Public Expenditure, excluding Social Security, is currently some £440 million pounds annually. This is spent on Public Works, the five million odd Public Service employees and their support services. There are no economies of scale indeed the complexity is seen as excusing an alienated largely inactive culture in which after two or three years "on the front line" those that wish to stay can as long as they don't rock the boat or insist on rational change. How different from the small to medium enterprise work ethic or indeed the activity levels in shops and catering
No doubt this is much the same all around the world but if you compare the best practice with the worst you get an idea of where improvements can be made. Just within the UK the best and worst are often five times better (or worse). Whether it is the cost of council house repairs or the cost of a hip replacement or even the survival rate for a particular disease or procedure.
When working practices in France Germany and United States are compared we find that in general the UK has a Productivity gap of 35%. When investment is managed by the Private Sector we find a 17% better performance making a target of 52% reduction in Public Expenditure a reasonable possibility by using only existing Best Practice. All of this from the turn of the Millennium Study by HM Treasury "Productivity in the UK" (SOL 11/00 19585)
We sought confirmation from National Audit Office. They told us they have no estimate of Waste in Public Expenditure.
This is bad enough but when we come to interpret this in terms of our own anecdotal evidence and, indeed, casual inspection, of Public Authorities we know that this is, in fact, an underestimate. It is so much part of our culture that we expect waste. It is only when we have real numbers to use we see how bad things really are.
Go to your local Council Offices. Are they busy? What are the support staff actually doing in your doctors surgery? See all the doctors and nurses in your local Hospital are they dealing with Patients or talking to each other? Estimates vary but according to the Number Ten website in May 2002 there are there are 67,000 (full time equivalent) doctors employed by the NHS in Hospitals. There are about 157,000 occupied beds in the NHS (about 15% are empty). That's two patients for every Doctor. Of course there is the odd three hour Outpatients clinic but each Doctor has almost 13 support staff including radiographers and lab technicians (one for every Doctor). Even 387,000 nurses is not enough to deal with the sick properly when they arrive. We have to accept that in Brutish Britain letting the patient get really ill is part of the routine confirmatory diagnostic technique.The idea of a Diagnostic Specialist seems like a crazy dream. Patients are so angry huge sums are spent on security to prevent attacks on staff. It also keeps private medicine patronised but don't get seriously ill because you'll probable end up back in the NHS. A nurse has to leave to pick up her child and an operation is cancelled. Everybody copes magnificently (that's the myth they like to promulgate) except they don't wash their hands enough, can't get their buildings properly repaired and patients spend most time in conversation with cleaners-where better to pick up an infection- they don't keep there records properly and often loose them. Remarkably to them there appears to be no readily available solution to this. In this cult the patient is kept in the dark and desperate long enough to ensure compliance and submission to the highly error prone procedures with undisclosed (and often unknown) risk. Thus many patients are happiest if you lie to them. There are no or at least few cures. Treat a healthy patient and see him get better as recovery from treatment side effects proceeds.There are no standard procedure for accidents, which are frequent, or the reporting of incorrect diagnosis. Oddly for most the NHS is a low pay culture. A Fair Pay culture with far fewer staff and strictly enforced compliance to an ongoing refinement of risk minimisation is required and a recognition of the safety critical nature of the Profession wherever a decision is made. Some complain about political interference but when a profession refuses to make itself properly accountable with a swiftly pro-active safety culture they show they are unfit to regulate themselves.Slowly Surgical Risk rates are being established both for procedures and individual surgeons but still outcomes of treatment are not routinely recorded in a way which makes quickly apparent the up-to-date risk of a given therapy, let alone the prevalence of misdiagnosis and iatrogenic disease.
The same criticism can be made of most of the other professions in the Public Service.This is not surprising. Doctors are regarded as standard setting for us all but it takes the techniques of those that formally accept error as part of their everyday lives, aerospace engineers, computer programmers and cyberneticians to show how to adapt to modern standards of properly risk minimised care and expectation.
So with waste at 52% we would expect the Public Service is employing twice as many people as it needs and paying twice as much as it need for Public Works contracts. In fact things are much worse than that with the possible exception of schools- but now the Minister is aiming to reduce pupil contact to 27 hours a week we see the same potential for under achieving and over staffing. Routine sharing of first rate easily adaptable teaching materials that enable criticism is what is required but rarely done. When we look at the Police we see similar redundant organisation. There are about 140,000 Police (according to one recent estimate) and about 5.5 million crimes reported.That means one crime about every ten days for every policeman employed.Yet still the bleating about inadequate resources. Add this to Social workers who don't work, tax inspectors that don't inspect and Lawyers that can't acknowledge that their purpose is to interpret and establish Justice and we see the disaster of modern Public Service which as recent fraud in business has shown reflects in large commercial organisations as well. Banking costs which are extortionate and full of unacknowledged error. Financial agreements so complex that the outcome of a transaction is almost impossible to forecast or compare for efficiency. Telecommunications companies that charge far more than the technology costs indeed spend more on billing than infrastructure. Suppliers to Government in Defence, Railways- why can't trains run on time and London Underground mend its escalators? and building Portculis House, The British Library, The New Court in the British Museum- these are high profile projects whose costs were never properly controlled by specialist Public Service experts and commercial companies. How much does it really cost to fix a mile of railway rack, install new signalling equipment, build new roads or refurbish housing in London? Don't ask the people purchasing these services they seem to make it their deliberate business not to know.
Lastly in this catalogue of guilt we have the killer doctors and nurses, the child molesters working in Children's Homes and the nuclear fuel workers who thought it would be a good idea to falsify their fuel rod safety records. Strict Real Time Regulation with alerting for non-compliance would take care of all of that. Untruthful reporting would be an immediately sackable offence barring all future employment in the profession concerned. But everybody does it, the myth goes on, and few get caught, usually it doesn't matter and the client/customer/patient is an idiot anyway- so expect resistance especially from those who can make a living out of the chaos: the incompetent managers. In Management Cybernetics Stafford Beer has a term for this. He calls it pathological autopoiesis- parasitical self-production. Work rates and effectiveness are so poor those complying with real time reporting requirements can expect to be paid far more.
Ask a nurse or a waitress do they prefer to be busy or not. You may get a shock. Time goes quickly if you are busy and if you have a properly incentivised contract you may be earning more money. For those who have only worked in Public Service the idea is to avoid work and the higher up you go the more ceremonial your role becomes. Many of us in the Small and Medium Enterprise economy (most) know what a real job is. We willingly seek responsibility and the challenge of introducing change and improving and developing our skills to serve real customers. It is sad to see the vacuous posturing of those who have only known schools and the protection of a life in the law, medicine or even some large commercial organisations when talking about management. Not for them the positive joy of taking responsibility and achieving goals. The first move is to try to control the client relationship with
worldly wise posturing that demonstrate how naive we are in expecting justice from a lawyer or a cure from a Doctor. Who is sickest the Doctor of his patient? Who is most unjust the Lawyer or his client? Even the leaders in their profession become pathologically autopoietic and completely alienated from the motive of their profession. The error rate in all these groups is enormously high even though the implicit error rate (as in Medical Diagnosis) is not high. In the Law, for example, and in the building industry. Ask the council to do something for you. How often do they get it right? Car repair? Retail Engineering shows us the natural way forward. Some of us do it correctly, however. The less you pay for your electronics the more reliable and easier to use it becomes. The profit margins are too low to tolerate high failure rates or user difficulties. But the professions lag appallingly. What is the medical or legal equivalent of the Super Market? Whatever it turns out to be you can be sure the techniques of Real Time Management, recording events as they occur, will be ensuring quality is assured.