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NHS

  • The NHS is a great success story:
    • On average UK citizens now enjoy much longer, healthier, pain-free lives
    • Treatments offered are far better and time in hospital has been dramatically reduced thanks to better methods like day and key-hole surgery
    • The great majority of people are happy with the service they get from the NHS

 

  • But the ONS and others say NHS productivity has fallen over the last ten years:
    • They mean we now get less output from the NHS per pound sterling input
    • They also claim to take account of improved quality and service levels

 

  • In fact, most NHS staff work hard and are keen to do their best for patients – so why haven’t output volumes improved too?

 

  • Usually, it’s because of the methods and procedures that managers and inspectors have imposed on the staff – ones which prevent them offering a better service e.g.
    • Too few good performance measures and too little accountability
    • Too many blockages/ handovers/ delays involved in ‘patient flow’
    • Too little focus on what patients need
    • Too much focus on government measures and meeting targets
    • Too much corralling of patients together in hospital or GP waiting rooms where they infect each other – or recirculation of warm air to save on energy costs so one sick contagious patient can infect many more

 

  • Areas where there’s scope to improve include:
    • Nurses’ time with patients, which is often too little, versus time on paperwork
    • Admission/ discharge processes to reduce turnaround times
    • Use of email/ phone communications with patients versus face-to-face
    • Better use of spare capacity of operating theatres, special equipment and skilled people – much is wasted because of budgetary constraints and some hospital managers only doing what they can afford at the time
    • Removing the incentive for some doctors who spend a percentage of their time on lucrative, private practice work to not reduce NHS waiting times but offer patients their same services with no waiting if they go privately

 

  • Lastly, it should be widely recognised that the success of the NHS has meant there’s many more people living to old age, and old-age diseases take many more medical resources to deal with than younger ones

 

  • It’s perverse, but the NHS is a victim of its own success – without major method changes, costs per episode were bound to rise and productivity was bound to fall

 

 Outcomes the public wants of the NHS – by Dr A Inwald

  • Easy access to and sympathetic time with his GP
  • If necessary, referral to a good quality consultant at his local hospital
  • An appointment within 4 weeks for most conditions, and this appointment not to be cancelled or postponed at the last minute
  • To be seen on time, and be given enough time with the consultant:
    • To explain his condition
    • To be examined
    • To have a discussion about the treatment needed
  • To have all investigations, including blood tests, X-rays and scans etc completed within 2 to 4 weeks
  • If need to be admitted, to be given an admission date and time within 2 to 4 weeks which will not be postponed or cancelled – not to be told to go home and come back another day when a bed might become available
  • To be welcomed to a clean, single-sex ward managed by an experienced sister with authority over all the staff in her ward, including cleaners and junior doctors
  • The toilets and ward to conform to the highest standards of hygiene
  • If need surgery, to know that administrative staff cannot close the operating theatres to save money or postpone surgery because there aren’t enough post-op beds available
  • If have to attend the A&E department in an emergency, to receive prompt care in a clean and well-run hygienic facility
  • And any surgery or treatment to be successful