The harsh financial climate in the public sector means we will have to do more with less. But what does doing more with less mean? Is it another way of saying be more efficient? Is it part of the myth that there are some painless options for reducing spending with out cutting services or reducing staff? Is it a belief that technology will save us if we just embrace it? Is it based on an assumption that if you have less managers they will concentrate more on what’s important? Does it reflect the view that the best way to improve a service is cut its budget and in so doing focus minds and force people to be innovative.
It’s difficult to argue that any organisation couldn’t be more efficient but if the price is to be less effective is that acceptable in public services? Should the NHS use cheaper but less effective drugs? The NHS spends millions on drugs. Primary Care Trust want GPs to use cheaper generic drugs but GPs want the right to prescribe branded drugs if they think they will be more effective.
In the public sector costs are mostly about staffing, the number of people employed. So efficiencies are about getting staff to work harder, longer, pay them less or get someone else to do it cheaper. Alternatively you can replace some teaching posts with cheaper teaching assistant posts and not pay them for school holidays. Instead of using expensive supply teachers to cover for absent teachers you can user cheaper teaching assistants. Of course this may impact on quality. The NHS is often criticised for using expensive agency nurses but if a hospital bans the use of such staff it may find it has to close a ward due to staffing shortages with the result that waiting list for operations increase.
Another way of doing more with less is to use economies of scale in procurement. That is get together with others and negotiate a discount for bulk purchasing. This can work with office furniture or computers but it’s difficult to see how this would work in buying residential care for older people where block contracts are to be replaced with people having the money to buy their own care.
Accommodation for all these staff is expensive so if we can get more staff into fewer buildings we will be more efficient. Hence the fashion for hot desking, mobile working and home working. This is also an example of making use of technology like blackberries and laptops to enable people to work away from the office. Another example of embracing new technology and reducing admin costs is electronic filing. Do you know how much it costs just to rent the floor space for all those filing cabinets? Of course everyone should do their own typing. The typing pool is a thing of the past, no-one has their own PA any more but on the down side how many hours a day does a manager spend wading through e-mails?
Reducing the number of managers without having an adverse affect on frontline services sounds attractive and would appear to constitute doing the same with less. However, increasing an individual manager’s span of control and responsibility or removing a tier of management essentially means someone doing the job of two people. As this is not achievable within the working week decisions have to be made about what won’t be done that used to be done.
Partnership working is often given as an example of how duplication could be removed and how, if people would only just look at the bigger picture, take a whole systems approach then they would see it was in their interests to work together to achieve common goals. The only problem is that managers tend to be judged against their performance in areas specific to their organisation and their responsibility. The NHS might see the value in tackling homelessness, poor housing or long term unemployment in improving people health but hospital managers are focused on waiting lists. There is also a tendency when budgets are tight and services are being cut for organisations to retreat to core business and shunt costs to partners. So hospitals seek to discharge elderly patients from expensive acute beds as quickly as possible forcing some people to go into expensive residential care paid for by some one else. A jointly funded health and social care rehabilitation service would allow for speedy hospital discharge and prevent unnecessary admissions to care but why should the NHS contribute to funding if it can get the Local Authority to pay for it?
Back office savings are often presented as a painless way of reducing costs to deliver the same service and therefore if not doing more then doing the same with less. An example of this in local authorities is the centralisation of the human resource function. Why do departments need their own HR staff? Bring them all together in one smaller team and save on management costs. Why not also outsource the majority of the work which is around administration, for example placing job adverts, sending out job application forms, arranging interviews, sending out letters of appointment etc. Whilst retaining the expertise around employment legislation. The risk is that some of the work that was carried out by HR is now left to managers to do which may not the best use of their time and of course as a result of reducing management posts they are already doing more and with less help following the reduction in admin posts.
It is possible to do more with less, but the risk is ending up doing less and doing it less well.
Blair McPherson