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Good managers can slip up in the current climate of targets

6 April 2010

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AMSPAR Chief Executive

Here’s something we seldom consider: currency. It is accepted, taken for granted, and some will perhaps consider it in terms of margins, but it doesn’t seem as if we give it a second thought. You probably think I’m talking about money – but this is just one aspect of a word with many meanings.

The term currency covers a number of aspects, and monetary value is only one of them. The dictionary gives a number of definitions, including “a continual passing from hand to hand, as of money” and, more pertinent to this article, “the period during which anything is current”.

I’ve been pondering over the currency of language and issues we have to face on a daily basis. For instance, six months ago, if you asked healthcare managers about “salt”, the focus would have been on health. The importance of salt was drummed into me from an early age during my schooling years – my headmaster, who had served in the wars, would say that without salt, you could not survive.

Indeed, salt is essential for animal life (although not good for that many land plants). It is probably the most common flavouring used in cooking. I’m always amused to see restaurant diners reaching for the salt mill before even tasting the food that’s been served to them.

The healthy property of salt is demonstrated by the number of people attracted to the Dead Sea. Herod the Great reputedly built one of the world’s first health resorts on its banks, and people used the sea’s products for cosmetics and herbal sachets.

While salt is vital to us in regulating our water content, we are only too well aware that excessive amounts in our diet can be detrimental and lead to health problems such as high blood pressure (and if you watch In Which We Serve (1942), the salty seawater doesn’t help mentally!). Many high-profile campaigns have been launched to persuade us to cut down on our salt intake.

True grit
Today, following the “big freeze” of recent months, the mention of the word “salt” will immediately conjure up visions of trucks struggling through blizzard conditions in order to spread grit on the roads. Many UK communities were cut off after routes were made impassable due to the inclement weather. These key arteries are vital and need to be kept open to ensure the supply of goods throughout the country and to enable key workers to reach their destinations.

It was interesting to listen to a number of debates that took place during that period. Some councils were able to keep their main roads open, while others admitted they couldn’t cope. This all came down to the varying stockpiles of salt each council thought necessary to hold.

While national guidance is available on the amount of salt to be held, the final decision is left to each council. They are expected to take local conditions into account. Some said they anticipated the bad weather so ordered extra, while others said it was so rare they would respond when necessary.

Unfortunately, “when necessary” arrived – and there was not enough supply to meet the demand. Not surprisingly, the costs then rose. Central government intervened and instructed the distribution of salt across the regions. Those that had anticipated and planned lost out to those who had no contingency arrangements – or, even worse, thought they would be helped out, come what may.

Hard targets
Does such a thing happen in the health sector? How many people are frustrated after being given a budget, working to it, achieving and planning for the period, only to be told the targets have changed and that some other area has to be bailed out?

Targets have of course been in the news recently, with the publication of the Mid Staffordshire hospital trust inquiry report (see Resource). It has been suggested that the trust’s management were too target-driven, to the detriment of patient care. Good managers know that targets are merely tools used to fulfill tasks – they are not the objective. Perhaps the one good thing that may come out of this tragic episode is that good managers will be recognised, valued and demanded.

Needless to say, we are approaching a crucial couple of months. The financial year end is upon us and planning is well underway for the next. A number of extra factors have to be taken onboard this time around. In addition to the burden of the debt we face as a nation – I heard from a member of staff in one trust who had been told to find savings of 10% – there are the changes to the PAYE. It would also seem wise to start planning for the pension changes in 2012, rather than be faced with a substantial hike when it comes around.

One wonders if Whitehall considers impact reports when making plans. The rise in National Insurance will have an adverse effect on employers and the NHS –1.4 million employees will be hit with a massive bill. Then again, National Insurance was first introduced to fund the NHS …

Poll axed
Whatever plans we all make, they will all have to change after the imminent poll date. Even if the current government were to be returned to power with a working majority, budgets will still change. Reality will have arrived, and what was evaded prior to the election will have to be faced.

As the poll date approaches, we know that the currency of language will change, and figures and budgets will alter many times over. However, as we go about our daily work, our values shouldn’t.

The Mid Staffordshire NHS Foundation Trust Independent Inquiry