LETTERS
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From: Name and address supplied Subject: Outsourcing
As someone who has tendered in the past for cleaning services, we replaced one outsourced supplier with another and in the end improved our PEAT scores.
In the end, the devil is in the detail, namely the specification. Get that wrong, then any remedy to correct a poor standard of cleaning incurs an additional variance cost.
In our tender, the winning company was able to offer better supervision arrangements and better pay than the predecessor (another private company) and with a better agreed cleaning regime we got in the end a better quality of service.
But outsourcing alone does not guarantee better standards as I am aware of at least one PFI site where the cleaning has been criticised in the past. The problem is that everything is price driven. The cheapest solution is not always the best.
From: Zena Woodley Subject: Consultancy costs
Management is not something the NHS does well, except in isolated pockets. Yet managing - from wards upwards - is essential to the whole. Courses - high-powered ones - on management are an imperative - and it’s where some of the money should have gone.
It would be most interesting to have a breakdown of the different fields in which this sum [£300M] was spent. How much in Finance? How much on IT?
12 nhe
Consultancy is analogous to overseas aid. As long as we keep giving aid, users will find a means of spending it. As long as external consultancy companies keep recommending dependency upon them, so groups within the NHS will never learn to manage of their own accord.
Feed a man for a day with a fish. Teach him to fish and you feed him for life.
From:
Gordon.MacLellan Subject: PFI
If only our new hospital build had been between 7 and 10 percent we would have had a chance but with 15% we never had a chance! We were all told if we did not accept the deal on offer we would not get a new hospital in the reasonable future.
Managers therefore signed on the dotted line for an extortionate rate of interest for a building which is not fit for purpose. The effects have been catastrophic.
There needs to be an enquiry into how this happened so it cannot happen again elsewhere. It seems that a ‘good’ PFI is the solution whereas a bad one is a disaster.
A good first step is to ensure that no manager is allowed to sign off a deal in a hospital unless they live in the catchment area. If it is the hospital where they and their family will be treated it would concentrate their minds wonderfully!
Most of their acute consultants are in just such a position and I am sure it is one of the many reasons
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why there is such a breakdown of trust between managers and consultants.
Managers move on from trust to trust leaving the consultants to clear up the mess they leave behind.
The manager who signed off our PFI has gone. His successor has gone. The current incumbent has been left a ‘poisoned chalice’ (but nobody forced him to take the job!).
There was nothing prudent in the way our PFI was set up at 15% interest for 30 years. However there is now a new chancellor so perhaps we can look forward to the public purse being treated more responsibly now.
From: Patrick McCormick Subject: GP Commissioning
I am a supporter of this coalition government but I believe they are likely to make the same mistakes that have been made time and again in the past and which take more than one parliamentary term to correct.
So, I think the GPs are right to be concerned about the ability of the government to implement a system that will work.
Its not as if there isn’t a need for effective change After 25 years working with successful, commercially-minded, private sector organisations I have only started working in the public sector this year.
I have been astonished at the ineffectiveness of many (not all) of the people responsible for
spending our money wisely, the inefficiencies and waste that are endemic and the inability to apply practices and procedures that represent best practice and which ‘follow the money’.
Despite the need, whilst the government may believe it can be a ‘new broom’, I think the challenge of making sweeping changes in short order are too great for it to succeed.
Sadly the likelihood is that sweeping changes will be implemented which are insufficiently robust to meet the need, which break the old system irreparably and which lead to a collective inward focus by the majority of managers – losing sight of the real customer.
I’ve seen it happen in the private sector which is much better at managing changes of this kind. It is almost a given for the public sector.
Despite this, politicians’ careers will flourish regardless of the outcomes. No sense of real accountability there, just a mid- term ‘reshuffle’
The way forward: engage all the people who will still be holding the baby when the next government is formed in a dialogue that elicits the best possible solution and which gets them ‘on board’ with delivering the expected outcomes.
Please don’t just impose a half- baked plan and allow everyone the opportunity to prove, over the next four years, that it will never work.
Sep/Oct 10
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