NHS Shared Business Services – were we wrong to be positive?

We wrote about the National Health Service Shared Business Services operation before Christmas, and also mentioned here that Howard Clark had published a very interesting critique of our analysis. I said we would analyse his analysis – so without wishing that this to become a Russian doll-like analysis of analysis of analysis, I did want to make a few points about his piece.

The first thing to stress is that I’m no cheerleader of shared services. Anyone who reads us regularly should realise that we try hard to be independent and look at everything – whether it is technology, procurement initiatives, the performance of  public sector organisations – on its merits. We’ve been pretty rude for instance about the lack of best practice shown by some Whitehall shared services operations, for instance! (I have to post hard copy invoices to them – crazy).

Clark is right to say our posts weren’t based on rigourous analysis, but mainly on a half-day visit to SBS in Leeds. He’s also right that I didn’t publish a lot of data about (for instance) improvement s in performance. That’s true – partly because SBS did give me more than I published, but I thought it was a bit dull! “They now handle twice as much incoming post with half as many people” is not particularly thrilling stuff.

He’s also right that meeting a few impressive people doesn’t mean it is a great organisation. As he says:

“Talking to staff, listening to managers claims about services will tell you nothing about the truth of service performance. Even poor services can look organised”.

I don’t disagree – but I have visited an awful lot of businesses over the years, and I do believe you can get some sense of motivation, of levels of organisation and effectiveness from observation.  For instance,  I mentioned I met two people in management roles who had worked their way up from the “bottom”. One who was running a Department had started as a post-opener! OK, not a statistically valid indicator of performance, but I tell you what – there are many organisations who couldn’t point to a single example of that, so yes, I do take it to be an indicator at least of a certain positive attitude to staff development.

Clark also criticises the use of surveys. Whilst I do acknowledge that they can be “fiddled” I think that criticism is a bit harsh. I’ve seen customer, supplier or staff surveys that genuinely produced useful information.  I find it hard to believe SBS could fiddle the data I quoted that, “the number of clients who would recommended NHS SBS to others” has grown from 39% in 2007 to 95% in 2011.

Suggesting that is not genuine would be a pretty serious allegation of misrepresentation – but perhaps we should ask SBS for the raw data behind that?

Then Clark does fall into one or two of his own traps. He criticises me, perhaps fairly, for relying on hearsay and subjective evidence. Then he uses odd comments and even anonymous quotes that criticise SBS – of course they could even have come from their competitors!  One comment I tracked to source, and it is a reported comment in the minutes of a meeting (where there are also positive remarks about SBS to be fair). It is not even clear in this case who said it to whom, there’s no supporting data… it is as “soft” a bit of evidence as you can imagine, frankly.

He also says that in 2009 David Nicholson, then Chief Executive of the NHS in England, “demanded that trusts justify why they hadn’t taken-up SBS”.  Here is the actual text:

“Where corporate services are currently retained in-house, I would encourage NHS management boards to be clear that the decision to retain them represents better value for money than alternative options such as NHS Shared Business Services, or other shared service or outsourcing solutions”.

Well, that’s not the most aggressive “demand” I’ve ever heard, to be honest…  Now I have very mixed feelings about the power Sir David Nicholson has wielded for some years, but ultimately, Trusts have a lot of independence, and now the SBS framework has expired, they really are “just another supplier”.

Having said all that, I do welcome the criticism and it is a reminder that we have to strive to be objective and analytical in everything we write. I’d also stress Spend Matters has never received a penny in fees from SBS or the Department of Health. (I had about three days consulting fees from DH quite a few years ago when that was my main business.)

So a good debate, and we’ll keep our eye on SBS, the NHS and shared services I’m sure through 2013. And I fully agree with Clark that we should continue to seek evidence of the “success” or otherwise of the whole shared services concept.

 

Comments

  • Sam Unkim:

    Yes

  • Rob:

    SBS is a rare success story in shared services in government, especially when you consider that, as you rightly confirm Peter, it has never been mandated, yet covers 40% of the NHS. FDs within the Health system regularly shares insights with each other and surely they would be leaving in droves in favour of other solutions – they’re not.
    There are gaps and occassional ‘hiccups’, of course, but it is, afterall, an Oracle platform…

  • Howard Clark:

    The argument isn’t about NHS SBS, but about if the information is available for Spend Matters to conclude that NHS SBS is an example of ‘excellent shared services.’

    My use of anonymous posts, alongside reports published in the press and NHS performance reports are meant to identify dissonance (not prove NHS SBS are good or bad.

    As I wrote ….

    ‘I included anonymous sources as evidence of dissonance, rather than evidence that NHS SBS were good or bad. I wrote that ‘an anonymous source does not amount to evidence‘ and concluded:

    Now this doesn’t mean that the NHS SBS service is bad or good. It means that there has not been any new compelling evidence’

    You can find my responses to the NHS article series on NHS SBS here:

    http://calchaspss.wordpress.com/2013/01/24/spend-matters-and-nhs-sbs-setting-the-record-straight-you-decide/

    • Rob:

      Howard, I’ve read your latest blog, and can assure you that I don’t work for SBS, but for a major NHS Trust. As I say, their solution isn’t perfect, but it seems to have made more progress than any other shared service in government, and I was using this reference as the prime comparator.

      • Howard Clark:

        @Rob. My argument wasn’t about NHS SBS quality, but the evidence that allowed Spend Matters to claim NHS SBS to be an example of ‘excellent shared services.’

        Assertions do not evidence make. So when you say better, what is the evidence to support that claim? It doesn’t look like that evidence currently publicly provided can be drawn upon with confidence. There is counter ‘evidence’ [dissonance] on performance.

        If you do work for a major NHS Trust, what position do you hold? Were you involved in setting-up the shared services? Can you provide evidence to support your identity and your statements?

        • Rob:

          Peter has my email address at the Trust and has my permission to provide them to you.

          • Howard Clark:

            Rob. I would be very curious and interested in talking to you about this.

  • Dave Orr:

    I agree with Howard that there is an awful lot of self-generated PR, favourable case studies and “impressive” awards (usually self entered and mutually awarded) from outsourcers in shared services. “Bulls**t baffles Brains” stuff.

    Down here in Somerset, IBM for Southwest One have generated and continue to do so a set of professional claims and positive PR for their shared services, yet will be meeting their lead Partner Somerset County Council in High Court in November.

    The Southwest One web site continues to make ludicrous procurememnt spend claims and retains the £200m of savings claims, over 5 years into a 10-year contract, when it is crystal clear that these claims were, are & remain “PIE IN THE SKY”. Right now the costs exceed savings by £60m. And another round of cuts of 320m are being implemented from April including Childrens Services.

    These aren’t harmless commerce issues in the NHS and Local Government – it is playing with peoples lives. Like poor PFI deals sucking the revenue life blood out of South London NHS Trusts. Money transferred from patient care to bad deals that can be excessively profitable and adding insult to injury, be offshored so that those profits avoid tax.

    From a macro economic and social capital standpoint, I remain very concerned about the extent and amount of offshored work to India by SBS. This is public taxpayers money being used to export work and skills to a global competitor. Is that in the longer term wise?

    Peter: Are you sure that the skills and work transferred to India is low skill admin work or will there be “mission creep” (to drive further profit) and we will see IT and other key professional skills also lost to India (as IBM did with SAP and IT in Somerset – via their Bangalore division)?

  • Dave Orr:

    Errata: TYPO “cuts of £20m” (NOT 320m) above.

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