Thursday, 24 November 2011
Egypt Again
The Egyptian people are urbane and civilised. They deserve to be masters of their own destiny and be allowed to elect their own government. This is not just a luxury: it is their right. It is their right to decide how their country will be run and to vote for a new constitution. They have had to experience much deprivation, unfair arrest and violence to get this far. Let us hope there will be a peaceful resolution to their predicament and that the army cedes power to a democratic government which is elected fairly. The country can then be led to social justice and prosperity.This will not just benefit Egypt but also every other nation in North Africa and eventually the Middle East.
Zero based budget for care of the elderly
There has been much furore in the press recently about the standard of care given to the very elderly and infirm in the UK. Much criticism levelled at care workers who do not spend enough time with the aged or the infirm. Some of this criticism may be justified as the "care industry" probably employs people who just do not care and it probably has its fair share of employees who simply are criminal. Most "care workers" are probably trying to do their best under difficult working conditions.
This morning I saw a "care worker " being interviewed on television; she was obviously sympathetic towards those who she looked after. But, she explained that she was paid £2.76 per hour for the time that she spent at the patient's home only, and she was not fully compensated for the travelling time and expense when moving from one patient to another. She also averred that she was given very little time to spend with each patient and that in fact the time allocated, in many cases, was insufficient to provide an adequate service.
I suggest that the pay is inadequate for the importance and pressure of the work.
A representative of the United Kingdom Homecare Association Ltd (UKHCA) was also interviewed . He intimated that the budget allocated by the local authorities was probably insufficient to meet all the demands of home care placed on UKHCA members.
The problems are caused not just by budgetary constraints but problems of morale. The carers are expected to perform work without sufficient time allocated to complete their job to the standard expected. No wonder there is low morale given the poor pay.
There is a case for applying the techniques of scientific management to the work of carers and not just allocating work within a budgetary constraint. This just encourages bad management and the arbitrary allocation of work based on a whim and desire rather than facts from the ground. It also encourages a bureaucratic mentality of inefficiency and ineffectiveness. The aged and the infirm deserve better than this. They need to be looked after by well motivated staff who really care about them and who have the time and resources to do a proper job.
A quality standard should be set. There should then be a fair amount of time allocated for each caring task to be completed. The carer should be allowed a fair amount of time to move from one patient to another. A contingency time should be added to take account of difficulties.
Sufficient redundancy should be built into the system to allow for sickness or staff absence.
The staff should be paid a fair rate for the job and this fair rate should be independently assessed. Staff should be interviewed and selected by assessing their personality and attitude towards the aged and the infirm. From this the number of staff needed to provide a high quality service "manned" by dedicated staff ,who really care about the patients, should be calculated.
From this calculation, a budget should be built up from a zero base to include not just the direct staff costs but also the cost of administration. I suspect that this cost would be substantially higher than the budgets allocated from on high by the council and the government.
The public should be made aware of the real budget required to provide the high quality service which is expected.
A similar process of zero based budgeting should be applied to all our key services: health, the police, the army etc.
Once the budget is prepared it should be made public. The public will probably be shocked how much it costs to provide these services. But scientific management, if used effectively, could ensure optimum productivity based on facts and not just on the whim of accountants and bureaucrats wielding spreadsheets and making arbitrary decisions about "service delivery" .
The public could then make a decision of how services are delivered and at what quality level and how this is to be financed through the balance of taxation and borrowing. If we want very high levels of quality for health care, care for the elderly or policing etc. then we have to pay for it. We may have to do this at the expense of a new car or a new PC every year.
The very idea of setting a budget before the cost of job that needs to be done is calculated is anathema to good management. No wonder the care of the elderly and infirm is in such a mess. No amount of inspection or public relations statements will cure this problem. Only hard headed decision making based on the facts will go anywhere near to resolving such difficulties.
The public must make a hard choice. Are we prepared to pay the full cost for the services which we demand or do we want to pay less money for a reduced service? How is this to be financed - by charges, taxes or borrowing or a mix? Are we prepared to sacrifice the consumption of consumer goods for improved public service when budgets are stretched? It is our choice and we can only expect our politicians to follow our lead on this issue.
This morning I saw a "care worker " being interviewed on television; she was obviously sympathetic towards those who she looked after. But, she explained that she was paid £2.76 per hour for the time that she spent at the patient's home only, and she was not fully compensated for the travelling time and expense when moving from one patient to another. She also averred that she was given very little time to spend with each patient and that in fact the time allocated, in many cases, was insufficient to provide an adequate service.
I suggest that the pay is inadequate for the importance and pressure of the work.
A representative of the United Kingdom Homecare Association Ltd (UKHCA) was also interviewed . He intimated that the budget allocated by the local authorities was probably insufficient to meet all the demands of home care placed on UKHCA members.
The problems are caused not just by budgetary constraints but problems of morale. The carers are expected to perform work without sufficient time allocated to complete their job to the standard expected. No wonder there is low morale given the poor pay.
There is a case for applying the techniques of scientific management to the work of carers and not just allocating work within a budgetary constraint. This just encourages bad management and the arbitrary allocation of work based on a whim and desire rather than facts from the ground. It also encourages a bureaucratic mentality of inefficiency and ineffectiveness. The aged and the infirm deserve better than this. They need to be looked after by well motivated staff who really care about them and who have the time and resources to do a proper job.
A quality standard should be set. There should then be a fair amount of time allocated for each caring task to be completed. The carer should be allowed a fair amount of time to move from one patient to another. A contingency time should be added to take account of difficulties.
Sufficient redundancy should be built into the system to allow for sickness or staff absence.
The staff should be paid a fair rate for the job and this fair rate should be independently assessed. Staff should be interviewed and selected by assessing their personality and attitude towards the aged and the infirm. From this the number of staff needed to provide a high quality service "manned" by dedicated staff ,who really care about the patients, should be calculated.
From this calculation, a budget should be built up from a zero base to include not just the direct staff costs but also the cost of administration. I suspect that this cost would be substantially higher than the budgets allocated from on high by the council and the government.
The public should be made aware of the real budget required to provide the high quality service which is expected.
A similar process of zero based budgeting should be applied to all our key services: health, the police, the army etc.
Once the budget is prepared it should be made public. The public will probably be shocked how much it costs to provide these services. But scientific management, if used effectively, could ensure optimum productivity based on facts and not just on the whim of accountants and bureaucrats wielding spreadsheets and making arbitrary decisions about "service delivery" .
The public could then make a decision of how services are delivered and at what quality level and how this is to be financed through the balance of taxation and borrowing. If we want very high levels of quality for health care, care for the elderly or policing etc. then we have to pay for it. We may have to do this at the expense of a new car or a new PC every year.
The very idea of setting a budget before the cost of job that needs to be done is calculated is anathema to good management. No wonder the care of the elderly and infirm is in such a mess. No amount of inspection or public relations statements will cure this problem. Only hard headed decision making based on the facts will go anywhere near to resolving such difficulties.
The public must make a hard choice. Are we prepared to pay the full cost for the services which we demand or do we want to pay less money for a reduced service? How is this to be financed - by charges, taxes or borrowing or a mix? Are we prepared to sacrifice the consumption of consumer goods for improved public service when budgets are stretched? It is our choice and we can only expect our politicians to follow our lead on this issue.
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