Examination of Witnesses(Questions 540-559)|
THURSDAY 27 FEBRUARY 2003
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.
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,
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 managementwhich he talked about very
eloquently to the Committeeand 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 suggestionsor
criticisms for that matterand 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 prioritiessome
are national, some are localwith 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
(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.
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.
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
(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.
(Mr Macpherson) Very good slides. Far from bewildering.
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 announcementthe moving of the asylum
seekersthe 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
(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.