Getting My Sh*t together and other belated New Year resolutions

Faecal occult blood has a certain fashionably vampire ring about it. It gives the right air of spooky mystery so encouraging us all to get engaged and involved in our own health by sending in our samples for the bowel cancer screening programme. The instructions for collection are admirably brisk and matter of fact and we need not go into the detail here – the main point to remember is not to put the cardboard sticks down the loo. The collected goodies are then to be consigned to the post where we must hope there will be no recurrence of industrial action and postal delays. Anyway resolution one – to take more interest in my health – is  being put into practice although it may take a moment to get beyond the instructions in the leaflet. (Sound choice of communication channel – not one for You Tube.)

So I was already  in the right engagement frame of mind when a couple of days later I got an ‘invitation’ to join  the UK Biobank research project inviting me to come and be what – cloned in Croydon? Well something is happening in Croydon that  the distinguished researchers signing the letter assure me that while it will not help me directly, future generations will benefit from the data gained from tracking me and my health (are they separable?) into my grave.  This is one – positive – demonstration of how electronic health records make our addresses available to the passing researcher. They even offer to pay parking and travel expenses.

Add to this, the Tribunal action with other residents of my block of flats and the cup of public involvement rather over-runneth. But I and the other MAC Partners busy contributing as parents, members of the friends of the local park or in the GP practice patients group, do find that active engagement means that any advice we may offer others on how to engage people is all the better for having seen it from different perspectives – researcher, organiser, participant.

This gives us lots of stuff we can blog about on our new and improved website. We have brought together the public involvement blog and the main site and given it a new and lively look. We hope you enjoy it and feel free to give us some comments on how it looks and feels for you.

There have been a couple of blogs already this year. What do you think of the NHS Constitution? We give our views. The other blog is an inspired piece of photo journalism showing how a Kenyan hospital near Mombasa goes about getting its vision and service commitments across – they have not yet embraced the label ‘Constitution’.

2010 is looking good already and Partners enjoyed a Chieftain Haggis from MacSweens of Edinburgh. And if you thought Chieftain was the name of a tank, take another look at both haggis and monster vehicle and wonder which was named after the other. Memo to self – engage in own health and eat fewer tanks in 2010.

Belated though our resolutions may be as this letter emerges at the beginning of February, that does mean that they were not forgotten by 2nd January. To all our readers working on their 2010 plan, we hope that your resolutions are similarly durable and do not vanish like snow off a dyke.

NHS Constitution – Thanks, but you can keep the screening just the same

It’s been a long gestation since publication in January 2009, but the NHS Constitution is now closer to reality (if not legal enforceability, which was never on the cards anyway).  Its provisions get written into an increasing number of official documents, viz Mr Burnham’s next 5 year plan for the English NHS, From Good to Great – which must mean that someone  in high places is taking it seriously even though the public – we suspect – is still blithely unaware of its existence.

We don’t really “do” written constitutions in Britain.   That aside, there is currently a consultation on the rights and commitments in the NHS Constitution which closes on 10 February.  So to get your New Year brain cells going , MAC offers below our response to the consultation.  We hope this will spur our readers to make their own response using the online questionnaire .  And it might even stir up some debate on one provision in particular.  Read on to find out which one.

There is one general issue which we believe still needs to be addressed and we talk about that next.

Hyperinflation of the Service Promise – from statement to code to charter to manifesto to constitution

One of the earliest by-products of the focus on consumer rights and customer service excellence were documents that trumpeted what those rights were, how they were enforced and what to do if things went wrong. The content will be familiar to all our readers. The granddaddy document for all this activity was the Kennedy era ‘Consumer Rights’. The offspring offerings of these rights could be called (at the duller end of the promotional scale) codes of conduct/ practice as negotiated with the OFT. There was the down to earth promise of ‘Money back if not satisfied’ and turning up the marketing volume a little we saw ‘Service Guarantees’, ‘Service Charters’. ‘Our commitment to Service Excellence and to You’  or ‘Customer First Manifesto’ were first choice for a while. ‘Consumer Manifesto’ was thought to have a certain ring to it.  Now we have upgraded from a manifesto to a Constitution which appears to add another  element of political gravitas to the mix. The common motivation was to place (or at least appear to do so) information about service in the public domain so that service users knew not just what their rights were in theory but what they meant in practice e.g delivered the next day; your call answered by the third ring; refund of double the price you paid.

The common problem with all this was instant obsolescence of what had seemed at the time a ground-breaking promise by the service provider. Once offered, the promise became the norm – a process of instant discounting by users so that the new and revolutionary became the market norm overnight. To stay ahead and generate the long-term loyalty that provides the profits, service providers have to innovate not just once but continuously and ever more frequently. If Apple brings out a new iPhone then everyone has to bring out a new phone with even better features.  If the NHS had real competitors, this lesson would be more easily understood.

So any written service guarantee risks going out of date the moment it is published. The way marketeers coped with that was to keep the base document general with talk of consumer-oriented values and principles and not commit to a set of service standards that  would look pathetic the day after publication. The best in class companies also created new technically innovative ways and means of understanding the way their customers actually behaved – you have no secrets from your Tesco Club Card. The means of collection, analysis and use of customer behaviour data were improved to yield data continuously in a format that was instantly accessible to a wide selection of managers all with the authority to put the findings to use at once within their areas of authority.

We say Constitutions are not there to say you will be seen in 5 minutes or 18 weeks – why not at once on the phone or within 5 days? They are about ‘values and enduring principles’.  The standards and commitments of the day should be there as what we might call a Constitutional Protocol that is there to be updated and changed to reflect changing expectations and local conditions. We like customer service specifics – what we like even more is a  user-focused means of deciding what they should be and an easy to action update mechanism. Also at all costs lawyers must be kept away from the process and we agree that an internal champion is needed within the service provider with a clear mandate to be the user advocate and that this duty is not just another element in the work of the PPI manager. See reply to point 7.

Agents of Constitutional Renewal

The element that is needed is the supply of user data and the existence of an organised user lobby to advocate evidence-based change. Here surely is a role for the current structures of patient representation in the NHS – they can be the updaters, the people who are the guardians of the new way of setting targets once the centre lets go. They become agents of constitutional renewal where the basic texts hewn in the rock are refreshed and re-interpreted in the light of experience.

There are eight questions in the consultation.  Here’s what we are saying in our response.

1. Should a right in respect of waiting times be established and included in a revised NHS Constitution?

While this is a heading for the Constitution we recommend that specific figures for waiting times be kept out of the main body of the Constitution.

2. If so, should the right include the current standard for treatment within 18 weeks?

See above. 18 weeks is certainly an improvement on things only a few years ago, but frankly it is still too long, 4.5 months.  “Urgent” does not mean over four months before being treated.  The maximum should be 12 weeks and shorter for more urgent matters.  One size does not fit all.  If urgent cancer referrals can be done much more quickly than this why not for other conditions of equal severity?  The existence of indicative figures soon becomes the norm and a low one at that. The figure gains a certain respectability from its assocation with the constitution and blocks future service improvement

3. Should the right include the current standard for urgent referrals of suspected cancer to be seen by a specialist within two weeks?

See above

4. Should GPs provide specified information to patients on their rights around a two week referral?

GP s have to be up to date with all the latest service standards and advise their patients accordingly. It would be scandalous if this were not happening already. The question of how patients are “informed” is an important one.  Something stated in the small print of a seldom read leaflet does not constitute proper information.  Patients should be told in person (with the message also clearly stated in writing) at the point of referral.  They should also be told what they can do if the timescale is not met.

5.   Do you agree that a right to a NHS Health Check every five years for those aged 40–74 should be established, with effect from April 2012, and be included in a revised NHS Constitution?

No.  This is a blank cheque that has no place in the Constitution.  The general reasons of principle we have argued earlier in the document aside, it would be a waste of resources and stimulate unproductive activity which would reduce access in primary care for more urgent work. Little would be picked up on mass routine, “health checks” and it would not reach those who needed it most, thus perversely increasing health inequalities. There is a shiny new website for NHS HealthChecks but it does not provide evidence that such services will meet their objective of “empowering patients and preventing illness”.

Keep this “right” out of the Constitution and reinvest the money the NHS would otherwise waste in something more worthwhile that would make a difference to quality of life for a targeted group. We suggest  commissioning care pathways for long term neurological conditions for starters.

6.  Do you agree we should explore potential future rights for patients and the public in the areas set out in Chapter 3?

•                   evening and weekend access to GPs

This should be a contractual requirement not an “extra.” No practice should be paid for it unless they are fully compliant with access requirements in-hours – 8am – 6.30 pm M-F.  Paying practices to offer extended hours when patients cannot get access when they are supposed to be open anyway is absurd.

•                   access to NHS dentistry

Yes.  Every area should have a well publicised “find a doctor” and “find a dentist” service.  A pilot to give people personal dental care budgets would be a good test of the response of the market in hard to access areas.

•                   personal health budgets

What must be offered are integrated budgets spanning an individual’s health and social care needs.  The numbers of people who would need purely a health budget or a social care budget are probably relatively small.  People with long term conditions use the full range of services and don’t want barriers placed in the middle of this.

•                   choosing to die at home

This is what the majority of people say they want, but only a minority actually get.  Much more could and should be done through “hospice at home” and the Gold Standards Framework to ensure that a “good death” at home is possible.  End of life care planning is usually neglected and crisis decisions rarely work out in the interests of the patient or family.

7.  Do you agree the role of the Constitution champion should be determined locally by PCTs?

We suspect  that under the arrangements proposed it will turn out to be an ineffective and unpopular role, assuming anyone can be persuaded to take it on. We therefore recommend that in  line with our arguments expressed in the preamble that this be seen as an advocacy role linked to patient representative organisations acting as agents of constitutional renewal and that the person be appointed by a process where the patient/user view is in the majority and therefore takes the appointment decision. The post would be salaried, supported and full-time and paid for by the PCT.

8.  Do you think there are any particularly important aspects of the role?

The pre-requisite is a very thick skin.  If GPs don’t “get it” about patient participation (and in our experience largely they don’t), then selling them the NHS Constitution with rights and obligations is going to end in tears.    Make it part of QOF or the coming CQC registration scheme in 2012 and their tune might change. What about a right to redress?  Can we give patient organisations supercomplainant status like Consumers Association and NCC have about market matters?

Service Quality and Service Promises

Constitutional Issues in the Health Service

We are busy putting together our response to the latest consultation on the NHS Constitution which you will see soon. It has set the old hare running of whether statements of service quality are worth the paper they are written on – however grandiose the label. The latest moniker of ‘Constitution’ is the most recent manifestation of an ancient cult of service quality codes, charters, commitments, manifestos. Consumers have seen a lot of promises pass under their noses and disappear without a trace from the institutional history only to be revived by the new service manager who rewrites and reissues them with a new logo and a different phone number. The approach is now an international one as I saw on a recent trip to Kenya.

Benchmarking Kenya

So how do they do it in the Kilifi District Hospital north of Mombasa. How have the management addressed the question of service levels and commitments? They have a vision – health services that are ‘acceptable, accessible and affordable to all’.

The service charter commitment painted on the wall in different places around the hospital which is associated with the Kenya Medical Research Institute (KEMRI). Below is the main board near the entrance with the service commitment, the prices and the time you get.

See how the  notice of the Citizen’s Service Charter below has both the general claim ‘within the shortest time possible’ together with specific claims about timelines of up to 30 minutes for emergency surgery and the price to be paid. The final approved ingredient is the person/ position to be contacted with a complaint.

There was no display recording achievement of these stated aims – perhaps this is something that could be added to the research being done by KEMRI working with the Wellcome Trust and Oxford University on that site into malaria and other infectious diseases.

No buts? This has got to be utterly better.

A while ago in a fit of enthusiasm brought on by my experience with Eurostar I promised to tell you about my experience with the butter.  This is a simple tale of how to complete the feedback loop and turn a complainant into a fan.

A change for the worse

For several years I have been buying a particular sort of butter which, despite containing no oils and remaining pure butter, spreads pretty much straight from the fridge without being horribly greasy.  Such a product is a huge asset in a house like mine where at any time of the day or night someone can be found eating toast somewhere.  Sometimes these people even live here.  All hell broke lose last Spring when Fussiest Daughter pointed out that the butter had changed and now, if left out of the fridge for more than a minute or two would turn “vile and slimy” (her words, not mine, but none the less accurate for that).  To reinforce the horror of this, the packet now bore the legend “now even softer”.

And so I emailed the company and asked them what had happened.  They wrote me a charming letter on very highly quality creamy coloured paper explaining that they had had complaints that the butter was sometimes a little harder than people liked when it came out of the fridge.  They sent me three shiny pound coins and hoped I would continue to buy their product (which, rather than incur the wrath of the Daughter, I didn’t).

Buttering me up – or just common sense?

Several months later I received another letter and this is what it said,”Since the launch of the new product, and due to feedback we have received from you and other customers, we have sought to improve Kerrygold Softer Butter even further. Our aim has been to maintain the softer consistency we have achieved when used from the fridge, but to make sure it stays firmer longer if it needs to be kept out of the fridge during mealtimes.  We are now delighted to announce an further improvement – our new butter is still significantly more spreadable from the fridge than our original formula, but is firmer for longer when left at room temperature….Once again thank you ever so much for your feedback.”

Now I am happy.  They even sent me a voucher so I could try their new product for free.  And Fussiest Daughter is happy too as are all the other people who eat toast in our house at mealtimes and toast-times.

Wouldn’t it be nice if other organisations could treat our comments and complaints like this?  How common is it to get a letter from the NHS or the bank saying “Remember when you complained a while ago?  Well although we explained why we could not do anything then, we have thought about what you said and decided to try to do things a bit differently and take account of what you said.  Hope you agree and here is a few quid as a gesture of goodwill.”

Given decent complaint management software and a properly maintained database, this should be easy. In these days of data protection and difficulty in collecting customer details, complainants freely offer theirs and turning them from critics to advocates remains the great goal of complaint departments.

STOP PRESS:  someone known to MAC has discovered a secret department of BT that can actually sort problems out. He had been wrongly disconnected and faced an enormous struggle to contact BT customer services since the first prerequisite for dialogue was an existing telephone number. On giving his old one, he was told that number was no longer in service and was disconnected. Heroically he persisted and eventually a unit so secret that it has no address or telephone number on its writing paper – he thinks it is in Doncaster – sorted his problem out – block of flats, someone leaving, asks for disconnection, wrong flat disconnected.

Health Act rag bag delivers part of the real prize

Health Act Rag Bag

Almost unremarked in the rush of bills getting  the Royal Nod on Friday  the 13^th was the rag bag of measures collectively known as the Health Act 2009. Tucked away among new powers to strengthen tobacco control; to place a duty on all NHS bodies, private sector and third sector providers of NHS services to have regard to the NHS Constitution (more on that in a later blog); to deal with (whisper it) failing Foundation Trusts; to require (largely meaningless) “quality accounts” from NHS bodies and to reform pharmacy services is the provision to give money directly to certain patients so they can obtain their own health care.

It’s Getting Personal

But it isn’t as simple as it looks – the consultation on the regulations and guidance is pretty daunting.  The real problem is that this will deliver only half of the prize that should really be on offer:integrated health and social care individual budgets reflecting the real level of user and carer need.  This is going to be big in coming years given an ageing population and more people with long term conditions surviving for longer periods with better quality of life.  How many?  The think tank Demos At Your Service report estimates 1.5m people in five years will be controlling personal budgets for health and social care.    When this happens, public services will never be the same.

The progress in freeing up NHS money so it can flow direct to individuals for this purpose is welcome (NHS money can already be handed to third party organisations to spend on behalf of individuals) and it evens the scorecard with what is increasingly common practice in social care. In fact, the consultation on the health care budget regulations largely proposes to mirror existing good social care practice.  If this is a hint that the two channels of care services are converging then we welcome it.

If our public services could just get their acts together about this we might see some progress towards the real prize.  David Cameron had the right idea in his recent statement on health priorities earlier this month when he included as part of a reform of long term care that “budgets combining social care and health care funding for people with long-term conditions will be rolled out.”

People Powered Public Services

The latest report from NESTA*  The Human Factor provides the evidence about moving to “people powered public services”  which could save billions. It should be required reading in PCT and Local Authority boardrooms as well as by political party strategists. The word is that Andrew Lansley likes this approach.   Both parties are making noises that the boundaries between health and social care services are going to be intentionally blurred in the near future.  In that light, keeping separate budgets for healthcare and for social care is simply perverse and discriminatory against the very groups who are meant to benefit.  It perpetuates an impediment to integrated services which goes back to 1948.  It really is time to come into the 21^st century with how we commission and provide public health and social care services for our increasingly complex and diverse population.  That’s the challenge MAC would like to see all parties grasp as the election temperature starts to rise.

*NESTA is the National Endowment for Science, Technology and the Arts

Telling it like it isn’t: the language of the NHS

I always like it when the newsletter of NHS Networks pops into my inbox with its cheery “ping”.  Not only does it save me lots of time finding out things, but occasionally it brings a dose of real wisdom coupled with wit.  Today’s was no exception with its offering of a front page mini essay on the problems of language in the NHS.  I can think of no better way to share this with our blog readers than to quote it verbatim below, together with a “thank you” to its anonymous author whose frustrations about NHS communication MAC shares and whose humour in the face of frustration we can but admire.

“Language matters. If you want to get people on your side or avoid turning them off, choose your words with care.”As the railways have learnt, promoting mere passengers to customers does nothing to mitigate a poor service. If anything it deepens the irritation. Similarly, having a more elaborate and cunningly worded excuse — “lack of availability of a train crew” or “delays caused by the failure of an earlier service” — does not fool anybody. The facts are as follows: the driver didn’t show up for work and the train broke down; the station is draughty and crowded and you are going to be late for work.”

“The NHS is not like this. There is a genuine desire to communicate, to clarify and to explain but for one reason or another, the harder we try, the less sense we make. We can’t even talk about talking without lapsing into a strange language that sounds like English and even uses English words but in other respects is clearly not English.”

“For example, we insist on “engaging” people, giving them the disturbing impression that either we want to offer them a job as our butler or that we want to marry them, settle down and have children.”

“We refer to people as stakeholders, a meaningless term soon to be adopted by the railways – “stakeholder under the train at Chorleywood” – and which implies a much greater sense of ownership than anybody really wants. We all know it’s our NHS, just as it’s our Inland Revenue, our BBC, our national sewage network and our Parliament, but frankly there’s only so much stakeholding we can do if we’re to leave time for involvement, engagement and consultation.”

“The NHS mistakes its internal language for universal currency. Just as the British Empire was founded on the belief that the world would be better place if it spoke English, worshipped a Church of England God and played a lot of cricket, so the NHS believes that if it speaks loudly and slowly enough and keeps peddling the same dull linguistic tokens to the natives they will eventually sign up to the programme.”

“Like any large organisation, the NHS has a language of its own. The jargon may or may not promote understanding among those who speak it. For everyone else it is completely baffling. The sooner we realise that, the sooner we will start making sense.”

Next week’s instalment is on polyclinics, billed as ”where to take your parrot when it becomes unwell”.  I can hardly wait.

The November Newsletter

Dread Moment, Dead Time – the Roots of Laughter and the Prompt to Action

I was in the queue at the Post Office – two positions open for business; 12 people in the queue; having to pay £5 for special delivery because of strike. The message on the QTV? ‘The only real laughter comes from despair’ attributed to Groucho Marx. Nothing could have better fitted the mood of existential gloom at the prospect of 20 minutes queuing while South London people sort out their complicated lives clutching half-filled-in forms and expired passports. None were laughing. It was the most apposite message I have ever seen on that medium but the best was yet to come two seconds later with the name and location of a photocopying shop new to me and just up the road. The ad worked – 20 minutes later I was in there and their sales figures leapt up by 0.72p.

Partners’ Prose

Schools

Of course had I been connected to the internet. the time in the queue would pass in a flash because I could read the Partners’ blog entries in October and November. Caroline Millar sends politicians to stand in the corner for wilfully getting the important Cambridge Review wrong.

It seems to be open season on schools and the question of how they should be run and who should run them. Caroline documents the candidates in some detail in the following terms:

“whether it be local authorities, faith groups, used car salesmen or aspirational lasagna-eating anxiety-monkeys who are running the schools of the future, it should be a requirement for all of them to demonstrate that they know what their pupils, parents and local communities think of them and to show that they are responsive to their needs.”

Read the full post to see where they all come from.

Governance

Val Moore updates us with tales of a Norwegian state pension fund seeking to persuade large American concerns of the advisability of separating the post of chief executive from that of chairman – a central tenet as it happens of Policy Governance®. Val had recently attended one of a series of workshops being run by Caroline Oliver and the UK Policy Governance Association and this separation of function and titles still seems to be causing problems for many organisations.

Val wrote

“Many of these organisations are struggling to see the unique role of the Chairman and Board and want to avoid that well known situation where the Board usurp the role of the Executives and the Executives second guess the Board.  Policy Governance separates the two roles and maintains that the Chairman and the Board are ‘owners one step down’ and not ‘management one step up’.  This thinking frees the Board to concentrate on the ‘ends’ or goals of the organisation and to allow the CEO and executive team to work out the ‘means’.”

Politicians’ promises and social care

Ends and means were very much part of Andrew Craig’s piece musing on how strange it was

“that with little over a month to go for people to have their say about the government’s social care proposals for England, the Prime Minister pulled a monster rabbit out of his capacious hat which made roadkill of the consultation process.  Mr Brown pre-empted discussion by giving a personal care pledge to adults under 65 -  later clarified as also extending to younger disabled people aged 18-64 needing personal care at home.  That’s a lot of people and a awful lot of bawbees, Gordon, even if the Government is still around after 2010.”

If the consultation is to have any useful effect, it should provide some insights into what Andrew identified as the three main issues around social care:-

• First and foremost, we need one, integrated system of health and social care not two
• Second, the social care debate must be widened to include younger adults with disabilities and chronic conditions and people who care for them
• Third, while raising the universal standard of social care we must reclaim the Beveridge principle of individual initiative to make extra provision.

Complaints – Opening Up on Complainant Satisfaction

Back to where we started with a moment of existential despair in a Post Office queue – the mood seems right when comtemplating the Kafka-esque world of a complaint about service at our bank. We take a look  at the experience of having a problem with banks, specs and teeth – and no the NHS does not feature in any of them. The world of the banking back office and that modern contradiction in terms ‘the customer service team’ – neither a team or much to do with service -  and how best intentions and efforts can still go wrong even when all are trying harder than Avis.

But we finish on a good note – if you have a complaint about your private dentist’s service, find your way to the Dental Complaints Service and your complaint stands a good chance of getting sorted according to some new data. Well done Derek.

Complaints – Despair, Specs and Teeth

Coming in Threes

You know how it is – life is ok for a while and everything more or less works. Some minor niggles, something goes wrong perhaps but it is soon fixed or can be parked for the future and then bang! like the proverbial No 11 bus they all come at once.

Banging our Heads against Banks

The MAC Partnership has been involved in a prolonged and head-banging dialogue with Barclays our bankers for over a year trying to achieve a simple administrative task – adding a person to our internet account with the authority to make payments. The saga of lost pieces of paper and endless delay while the ‘customer service team’ conferred and promised to phone back will be familiar to all who have gone a few rounds with their banks but the unexpected one that amazed us all was the sending of our data, equipment and PIN to a local Park User Group. This rang a chord with me since in the summer I had asked for a replacement bank statement and some time later found I had been sent the statements for a football club in Wales and a Somali refugee centre in Birmingham. Where my statement went, no one knows. A nice man called Alec took my details, gave me a reference number and disappeared. We still have no solution after a year to letting one more Partner use the internet banking facility.

The key block to solutions here is that when the team – see ‘customer service’ above – is in charge, no one is in charge. When no one is in charge, no one ever phones you back or if they do or you phone again, they know nothing. Also since they have no history or experience of the account, they tell us that it is impossible to do things which we have been doing for 5 years. This is the world of the customer service team – unable to connect with or comprehend a world that is not on their screen, unable to call with confidence on other parts or people in the bank to help them sort out their – well not their actually – customer’s problem. The internal emphasis of Barclays as experienced is to end the call not resolve the case. The customer is always someone else’s.

We have been passed from relationship manager to complaint department to special services team to web development to branch business manager. For over a month we have been trying to get our Business Manager to ring us.   Every time we are told she or he will call back in 3 hours and a week later there is still silence.  We have spent an estimated 5 or more hours on 0845 numbers. In the meantime Barclays are as far as we can tell in serious breach of data protection regulations. In the meantime of course we still cannot get the third partner permission to use the site. View it – OK. Do anything useful with it – no. Ombudsman as well I think. Of course if we had wanted a loan or an overdraft they would have been all over us.

Complaints and Sod’s Law – how bad things keep happening to good people

Of course it is not just banks that get it wrong – even when complaint handlers are trying hard, taking responsibility and sorting stuff out, their lack of success in getting something sorted can still provide a decent anecdote or two for the Sod’s Law training session. Specs handed in for repair to Boots were not returned and no one could tell me where they were or when they migth be back. Central customer service was involved since I am a lazy man and thought that they would be able to pull the strings and sort stuff out while I was away. Also I have reason to know that they are a well-trained and professional bunch.

Emails were exchanged and promises made and then the final call that they were ready and in the shop. Except they could not be found when I turned up. The manager had them in her drawer – eager no doubt to make the handover herself but alas she was not around. Another phone call and a second visit since the postie’s strike made posting them problematic and I have my specs plus a cost waived and a Boots Gift card. There was a solution and I think I will go back to Boots for the next pair but even here in spite of efforts to resolve, Sod’s Law meant that once one thing had gone wrong, lots went wrong. Even the generous gesture of refund plus gift card funds came over as rather hesitant since the person who finally saw me had to pick the story up by reading post-its and bits of paper atttached to the spectacle case.  I got the glasses but felt glum and as for Boots Optician in Croydon, all that effort and expenditure with what result – a customer rescued and twice as loyal as they were before? Don’t know.

Opening Wider on Dentists’ Complaint Data

This was all prompted by seeing a survey done about complaints about private dental care. I know the man who was instrumental in getting their Dental Complaints Service – the escalated complaint handling system for private complaints set up – Derek Prentice ex of Consumers’ Association and a long time believer in the power of an effective way of resolving complaints.

They got some uncomfortable answers but were brave enough to publish them. All the data is actionable and useful – the 26% with a problem who did not complain plus the reasons why not – fear of the consequences, ‘not worth it’, did not have the confidence to see it through. The % satisfied amongst those who did complain to the practice?  Low at 53%.

The central service was seen as doing better with 85% rating them as good or excellent when it came to responding with the time promised; 98% rating the overall attitude and courtesy as excellent or good (84% excellent). Encouragingly enough, the dental professionals liked them too. Too often those on the ground, the front line see themselves as shafted by the people at ‘head office’ flinging money around and agreeing solutions which appear ludicrously biased towards complainants, all too often labelled as ‘vexatious’. On the attributes of attitude and courtesy 98% rated them as excellent or good (79% excellent.) So once people get to the escalated service they are OK.

However the main point I wanted to make was that it is good to see the data – I am sure Boots collects data about satisfaction and probably Barclays too. Let us see that data and then we can tell what is going on and more importantly so can the people within the company who either do not see the data at all or bin it when they do. The thought that it might emerge into the public domain would concentrate minds.

Bye Bye WM

Which reminds of the great achievement – one of many – of Walter Merricks at the Financial Ombudsman Service where his service now names the worst offenders. I missed his leaving party on 8th October and so must say our farewells in this blog. Great work and we hope to be in touch again soon.

Never mind the quality, feel the blazer

His vision for schools?…..

Or his?

All of a sudden everybody seems to be interested in schools, with the two main parties slugging it out over who can be the more Dickensian whilst a major academic review of primary education (the Cambridge Review) is briskly dismissed by the Secretary of State for being out of date because the team had the audacity to spend six years on their research rather than six minutes on Google. Politicians and journalists of all hues seem to have decided that the only things parents are interested in and the only things that make schools “good” are uniform, rigorous discipline applied to (other people’s) children, vigorous teaching of the 3 Rs and shiny new buildings.  Oddly they seem to be promising to free schools and teachers from any sort of central government or local authority control whilst simultaneously banging the drum about how they intend to get a tighter grip on them.  Behind all the rhetoric there is little clarity as to how schools can be freed from the red tape whilst remaining accountable to both tax payers and parents.

Fancy running a school anyone?

For the last couple of years it has been hard to open a newspaper without seeing a photo of a Labour party politician lurking in the playgrounds of Mossbourne Academy in Hackney surrounded by a rainbow nation of manically grinning young people in their Billy Bunter blazers (designed by Jasper Conran no less – see photos above).  Recently the Conservatives have joined them.  The so-called Opposition, rather than attacking this symbol of New Labour, has decided that Mossbourne is the best thing since the Chalet School.  In his speech to the Tory conference earlier this month shadow schools minister Michael Gove praised the school’s head: first and foremost for insisting on “a proper uniform – with blazer and tie”.  The Conservatives have been reported as wanting to put a “rocket booster” under the Academies programme and to “dramatically accelerate the number of academies” with the addition of all sorts of new schools run by pretty much anyone who fancies it (and presumably find someone famous to design the uniform).   They are even offering £5k per child per year to anyone who will take the pesky brats off their hands.

One of Michael Gove’s favourite claims is that he will empower parents by allowing them to set up their own schools.  A new charity called the New Schools Network has appeared on the scene last week, allegedly thought up over lasagna at a west London dinner party.   Luckily the people round the table had a few friends in high places and managed to set up the organisation now headed by a former advisor to Boris Johnson in some nice offices in Queen Anne’s Walk.  According to the Sunday Times, most of the dinner guests that night either had children who were not yet of school age or had so far only tried the private sector.  But no matter! It is easy to see the attraction of taking your £5k per child and setting up a small and caring school for your own child (perhaps with an unusual blazer) modelled on something Swedish (or possibly Canadian) and “Free” (whatever that means) but I cannot be the only person who hears loud alarm bells ringing at the thought of state schools being set up and run by the sort of parents who want to set up and run schools for their own children.  How long is it going to be before the majority of parents find that the only “choice” on offer is between the Academy run by the Creationists, the “Free” school run by Blair and Lucy (yes really, these are the names of the most recent contributers to the New Schools Network website), or the “sink” school with all the kids in it that no-one else can be bothered with?

Putting schools (not children) to the test

The trouble is that in all this flurry of excitement about giving parents more “choice”, both parties seem to have entirely lost sight of the need to make sure that all schools are accountable to children, parents and society as a whole. SATs and league tables are being demonised because of the destructive effect they have on children’s experience in schools but this is in part at least because the current system fails to distinguish between the need to assess children for the purposes of ensuring their individual educational needs are met and the need to assess the overall performance of children in order to allow the school to demonstrate that it is doing its job properly.  The Cambridge Review makes a very clear and important distinction between testing for attainment and testing for accountablity and it is one that politicians could do with getting their heads around.

If we believe that all children are entitled to a decent education then what we need is a school system in which all children stand a decent chance of going to a decent school.  Parents and society in general need to know that schools are working to roughly the same agenda and are of roughly the same standard.  This year’s GCSE results show that whilst some Academies have undoubtedly produced better results than the schools they have replaced, a third are still failing to meet the government’s minimum target for GCSE results. Perhaps Blair and Lucy’s school will be exactly what we all want for our children – but how will we know?

Whose schools are they anyway?

One way to ensure that there is a degree of accountability in schools whoever is running them is to insist that users of the service (young people, their families, employers) are able to hold the service providers to account.  Whatever Michael Gove says, we can safely assume that beyond the lasagna-scented streets of West London and Bristol there will not be that many parents wanting to set up and run their own schools.  And anyway, you should not have to be running a public service to have some say about what it looks like and how it operates.  It is simply not enough to have a few spaces (often unfilled) for parents on your governing body and to write the occasional letter to parents telling them what your have done to their children.  SATs results may be of some use to schools but they tell you as a parent little about what actually goes on in the school and nothing whatsoever about how your child is doing, or will do, or whether they are getting what they need from their school.

Over and over again research shows that one of the key factors which influences success at school is the degree to which parents are engaged with their child’s schooling and it is good to see that the the government is taking steps to enable parents to do this better by improving how schools report and talk to parents.  Yet many schools are at best clueless about how to get parents involved whilst others actively (albeit sometimes unwittingly) drive parents away by simultaneously bullying and patronising them. Sometimes of course parents can be the bullies and their children the aggressors. Anger and fear on both sides are not mentioned in the new Parent Guarantee but perhaps they should be since together they guarantee a dysfunctional school.

Could do better

It seems unlikely that any future government is going to tackle the thorny issue of who should be allowed to run our schools and many may question the creation of a pseudo market economy within the state school system.  However, whether it be local authorities, faith groups, used car salesmen or aspirational lasagna-eating anxiety-monkeys who are running the schools of the future, it should be a requirement for all of them to demonstrate that they know what their pupils, parents and local communities think of them and to show that they are responsive to their needs.  This means a major shift in the way that schools and teachers relate to the outside world.  Some schools know what they have to do and are already doing it.   But there are many others which have lessons to learn and really need to try harder.

Norsemen boost Policy Governance®

Split those roles

Separating the roles of chairman and chief executive is a key condition to the successful operation of an organisation according to the tenets of Policy Governance®. This principle was discussed in a recent article by The Economist columnist Shumpeter asking ‘is there no limit to the audacity of Scandanavians?’ He cites the award of a ‘premature’ Nobel peace prize to Obama and tells us of a new culprit – NBIM (Norges Bank Investment Management)- interfering in American affairs.

Pension Fund Persuader

NBIM is a company running a monster Norwegian state pension fund of $400billion which is now trying to persuade 4 US companies to separate the jobs of chief executive and chairman. It has already persuaded Sara Lee to take that route. In the US 53% of Standard and Poor’s top 1500 companies combine the two jobs – 95% of UK companies in the FTSE 3.0 list split them. It seems that we in the UK heard Sir Adrian Cadbury back in 1992 when he urged companies ‘comply or explain’. But while the figures look good, the practice may be less so.

From Principles to Implementation – Health, Education and Voluntary Sector look to Policy Governance®

At a series of workshops run in the UK during the summer and autumn of this year, a number of public sector organisations are taking a good look at the principles of Policy Governance® and considering implementation in their own organisations.  The workshops, run by Caroline Oliver of Good to Govern and the Chairman of the UK Policy Governance Association, are attracting chairmen and senior executives from the health sector, from further education and from the voluntary organisations who are interested in sharpening up their governance practices.

The Struggle for Separation

Many of these organisations are struggling to see the unique role of the Chairman and Board and want to avoid that well known situation where the Board usurp the role of the Executives and the Executives second guess the Board.  Policy Governance separates the two roles and maintains that the Chairman and the Board are “owners one step down” and not “management one step up”.  This thinking frees the Board to concentrate on the “ends” or goals of the organisation and to allow the CEO and executive team to work out the “means”.

Note for Students of Governance

Policy Governance®  is the brain child of John Carver and is not only a governance theory but a fully worked out practical model devised by John Carver and his wife Miriam and implemented widely in the States and North America.

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