Select Committee on Public Administration Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)



  40. How much inefficiency should there be in the system?
  (Dr Bogle) You have to operate at least ten per cent below bed occupancy to be safe, to free up your A&E and to allow this freedom of access. It is all dependent on getting the information we were talking about earlier so that patients and the professionals they are talking to can make an informed choice.

  41. In my area, all my secondary schools have the choice, not the parents, because their targets have sent them in that direction.
  (Mr Hart) Absolutely. In London, for instance, the situation about admissions is chaotic.

  42. How do targets reflect that situation?
  (Mr Hart) I do not think you can. I am not sure it is the impact of targets. It is simply that certain schools are perceived to be more successful than other schools. The schools which are more popular than other schools, because of their results—we are talking about simple, good school results—attract more and more pupils. That does not necessarily lead to greater efficiency because the appeal panels often overrule the schools; more pupils come in and they do not necessarily have the staff and certain classes get bigger and bigger. We have yet to crack the problem of how you inject additional capital into expanding schools which are successful. That has a knock on effect for other schools which are struggling and are perceived to be operating ineffectively and inefficiently. It certainly has an impact in terms of recruitment because teachers will tend to move from the less successful schools and want to teach in the more successful schools. The people who really suffer at the end of the day are the parents who cannot get their children into the school of their choice. In London at the moment, there is quite a lot of evidence of children who have not got into the schools they should have got into from the beginning of this term. They are still out of school and we are beyond half-term just.

Kelvin Hopkins

  43. I have some sympathy with teachers and head teachers. My wife was a teacher for many years so over the breakfast table I had all these problems on a daily basis. I was also almost obsessed with the problems of education because probably two thirds of our young people who were less academic were being failed by society, by the system somehow. Do you not agree that, without this vigorous involvement of government in standard setting, testing, rigour and setting targets, we would not have changed that and the fact is it is changing now?
  (Mr Hart) I have absolutely no doubt about that at all. The government's intervention since 1997 has had a dramatic impact. Now the debate is moving and this is where this Committee session is so important. Michael Barber, the guru now at 10 Downing Street, said quite categorically that in his view we ought to be moving from what he readily accepts was a very prescriptive agenda to informed professionalism. That was the expression he used. In other words, we must rely on the professionalism of the teachers led by the heads and informed means with all the data and information they now have at their disposal, to use that to best effect. That is why there is talk about autonomy. Yesterday, Charles Clarke was talking about restoring the trust to the profession. The time has come for us to try and put some flesh on the bones of that debate. What does it mean: restoring trust in the profession? If the government accepts that it had to do what it did in order to shake up the system, at what stage do we take the foot off the accelerator pedal and start to move into a situation where we get the balance right? At the moment, the balance remains wrong. There is still too much bureaucracy, far too much time and money spent on driving through these targets in a very prescriptive way.


  44. All those teachers who from 1997 onwards immediately were complaining about this external intervention were wrong, because it has produced this dramatic improvement.
  (Mr Hart) They complained because it did have an enormous impact upon them in terms of their workload and that is still being sorted through these discussions and negotiations we are having with the Department about reforming the workforce, reforming the teaching profession and reforming the support staff, getting the work/life balance right. They were right to complain about the impact it had on their lives, on the hours they were working, but I think it was inevitable. I do not see how it could have been done otherwise. The situation in 1997 was not satisfactory. Something had to be done. The government chose to do it that way. It has caused pain. We do not want to go into the old OFSTED regime. That has changed to a certain extent as well now. The whole combination of the government's drive and the OFSTED regime certainly put a great deal of pressure and stress on our members and on the class room teachers. Was it worth it? Obviously, the people who lost out, who left the profession burnt out and took early retirement will say no, it was not. That is quite right. For them, it was not worth it. Was it worth it for the education service? Yes, I think it was, because we now have got ourselves into a situation where we ought to be able to build on that, moving through into secondary schools and beyond. If the government wants to retain the confidence of the profession and really work, as Charles Clarke said, in partnership with the profession, led by my own members who have a key role in terms of delivery of the reform agenda, we have to get that balance right.

  45. I have sympathy with teachers and head teachers. I think they have made tremendous efforts in recent years but I want you to suggest to me an alternative to what ordinary teachers complain about: bureaucracy, paperwork, teachers working until ten at night, filling in forms, ticking boxes and whatever, that kind of regime that has bee imposed on them, which they find very difficult. Is there a practical alternative to that?
  (Mr Hart) Yes. It is the outcome of the negotiations which we are starting next week with the Department in detail, which we hope to conclude by Christmas—quite ambitious—in achieving contractual change for the profession and in achieving a massive increase in the numbers of support staff. We are talking about 50,000 more support staff between now and the end of this Parliament; refocusing the role of support staff, bringing in people to support the heads and the rest of the staff in bursarial positions, administrative positions, technical support because of the computer networks etc, and refocusing to a certain extent the role of class room assistants. All that, if it is brought to fruition, will I think make a fundamental change. It will not be from day one; it will be over a phased period of time obviously for spending reasons, but I think that holds out a real prospect of a significant difference in the attitude of the teaching profession to the workload issue. I am optimistic that we have a package we are just about to negotiate on. The big thing about that is we have the support staff unions with us. We have UNISON, GMB and T&GWU working with the teachers' organisations in trying to get a unified package agreed with government. I think that is a major plus because for too long the support staff have felt themselves to be a bit out there. They ought to be with the teachers in trying to get this answer right.

Sir Sydney Chapman

  46. You have graphically explained to us how local education authorities had to sign up to the targets and how the schools effectively had to sign up to the targets and therefore there was very little room for variety in the curriculum. Does that mean that, for example, schools that have a reputation for specialising in music, to take one subject, cannot any longer do so?
  (Mr Hart) No, it does not mean that. The OFSTED report which came out recently demonstrated on the basis of 30-odd schools that there were and there are schools in the country still delivering a broad and balanced curriculum, including music, but there is no doubt that a lot of heads have been driven by the very focused literacy and numeracy strategies into marginalising areas such as music and drama and sport. That is generally accepted as being the reality in a lot of schools. That is going to have to be turned round. The government has committed itself to make sure that all primary schools do deliver a broad and balanced curriculum. There is a major issue about where we find people to teach music, modern foreign languages or sport or drama, for that matter. That is part of these negotiations about how we can perhaps get into our schools people who are not qualified teachers, who have a real gift for sport or music or languages. There is a lot more willingness to be open minded about how we deliver these things. If we can try and persuade 24,000 heads in England and Wales that the agenda is moving, that autonomy means autonomy, that the expectations placed upon them to sign up to these highly bureaucratically arrived at targets is going to be relaxed, without accountability being relaxed in any way, shape or form to the governing body and the parents, I think we are onto a winner.

  47. Tangential to that, what might or might not worry some parents is that, if the curriculum is getting into a straitjacket, a lot of such subjects as, drama and music, might become extramural activities. I come from Barnet and we have a pretty fine record on music. They have Saturday morning music centres. Would you deplore that trend if any school wanted to specialise in certain subjects outside the core curriculum, that they would have to have extramural arrangements? Do you think that would be a bad thing?
  (Mr Hart) I think it would be a bad thing if we could not deliver a broad and balanced curriculum for the vast majority of schools within the normal timetable week, or within what I think is going to be a different week. We are going to move into a much more flexible and longer school day, a longer school week maybe, as matters develop, in which we can deliver a broad and balanced curriculum. At the end of the day, what do the parents want? The parents want a broad and balanced curriculum but if you ask them what they primarily want it is what you and I want and that is decent standards of literacy and numeracy. That has to be the number one priority. We have arrived at a situation where that is not just the number one priority; but it is not such a priority that other, very valuable aspects are lost track of. Performance in the non-academic subjects does have a beneficial impact on performance in the academic subjects.

  48. Dr Bogle, you were pretty scathing about targets and you explained why. The distortion of clinical need caused by adherence to the targets or trying to meet the targets: have you any hard statistics that, for example, to take perhaps the most worrying factor if it is true, people needing serious operations are held back in order to undertake the easy, quick ones to meet targets? Do you have anecdotal evidence or hard facts on that?
  (Dr Bogle) It is mainly anecdotal because for hard facts we rely on the hospital returns, as the government does. It is the people actually working in the system. My colleagues tell me, going back to the example I gave of the simple procedures, to hit waiting times or waiting list figures, to take on a whole raft of simpler procedures while you leave the more complicated still on the list but still underneath the target on the list. From my personal experience, my practice does endoscopy sessions. There is a partner who is interested in gastroenterology who, at pressure times for the targets, is invited to do extra sessions of endoscopy to get the figures down. Although the procedures are very important to the patients who are having them, they are being artificially brought up the list to take the figures down. We have not an overall picture of the UK.

  49. Surely you would be capable of getting that with direct access to doctors, consultants and so on? Is that not one of the first priorities your association should have?
  (Dr Bogle) I will see if the information I have given you is right by doing some research when I get back. If we have that information, you will have it in a memorandum.


  50. It would be helpful because in the article you wrote recently you talked about meaningless targets that distort clinical priorities. We have talked about some of the distortions and you have given examples of that. I am not sure you have told us about meaningless targets. I think you signed up to the idea that these targets were all very splendid, but that they had certain consequences. If you could put some flesh on some of that for us, it would be very useful.
  (Dr Bogle) I did promise that I would produce more. The memorandum was obviously without the advantage of all the other paperwork.

Mr Prentice

  51. The consultants have been offered a pretty good deal, have they not, to help the government deliver on a whole series of targets? Why have they not accepted the contract and offer which gives a minimum of 10,000 a year extra, a maximum of 17,000 a year extra and that is just for NHS work? The consultants can still go and earn thousands of pounds in the private sector.
  (Dr Bogle) I would have to give you the feedback from roadshows we have done rather than being able to break it down at the moment. Very many of the consultants did not believe the arithmetic. You have given figures on earning increases. They dispute them, from their own experience. That is item one. The second thing that is reflected in quite a few of the letters I have received is that, "I am delighted to go in on a Sunday morning to follow my patients up as my proper, professional obligation to my patients but I am not willing to sign up to a contract whereby I can be instructed to do that every Sunday."

  52. It is only 40 hours, is it not? We are talking about an NHS contract of 40 hours and there will be a job plan, will there not, which will have to be agreed with individual consultants?
  (Dr Bogle) Yes, but if it is not agreed the consultants would have the right of appeal. If that right of appeal was not in their favour, it would be imposed.

  53. The consultants are not going to be dragged in every Sunday morning, are they? There may be occasions when consultants as professional people will be expected to do a little bit extra on a Sunday or on a Saturday morning but ordinarily consultants will have a pretty big say in their working week.
  (Dr Bogle) You and I, without the heat on in this room, might agree that in theory but when asked to sign up to a contract where that is a belief rather than a reality I believe that that is one of the main reasons they have rejected it.

  54. Without the new contract, a lot of the targets that we have been talking about will run into the sand, will not be delivered. What is the sanction? Do the consultants just work to rule, to their existing contractors? What happens then?
  (Dr Bogle) The targets that are meaningful are as deliverable under this contract as the new one, I believe. They are dependent on the ownership by the consultants of the target and not just the consultants but people working in the health service. The important thing is that the targets are meaningful and, in my belief, are focused locally.

  55. You want to see the melding of national targets and local targets. Are consultants team players? Would they go along with the local consensus or would they operate a kind of consultants' veto?
  (Dr Bogle) Nobody should have a veto. The consultants, the GPs, the nurses and particularly the patients would have an input locally into deciding what targets areas were important in that area and the consultants, like the others, would sign up to that. What is wrong at the moment is that the targets are imposed from on high. A lot of them do not appear as relevant as some other targets that the local people might want. Therefore, they are not owned. If you do not own a target, you reluctantly try and hit it.

  56. The problem is that there is a lot of scepticism out there that all this talk of professionalism masks a kind of self-interest and not a wider public interest. Is that fair?
  (Dr Bogle) No, I do not think it is fair. I can understand the perception. Obviously, if one is thinking about the consultant vote at all, I know where some people will be coming from what they believe that means. I have worked with these guys, particularly the ones who negotiated that contract, so I have heard the debate about what consultants felt about the contract and I have a lot of the correspondence from consultants who were not very enamoured. I believe that they are deeply committed to the health service like other doctors, but I believe that there are certain things in that contract that, if you are going to sign up to and sign up to for your life long work, they perceive as dangerous.

  57. The government wants to publish death rates for individual surgeons from 2004. Do you have a problem with that?
  (Dr Bogle) As long as the statistics hold up to scrutiny and as long as they are accompanied by the circumstances under which the consultants work. Take a surgeon. You are going to publish my death rates. I will be judged by that. If I am down on the table, maybe you can have sanctions taken against me. I will do simpler work so that I do not have the mortality rate. That is the danger.

  58. It would not spur you into better performance?
  (Dr Bogle) It will spur me into performance in areas where I know there is a minimum amount of risk.

  59. We are told that in a very recent survey of 40 hospitals looking at coronary bypass operations and so on, cardiac work, the hospital that came out best with the lowest death rate was the Bristol Royal Infirmary. Some people suggest that that is a consequence of the dreadful events at Bristol which made the surgeons—no pun intended—sharpen up their practice. Is it not absolutely astonishing that Bristol should be top of that particular league table?
  (Dr Bogle) Yes, I suppose, in view of the history. It would be totally unfair to try and break down the reasoning. You implied, because of the performance problems before, they have made it better. You may be right; I do not know, but the most important thing that has come out of this is asking for reasons for performance. Going back to your original question, have I any problem with mortality rates, if they are accurate, no, but as long as they are accompanied by the reasons why they might be off the scale. If the reason is that I am performing an awful lot of hazardous, highly complex surgical operations with a known high mortality rate, you have to take that into account before you publish a bold figure. The one thing that is not happening in the health service is, before the axe falls, why did you not reach your target? Are you having a problem? Could we help with that problem?

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