The news from Jeremy Hunt’s Spring Budget was that the UK public sector needs to improve its productivity.
In fact, there will apparently be a productivity plan! He claimed that ‘raising public sector productivity by just 5% would deliver up to £20 billion of benefits a year’. This would enable him to restrict expenditure on public services and make much sought-after tax cuts.
Such productivity improvement plans are not new, but most of them have been top-down, and many involve developing and implementing new technology.
“Invest in new systems” we are told, “and the productivity gains will come”. Provided the systems work, of course. And so, to help make the NHS more efficient, £3.4bn will be made available to fund new technology. Great news.
The NHS Chief Executive, Amanda Pritchard is certainly enthused. She says it “means the NHS can now commit to deliver 2% annual productivity growth in the final two years of the next Parliament, which will unlock tens of billions of savings”. Presumably, she knows how this money will be spent.
Unfortunately, we now know there is no queue of projects awaiting sign-off. This may be just as well - anything specified more than three years ago may now be technologically obsolete.
Much of this additional money will have to be spent on new projects – yet to be agreed, and whose productivity gain potential is probably still unknown. And that is as it should be.
The pitfalls of top-down productivity plans
Top-down specifications lead to project goals that focus on centrally-driven targets – many of which frequently change, rather than helping staff and others do their work smarter. There is a long history of miscalculation and disappointment when such projects fail to deliver.
Looking for an example, I turned to one of the best books ever written about the UK’s public administration. Back in 2013, Professors Ivor Crewe and the late Tony King wrote the seminal analysis The Blunders of our Government – a devastating critique of how the British state is prone to serious mismanagement.
This week I have re-read chapter 13, called IT – technology and Pathology. It describes the countless IT disasters where Government departments failed to reap the expected rewards of massive investments.
One of the stories was of the ICL Pathways project to pay social security benefits through post offices. It became Horizon, and ten years later we know rather more about its consequences.
But the other story it tells is of another massive IT investment – personally initiated by Tony Blair over twenty years ago. It aimed to transform the NHS by building “the world’s largest civil information technology programme.” Known as Connecting for Health, It became a case study of how not to do things.
Health Minister after Health Minister believed civil servants and supported the project despite almost every clinician in the land telling them it wouldn’t work - until the Coalition put it out of its misery in 2010.
One of Crewe/King’s conclusions was as follows:
“Largely because the intended end-users of the scheme had been so little consulted, the various IT suppliers often had no clear idea of what they were supposed to be supplying, and in most cases merely sold the NHS whatever they happened to have on hand….” (at page 199)
Whether this is altogether fair may be up for debate; suppliers will deny it. But what is clearly true is that consultation with key stakeholders was sadly lacking, and we still hear today from users of IT systems. “This isn’t working; if they’d talked to us, we could have told them it wouldn’t!”.
Today, when bespoke systems are less common and we all try to make standard applications (‘apps’) fit our individual needs, the risks are even greater.
The importance of stakeholder engagement
The only reliable way to realise true savings is where people who know their jobs intimately discuss the potential changes that might improve the services they deliver or reduce their costs. These are the true key stakeholders.
Working with those who understand the technology - what it can and can’t do, there is tremendous scope for ingenuity and co-producing viable proposals. Even then they may need piloting and ensuring they don’t cut across other parallel innovations and integrate with other essential system and operational interfaces.
I cannot find any sign that there is a £3.4bn programme waiting for the off in the NHS. Nor equivalent programmes in other departments. What we have are provisional political funding allocations with only speculative ideas about how much might be the resulting productivity savings.
Yet around this cloud of uncertainty, there is a silver lining. When the money becomes available, and with many projects at an early stage, THERE IS TIME TO GET IT RIGHT. The NHS immediately could and should empower and facilitate its staff in all its dozens of disciplines to work in small teams to identify what really would help.
In fact, it should happen throughout the public sector. If we have a productivity problem – that is the way to fix it.
Consulting the staff in any workplace is always a good policy.
In change management, it is usually the difference between success and failure.
Written by Rhion Jones
Rhion Jones was the Founder Director of the Consultation Institute and is an acknowledged authority on all aspects of public and stakeholder engagement and consultation. He advises Tractivity and will be contributing expert analysis and commentaries on current issues.
Rhion now publishes thought leadership articles regularly as the Consultation Guru.