Return to Action needed – Public sector


  • 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

    • Nevertheless, the majority of people are now less than happy with the service they get from the NHS

  • In fact, most NHS staff work hard and are keen to do their best for patients (most of the time) – 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 much back-office paperwork admin cutting front-line services signed up for

    • Too few useful performance measures

    • Too much focus on government measures and meeting their targets

    • Too many blockages/ handovers/ delays involved in ‘patient flow’

    • Too much corralling of patients together in hospital or GP waiting rooms where they infect each other

    • Too much recirculation of warm air to save on energy costs which also means 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 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 so, perversely, old-age diseases take many more medical resources to deal with than those suffered by younger folk

 Overall, the NHS is a victim of its own success – and, without major process changes, costs per episode are bound to rise and productivity 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