Home front
By Philip Johnston
(Filed: 31/01/2005)

Tick here to make wealth vanish

Here are two stories to illustrate why the state spends so much of our money unnecessarily. The first concerns a nursery school. Last year, it received a visit from Ofsted inspectors, an experience that caused unwarranted anxiety among well-educated and highly trained staff who have brought up their own children perfectly adequately.

Last week, the report of the inspection was published. As was well known to the parents who send their children there, the teaching was judged to be excellent, the premises clean and bright, and the place well run. Is there any more to be said? Well, according to Ofsted, there was five pages' worth more to be said, most of which bore little obvious relevance to the concept of what makes a good school.

For instance, the inspectors quibbled over the fact that the children washed their hands in a bowl, where the water was changed regularly, rather than in a basin using the taps. Other "failings" included not keeping a visitors' book to log the arrival and departure times of every parent and not recording relevant details in a fire-drill book.

Ofsted's advice to this splendid nursery and to the parents is a mixture of the patronising and the incomprehensible. The school "should review the curriculum planning to ensure the learning intentions of activities are indicated" and the parents should be "encouraged to support their child's learning within the pre-school and (be) informed of the six areas of learning within the foundation stage". The school has also been told that it needs "to ensure the children are presented with opportunities to use programmable toys to support their learning". (These children, remember, are aged between two and four.) The "provider" - ie the school - is required to draw up an action plan to make good these shortcomings within 40 days and to make it available to all parents and the local education authority. Just to make sure it is done, "an evaluation of the action taken will form part of the next inspection".

According to the preamble to the report, the purpose of the inspection is "to assure government, parents and the public that the nursery education is of an acceptable quality". But while some form of inspection may be advisable, the issue is surely one of proportion. What is the cost of these exercises, taking place in thousands of nurseries and schools up and down the land? The time, the effort, the worry; the requirement to buy unnecessary equipment; the forms to be filled in; the action plans to be drafted. You cannot blame the inspectors, because they are given no discretion. The specification of what makes a good nursery has been set centrally. The boxes must be ticked.

The second story is to do with the Government's attempts to reduce the amount of time people have to wait when they visit the A&E unit at their local hospital. Ministers have set the NHS a target to cut this to a maximum of four hours, which still seems an inordinate length of time to spend late at night in the inevitable company of drunks and beaten-up yobs when you are nursing a broken arm.

Within the next few weeks, with an election looming, the Government is expected to announce that this target has been achieved. So, this must be good news. Except that hospitals appear to be meeting the target by admitting more people from A&E if it looks like they may have to wait longer than the four hours, so that they do not show up in the figures. Data from something called the "hospital episode statistics" show that as hospitals have moved towards meeting the target, the volumes of admissions from A&E have gone up almost 20 per cent. What is going on here? Are people with sprained ankles or a minor injury who have been waiting more than three hours in A&E getting pushed into a bed? If so, the financial implications are enormous as it costs £300 for an overnight stay in a bed (and, incidentally, exposes an otherwise healthy person to the risk of contracting MRSA.)

These two stories go to the heart of the debate over public-sector waste. Why has spending under Labour gone up from £316 billion in 1996-97 to an eye-watering £516 billion in the coming financial year without an improvement in services that matches the investment, even if they have got better? The reason is the huge impact of inspections and target-setting on the public sector. As George Trefgarne points out (Opinion, Jan 31), the recent reviews of waste conducted by Labour and the Tories represent a difference of £15 billion to be eradicated from planned increases in public spending. Neither party proposes an absolute reduction, yet one might be possible if there were a fundamental rethink of the way services are expected to conform to centrally set targets.

Few think radically enough. One who does is John Seddon, an occupational psychologist and "management thinker" who has spent years telling anyone who would listen that command-and-control targets spectacularly fail to deliver what is wanted. They make people focus on the wrong things, hindering performance rather than fostering improvement.

"People's attention turns to being seen to meet the targets at the expense of achieving the organisation's purpose," he says. "All this effort constitutes and causes waste - inefficiency, poor service and, worst of all, low morale."

Seddon's concern is less with the concept of a target than what happens when they are set arbitrarily by someone in authority who is detached from what is actually happening on the ground. While they might suit a grand Whitehall plan, they have no bearing whatever on what can actually be achieved. According to Seddon, properly devolved management and a redesign of the way public services respond to the requirements of the people who use them, rather than to the diktats of the officials who run them, will save vast sums and deliver the better schools and hospitals we should be seeing for our money. It would even be possible to cut taxes as well.

philip.johnston@telegraph.co.uk