds to the pressures on public service workers that you have drawn attention to.

Annette Brooke

  550. I am rather seeing you at the top of a hierarchy of targets. I do not know whether I have that right. Does the Delivery Unit actually have targets for itself.
  (Professor Barber) We have a Public Service Agreement target which we share with the Treasury and the target is that we should improve Public Service by working with departments to help them achieve their PSA consistently with the fiscal rules.

  551. Is that measurable?
  (Professor Barber) It is measurable, yes, because we can first of all get the views of the departments on what they think about whether we are helping them or not, which we do on a consistent basis. Secondly, we can check whether their targets are being achieved over a period of time because we know when their targets come home to roost and we are tracking those. It is also measurable in the kind of perception way, which is the equivalent of what Nick was talking about earlier, of monitoring consumer satisfaction. Our consumers are, at one level, the Prime Minister and the Chancellor and, at the other level, the departments we work with and we can track that. Secondly, are the PSA targets being achieved over time?

  552. When monitoring, do you ever advise departments to get rid of a target?
  (Professor Barber) Nick mentioned earlier that there were 250 targets in the 1998 spending review and there are now 125 or so targets, so the answer to that is yes.

  553. Does the advice come from you?
  (Mr Macpherson) There is a dialogue and, for example, the target might have been achieved so you might want to drop it, you might feel that it is duplicating something else or it is quite possible that that particular area could cease to be a priority. The spending review is a good opportunity to review the targets and consider whether they should be rolled forward, amended, and so on.

  554. I am still thinking of this hierarchy. Do you actually go out very frequently to visit the schools, the hospitals? If so, how frequently?
  (Professor Barber) Staff in the Delivery Unit certainly make visits and I do visits that involve conversations with front line staff periodically, maybe once a month or so, but I would not want to be tied to that specific ratio. I could check back through my diary. It is important that we do that periodically but the most important thing is that the department responsible for a given service has both the ministers and the staff who work in it constantly in touch with the front line because they are the people responsible for the achievement of the targets.
  (Mr Macpherson) In the Treasury we are very much re-focusing the department so it is now far more outward focused and on the Public Service side I would expect everybody to go out and look at services regularly.

  555. I ask that question because I suspect that we had some evidence given to us that would not have been given to departments who were out visiting some of the staff, particularly in the Health Service, and I just wondered if you had some mechanisms for picking up on that type of evidence. We have the staff who claim to be bullied, and so on, and I think it is unlikely they would have given that evidence to the department.
  (Professor Barber) In order to get the real nature of the impact of the process of improvement that is being put in place, it is important that Delivery Unit staff and the Treasury people make period visits to the front line and hear how people receive the policies as they have been designed.

  556. Finally, coming back to one of our other inquiries, you mentioned reporting to the Chancellor and to the Prime Minister, do you give full reports to the Cabinet for Cabinet discussions?
  (Professor Barber) I have on one occasion presented on delivery to the Cabinet as a whole, but our reports are done for the Chancellor and the Prime Minister on a six monthly basis.
  (Mr Macpherson) The formal reporting lines to the Cabinet are through the PSX Committee and the PSX Committee is regularly updated. Indeed, Michael comes and presents his findings to it from time to time.

Chairman

  557. Slides?
  (Mr Macpherson) Very good slides. Far from bewildering.

Mr Liddell-Grainger

  558. Who is responsible for these targets? Is it the minister? Is it the Chancellor? Is it the Prime Minister? If you have a target, whose baby is it?
  (Mr Macpherson) It is very clear. Each PSA sets out who is responsible. At the end of each chapter in this booklet it says who is responsible for delivery and invariably it is the secretary of state. For some targets there is joint responsibility, for example in relation to our target, the Chancellor and Lord Macdonald are jointly responsible. Alongside that, in any well run department, there will be a senior official who will be the senior responsible officer who will drive forward that target on a day to day basis. In our case it is Michael and myself.

  559. I find that interesting because when we had the asylum seekers announcement—the moving of the asylum seekers—the Prime Minister started it, it was countermanded by the Home Office, it then went through a metamorphoses through the week. Is that actually correct, what you have just said? It did sort of change out of all proportion. That is just one that was announced and it became different things as it went through the week.
  (Professor Barber) Nick's answer is precise regarding the PSA targets set out in the July 2002 white paper. What the Prime Minister announced in the interview that you are referring to was his aspiration, where we will get to with reducing the number of applications for asylum seekers. It is not a PSA target but it is his aspiration and no doubt you and many other people in the country will be holding him to account for that and he is confident that it will be achieved.


 
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