- Under the heading ‘Ailing Health’ a leader article in The Times claimed: “The NHS is delivering poor outcomes and value for money” despite average UK citizens now enjoying much longer, healthier, pain-free lives – this laudable success has had a perverse consequence because increased old-age increases attendant old-age diseases and they need significantly more costly medical resources to treat than younger ones
- In particular, The Times offered two main reasons for their claim:
- Stubbornly high waiting lists for hospital treatments and GP appointments
- Unexpected deaths among the middle-aged, predominantly due to preventable conditions such as diabetes, heart disease and cirrhosis
- Wes Streeting, the UK shadow health secretary, also ruffled a few Labour Party feathers recently by saying: “The NHS must re-consider how it could be more efficient and not just ask for more money”
- Unrestricted demand on the NHS is the problem – but offer anything ‘free at the point of delivery’ and demand will mushroom – price is not available to sieve out time-wasters and hypocondriacs, and efforts to encourage a change in the lifestyle behaviour of many individuals tend to be ignored – the only major deterrent to NHS demand is thus lengthy waiting times – but most on those lists enduring pain or worse cannot afford to short-cut them and afford expensive private treatment, so they are condemned to suffer – shockingly, some are even driven to pulling their own teeth out – NHS productivity has thus become a major electoral issue
- Hence political parties compete for public votes with pledges to increase (tax-payer) funding for more hospitals, doctors and nurses, each claiming the NHS is ‘safer in their hands’ – yet, year after year, an already unaffordable public service steadily gets worse despite many improvement initiatives being tried e.g. wholesale restructuring of the service, hospitals competing against each other, outside management consultants forever advising on changes needed – nevertheless, demand and costs keep on rising whilst hard-working staff become less motivated, some driven to emigrate, doctors even going on strike and using patients’ suffering as a bargaining chip despite their hippocratic oaths
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The Times offers their solution: “The only sustainable way of meeting NHS demand is by improving productivity” – they add: “There has been an increase in real spending on the NHS and an increase in the number of doctors and nurses but average productivity has fallen”
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The ONS – Office of National Statistics – concurs: “Over the last 10 years there has been no significant increase in NHS productivity, yet huge increases in funding”
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Just don’t ask quite how both measure NHS productivity – how they measure overall productivity of the mix of different hospitals, doctors, nurses and support staff plus all their different systems and procedures plus all the various GP practices – the fact is that any productivity statistics covering any one or more hospitals, and above, are at best meaningless – they might make headline splashes for bystanders but no NHS manager could make any good use of them
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However, The Times follows up with: “Policymakers must refrain from idle promises of increased spending and first improve the way resources are used” – at long last, an approach that’s been needed for a long long time – an approach that doesn’t rely on magic money trees to fund more and more costly input resources – an approach that first steers well clear of high-brow strategy and leading edge technology thinking and focuses on making big practical improvements now – an approach that covers the entire NHS production line, end-to-end, from GP gatekeepers to hospitals to social care
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So what action will make the big difference needed to provide the service the public wants at a price they’re willing to pay?
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The government recently announced they are employing outside management consultants, yet again – and for a mere 10 weeks – somehow, the cohorts of NHS managers responsible for NHS cost and productivity levels are thought to need such brief support but one knows already how enthusiastic they will be when asked to implement any recommendations made in the imminent panacea report
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So let us, for free, pre-empt said report and offer our ‘shadow’ recommendations – a three stage approach, with Stages 1 & 2 involving in-house managers and staff alone – with expensive outside management and technical consultants only considered as an option for Stage 3 – as follows:
- Stage 1 – Cut waste of input resources and outcomes which are not RFT (Right First Time) – imagine if it became known that 40% of all costly input resources were wasted because of their non-availability, non-utilisation and/ or inefficient use of their capacity – but nobody knows because they’re not measured – whilst staff have measures and targets galore, plus over 50 different inspection and regulatory bodies watching over them, they don’t have what they, and the public, need – nor any good database of best practices elsewhere for them to consult and learn from
- Stage 2 – Optimise the mix of existing resources and methods used to provide best outcomes for patients and tax-payers – at present, nobody questions the mix and processes that hard-working staff have to follow, especially the admin and box-ticking they have to do – slashing much of it would also benefit staff who could then be with their patients more
- Stage 3 – Invest huge savings from Stages 1 & 2 in new ‘skills and technology’ – this stage may well need the support of outside advisers given the areas involved could include use of drones for rapid delivery of organs and drugs, personalised medicines, remote monitoring devices, precision gene therapies, robotic surgery, AI diagnostics, predictive data analytics and illness prevention services
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In other words, it’s not blue sky, leading-edge thinking that’s first needed – mostly common sense to complete Stages 1 & 2, using existing staff already paid for – not lurching on to the latest and best beforehand
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A good example only recently made the headlines – two London hospitals had just realised that, if they ran two operating theatres side by side, as soon as one procedure was finished in one, the next patient could be already under anaesthetic and ready to be wheeled in to the other – nurses were on standby to sterilise the first operating theatre so, instead of taking 40 minutes between cases, it took less than two – this enabled surgeons to perform an entire week’s worth of operations in a single day
- One is bound to ask how many more such process and task improvements might be possible, and so whether the NHS really does need the billions more of our money said to be needed?
P.S. NHS managers should also be made accountable to their local public and report regularly on their progress with the few performance measures they and the public, not HQ bureaucrats, are interested in – but that’s for another post