I previously blogged on the risks associated with ‘doing nothing’ in response to public sector funding pressures. I want to go into a bit more detail about one of the key risks I mentioned in that blog: staff burnout.
Most of the debate about austerity in public services focuses on money – the £ sign. But those £s translate directly into people. Most public spending goes on staff to deliver services. Yes, a big chunk goes on procurement. But procurement is not all about buying pens and desks. Public bodies procure a lot of services – like social care for people in their own homes and residential homes. Services, of course, need staff to deliver them.
The Office for Budget Responsibility predicts that across UK there will be a reduction in the public sector workforce of around 1 million between 2011 and 2018. That comes on top of reductions prior to 2011. In areport I produced for Wales Public Services 2025 we calculated, quite crudely, that this would mean a further reduction of 58,000 people working for Welsh public services by 2018. In total almost 1 in 5 public sector employees: quite a large reduction.
The demand for the services that those people would have otherwise provided is not going anywhere. Indeed, the Wales Public Services 2025 report showed that projections are for rising levels of demand and growing expectations. So if nothing changes in the system of public services, we are basically asking fewer staff to just work harder to deliver better services to more service users.
So what would that look like? Well it may ‘look’ a lot more efficient. Unit costs will be down as staff carry bigger caseloads and work extra hours in their own time at no cost to their public service employer: as many frontline staff are already doing. Plus lots of those leaving will be the most ‘costly’: the senior staff who are, shall we say, more mature and likely to accept the early retirement incentives on offer. So double bonus – unit costs are even lower! What could be wrong – mega efficiency savings and we’re quids in aren’t we? Most people would expect somebody working in audit, like me, to say ‘yes’. But I suspect the answer is no.
Those familiar with lean and the Toyota Production System may have come across the 3 ‘Mu’s of waste: Muda, Mura and Muri. Muda is the most widely known. It could be described as ‘non-value activity’ and covers the various tools for tackling waste at the frontline. The other two are less well known: Mura is ‘unevenness’ and is about the flow of a process to reduce variation. Muri– which is the one I’m most interested in here – translates as ‘over-burden’.
In the Toyota Production System, they recognise that it is not reasonable to expect a system – its machinery and people – to work at full capacity all the time. People and machines that work at full capacity are at risk of breaking down and making mistakes. And mistakes are costly to put right: much more costly than the ‘inefficiency’ of not running the machines and workforce into the ground. Also systems at full capacity struggle to adapt to variation – any surge throws them into chaos. That is why they see Muri – over-burden – as a form of waste, not efficiency.
So returning to public sector staff what may be the signs to look out for Muri? Well off the top of my head I’d say it may be social workers overlooking signs of potentially serious abuse as they struggle to keep in touch with more and more individuals and families with less support from experienced colleagues. Nurses that miss basic components of care – like topping up water and a friendly chat to concerned patients and relatives – as they struggle to deal with a growing number of complex cases. And it goes without saying that when mistakes happen most will look to hold individuals accountable, rather than look at a system that potentially makes such mistakes inevitable.
Mistakes and variation driven by over-burden potentially create more work to correct and hence more ‘demand’ and ‘activity’. So while there is an illusion of efficiency the reality is that it feels like chaos and tail-chasing to those working in and being served by the system. And if we were to measure cost per outcome, rather than per unit of activity, I’m confident that the efficiency of such a system would be pretty poor.
I want to emphasise again that this is all based on the picture if the response of public services is to ‘do nothing’ and try more of the same with less. It can potentially be avoided or at least mitigated if we take a radically different approach to designing and delivering services.
We talk a lot about ideas and methods for reshaping public services in the Wales Public Services 2025 report, so I won’t do it again here in detail. The key issues are to prevent demand wherever possible and better meet people’s needs and aspirations earlier by doing what matters for service users, drawing on their existing strengths and support networks. A ruthless focus on only doing things that are of value and drawing on wider support from service users and their own networks seem to me to be key components if we are to enable a depleted workforce to achieve the outcomes that the public and service users aspire to.
So, joining the dots together, the main messages I want to convey are:
1. The real terms funding cuts to public services directly translate to reductions in staff to deliver services
2. If we do nothing, rising demand and expectations will place a huge burden on the remaining work-force
3. We need to be able to identify the difference between a truly efficient system and one that presents an illusion of efficiency but is in reality over-burdened and as a result generating more avoidable demand and activity
4. A sustainable public service probably requires a radical rethinking of the form and purpose of public services rather than trying to flog the current system and its staff beyond their capacity to deliver
Please note – these are my own personal opinions and observations based primarily on my work for Wales Public Services 2025