PMQs: Stafford Hospital and the “frenzied” target system

Quite an interesting session this: several questions, from all sides, did a good job of uncovering the deeply managerial soul of New Labour, and its according fixation with formulating strategy rather than getting things done, and with punishing management failure rather than seeking its  root causes in the bigger picture.

First, Cameron and Brown battled again, quite earnestly this week, over the economy. The bones of contention were Stuff and Things this time, rather than the more usual Apologies and Hurt Feelings, and the session was the better for it.  Cameron sought to prove that all the grandiose schemes and initiatives Brown announces week by week are not being implemented properly. Ministers, apparently, have admitted as much, but Brown stays in his “bunker”. Cameron’s definition of when the recession began differs from Brown’s (to whose advantage I know not. Cameron says the recessions began when the economy stopped growing in April, Brown says we entered recession in July – is there a technical right or wrong answer here, gentle reader?)

Still, Cameron couldn’t resist using one question to demand that Brown retract his statement that Britain was better prepared for recession than many other countries. Let me just give you the closing words of Cameron and the opening words of Brown here:

Tweedledum: “…Admit it!”

Tweedledumber: “No, Mr Speaker…”

Sometimes, as Jon Stewart would say, the comedy just writes itself. And Gorbals Mick willingly plays his part during Cameron’s rowdy questions by admonishing one over-excitable Labour member to “take a wee pill or something”.

Cameron has a good point, of course, in saying that implementation on the cornocopia of government schemes is falling short; it is anecdotally confirmed later on in the session when Adrian Saunders mentions the “funding blockages” that are preventing South Devon College from expanding to accommodate the increased pressures placed on it by local unemployment.

But it’s not entirely clear to anyone why Conservative schemes would be any better implemented. Surely if Cameron’s point signifies anything it’s that endless strategising and top-down directives won’t make any difference without effective, autonomous services on the ground. He might as well just admit that for the purposes of screwing up local services and winding red tape around everything in sight, it doesn’t matter a damn which half of the twentieth century power-sharing consensus are holding the purse.

Playing on a related theme, Clegg then challenges the Prime Minister on the “frenzied target setting culture” introduced into the NHS by his government. Does he think it had anything at all to do with horrific events at Stafford Hospital? Brown must be having an off day, because he nearly accidentally answers the question, asserting that he has been assured that the hospital is an isolated case. He runs through the action to be taken and the words “management”, “review”, “Commission” and “lessons” feature heavily in this.

Clegg brings it down to specifics. Doctors were told by their managers to stop treating seriously ill people and treat minor cases so that quotas and targets could be met. Under those circumstances there’s no point looking for someone to blame. Brown should scrap the target system that forces hospitals to tick boxes rather than treat the sick.

Brown’s answer is essentially no, it is all to do with management failure. If those problems with management can be addressed, the system will work. Somewhere in the distance is a giant BOOM as Chris Dillow explodes.

In this answer and in his answers to subsequent questions, I found Brown’s language revealing. A couple of times he talked about the need to “reassure” people about the effectiveness of their health services, or the trustworthiness of the security services, or what have you. What he means by reassure, one can surmise, is regulating, measuring and managing these services. The will to actually improve said services and correct the weak points is implied in there somewhere, to be sure. But it’s never the first thing he says. He’s as hamstrung by targets, quotas and satisfaction ratings as the dysfunctional services his party has created.

Anyway, judge for yourself, and watch here:

Mr. Nick Clegg (Sheffield, Hallam) (LD): I would like to add my own expressions of sympathy and condolence to the family and friends of the three soldiers who tragically lost their lives in Afghanistan in the last week. With the death toll among our brave servicemen and women now at more than 150, it is right that we should pause to reflect on the immense sacrifice that they and their families have had to endure in serving this country and, of course, the people of Afghanistan.

Does the Prime Minister believe that the culture of frenzied target setting that has been introduced into the NHS by his Government had any role to play whatsoever in the horrific events that occurred at Stafford general hospital?

The Prime Minister: May I and Health Secretary first say that we apologise to those people who have suffered as a result of the mistakes that have been made at Stafford hospital? Everybody who uses the national health service has a right, if they put their faith in the NHS at that hospital, to expect the highest standards of treatment. These were not the highest standards of treatment. They have now been investigated, and they fell far short of the standards that people expect. The first thing that we have to do is to assure the families of those who have suffered and relatives who are grieving and who want answers to their questions that there will be independent reviews, if they seek them, of their families’ case notes so that they can be assured of what has happened. That is the first thing that we will do.

The second thing that we have to look at is whether this is a generic problem or a problem at a specific hospital. I am assured by the Healthcare Commission—the chief executive has made a statement today—that there is no equivalent case in all the other NHS hospitals across the country. We should therefore focus on the individual mistakes that were made by management and deal with them. A further inquiry is going on to look at what happened between 2003 and 2005. At the same time, the Care Quality Commission is looking into what lessons we can learn in general from what happened.

Mr. Clegg: When doctors at that hospital have confirmed that they were instructed by their managers to abandon seriously ill patients and to treat people with minor ailments instead in order to meet the Prime Minister’s targets, it is not enough to talk of reviews, inquiries and to blame other people. Will he scrap the mad targets that make hospitals tick boxes rather than look after the desperately ill?

The Prime Minister: Whatever happened in that hospital is unacceptable and should never be allowed to happen again. I too have looked at all the detail of the evidence in this report, which also says that nursing care standards were poor but that they were never discussed or identified as being poor, that results of patient surveys were available but were never reported to the board of management, and that, at the time of the C. difficile infection, nobody on the board or among the general public ever knew that the rate of infection had doubled. Those low standards of management in the hospital, therefore, must be dealt with by our review.

I take seriously everything that has come out of this case, but I think that it is not unreasonable in the modern age to expect a hospital to have the highest standards of care and at the same time ensure that every cancer patient is seen within two weeks. It is not unreasonable to say that hospitals should have the highest standards of care and ensure that there is a wait of only 18 weeks between a person seeing a doctor and getting an operation. It is not unreasonable to say that the highest standards of care should be pursued in accident and emergency departments and that people should not have to wait for hours before they get treatment.

We will look at all the evidence that is available. The Care Quality Commission will look at it too, but I think that we have to deal with the individual management failures in the hospital and then learn whatever lessons we can for the future of the national health service.

Read more by or more about , , , or .
This entry was posted in Parliament and PMQs.


  • uncovering the deeply managerial soul of New Labour

    Um, Labour doesn’t have a management bone in their bloated body. That’s the problem?

    That’s the reason there are no Financial Accountants/Controllers at the board level of any government department. They have no idea how to manage anything.

    Upwards urination in a brewery come to mind about them.

    It would be a mistake to confuse their desire for top down decision making with any management skills at all. They are very mutually exclusive.

  • C4’s FactCheck prefers Brown’s dating of the recession. (Add Julius Shiskin to the list of people to whom Cameron owes one of those apologies of which he’s so fond.)

  • In A Level Economics we were taught that a recession is generally held to have occurred when an economy has been contracting for two successive quarters. So Brown is right, and Cameron is wrong.

  • Ned + Tom

    Cameron was indeed right. A recession is indeed confirmed when the economy contracts for two successive quarters. After all, it’s possible a single quarter drop could be a blip, which the economy then recovers from.

    However, what Brown is doing, is taking the date of confirmation as when the recession first started. That approach just outright ignores two quarters of economic contraction.

    Cameron on the other hand, is taking the two quarters into account, which is the common sense approach.

    After all, if you are ill and you have a blood test say. The date the results come back isn’t the date you first got sick, it’s just confirmed what’s been already happening for a while.

  • Predictably depressing that they’re all back to the usual yah-boo politics so soon after they were all pretending to be civilised after David Cameron’s son died.

    I suppose the calculation was that the yah-boo stuff would have looked callous and lost them some votes then, but now everyone’s forgotten about it they think the best thing is to go back to debating-society point scoring.

  • David Morton 19th Mar '09 - 1:06am

    The growth figures for April to July 2008 were originally published at 0%. While dire that isn’t a contraction and the lay persons defination of a recession is two consequative quarters of contraction.

    However as with all official figures they are revised a few months later. Thats Quarter of 2008 now shows a contraction of 0.02% ( I promise I’m not making this up)

    So cameron was, in a very obscure way, was arguing that because of the 0.02% shift in the revised figures we had been in recession for 3 months longer than originally claimed.

    My personal tip for 2009 is Afghanistan. I think Clegg really needs to read the peoples names when he is paying tribute. You can’t do sincerity over their deaths if you can’t spare 6 or 7 seconds of air time to read there names. I may not win friends and influence people on here by citing Dianne Abbot MP on This Week however i thought she made an astute point a while back.

    With fatalities spiking and the mission costing £6bn a year its doubtful the public is going to put up with this long term. ( see recent You Gov poll). Ergo it will end sooner rather than later.

    On the week that the death toll passed 150 it might be time to start asking difficult questions about what the mission goal is and wether we are getting value for our ( or rather other peoples) Blood and Treasure.

  • Matthew Huntbach 19th Mar '09 - 10:43am

    The “managerial soul” of New Labour is sometimes put forward as evidence for its underlying socialist mentality, but we should recall it is actually part of its acceptance of the Thatcherite mentality.

    This mentality states that public sector workers are lazy, good-for-nothing people who lack the enterprise to become bankers etc, and who lead comfortable protected lives because there is none of the pressure a private sector worker has.

    Introducing targets was meant to introduce that pressure. It was meant to be bringing “private sector know-how” into the public sector. It was supposed to be doing what is done in the private sector, how private sector managers get performance out of their employees.

    Inevitable, it results in perverse incentives. It is often very demoralising, particularly to those who take professional pride in judging what is the right thing to do. It results in a layer of bureaucrats to enforce it. It is very often enforced by bullying, which results in further demoralisation.

Post a Comment

Lib Dem Voice welcomes comments from everyone but we ask you to be polite, to be on topic and to be who you say you are. You can read our comments policy in full here. Please respect it and all readers of the site.

To have your photo next to your comment please signup your email address with Gravatar.

Your email is never published. Required fields are marked *

Please complete the name of this site, Liberal Democrat ...?


Recent Comments

  • Christopher Haigh
    @peterwatson, HS2 is a very confusing issue.Its hard to work out whether it's a good or bad proje I wonder if anyone ever did a cost benefit analysis on it ?...
    With the cost of living having risen so dramatically, I don't think its unreasonable for a minimum wage to be at least £15/hr likewise the lowest level before ...
  • Katharine Pindar
    Thanks to all for developing an interesting debate here. I think we do have the means to end deep poverty and raise living standards in this country, if resourc...
    Just wanted to know if the ALDC is on line...
  • Peter Martin
    @ Nonconformistradical, The extent of nationalisation is always a matter of some debate among both socialists and no-socialists. Katharine does support the c...