Tidy processes but untidy outcomes

General Practice is managed by its local Primary Care Trust. Our PCT has a population of 330,000 patients and spends hundreds of millions of pounds of your money and mine. They are responsible not just for ensuring we are performing our duties properly, but also for introducing new services and the procedures to support them. They also commission new buildings; they modify and adapt the complex arrangements that are involved as a patient moves through the system from GP to hospital or to a specialist clinic, and then back again. From a general practice perspective, virtually everybody with who we come into contact is a "manager".

It may come as a surprise to you that so many of them have no specific previous relevant experience that they can apply to the tasks for which they have been recruited. The important essential criterion seems to be the ability to produce impressive word-processed reports with lots of tables accompanied by a multi-page spreadsheet with lots of colours. Too often, it is the triumph of style over substance.

Don't believe me? Then consider the following:

Yesterday I attended a meeting of a group meant to be steering an important screening service for people suffering from complaint found frequently in our population. There were seven of us managers and we all like to think we have the best interests of patients at the heart of everything we do. We were discussing the local hosptials failure to achieve a fourteen-day target for seeing urgent referrals.

Nice manager from the hospital: "We have a high rate (40%) of non-attendance in clinics."
Nice assistant director of PCT: "What are you doing about it?"
Nice manager from the hospital: "We're recruting a locum consultant to work thought the backlog".
Nice PCT service manager: "That's good to know. How long will it take?"
Nice man from hospital: "We are recruiting now and we believe it will soon make a signficant improvement".
Nice assistant director: "That's good to know."
Me: "Hang on a minute. If two in every five people aren't turning up for their appointment, why get more capacity when the capacity you've got sits unemployed for 40% of their clinic time?"
Nice man from hospital: "The consultants won't let us double book clinics".

Apart from the inherent nonsense of the consultants' stance, nobody else seemed the least bothered. They had dealt with the problem i.e. they had pushed and prodded it a bit (but not too hard) and had a response to write in the minutes.

Meanwhile, patients are still not getting urgent appointments within two weeks, and there is no date given at which it is forecast that this entirely avoidable situation will improve.

Their process is nice and neat but the outcomes which were poor are no better.