NHS – Measures needed?

  • Most patients applaud the individual efforts of their doctors, nurses and other NHS staff when treated by them – they clapped even more during the Covid pandemic
  • But, despite more and more being spent on the NHS and many more doctors and nurses being trained, demand keeps rising whilst service levels keep falling
  • All sorts of radical change have been tried over the years to arrest this problem but none have produced the quantum leap in performance needed
  • Meantime, demand keeps rising further, partly the result of NHS success because people now live longer but suffer more costly-to-treat old-age ailments, but also because more people are choosing to live unhealthily whilst expecting free treatment for inevitable results such as obesity 
  • Hence, NHS costs continue to mushroom
  • Clearly this cannot continue – politicians of all colours must bite the bullet and do something radically different, big, and soon
  • Simply outbidding each other by claiming they’re paying more and more for more and more to offer more and more is not the long term affordable solution needed
  • And employing outside strategy consultants, yet again, for a quick 10 week project, is hardly likely to make any difference
  • So back to basics – what are the big issues needing to be addressed for greatly improving this most visible and costly public service?
  • There are three:
    1. How to reduce long term demand, not least by keeping more people healthy rather than treating them when sick – plus considering unmentionables such as ‘a fundamental rationing of services’ and deterring hypocondriacs and time-wasters by charging for GP appointments, as with NHS dentists?
    2. How to increase short term supply by cutting waste and using existing resources more efficiently?   
    3. How to improve long term supply with investment in new processes and technology, including AI? 
  • A very impressive group of experts gathered recently – The Times Health Commission – and published 10 practical recommendations to address these issues – we will post our views on them next week
  • The most pressing short term need, as Julie Wright & Russ King say in their book ‘We all fall down, is for the NHS ‘to treat more patients better, sooner, now and in the future’ i.e. for major productivity improvement
  • On the demand side, the start point is to establish what it is the NHS customers, the patients, want and need from the health service they pay for – they have little interest in NHS unit costs, unless their taxes rise too far, but are very interested in the service and quality levels they receive, especially when waiting for medical operations, GP appointments or being held in ambulances or on trolleys whilst queuing for attention 
  • On the supply side, whilst NHS managers have to keep these customer requirements uppermost in their minds, they also have to organise work flows through a myriad of complex n-stage task units, from appointments, diagnoses, treatments/ operations and then after-care so as to maximise numbers of patients treated whilst maintaining quality levels   
  • To do this they need to monitor productivity levels at each stage to ensure optimum use is being made of capacities:
    • Imagine if they found that 40% of time was wasted by an individual or unit, as can often be found in a variety of private sector companies
    • Or that 25% more patients could be operated on with better use of existing theatres
    • Or that a happier, more motivated workforce in one unit achieved 30% more output and better quality results than an exact equivalent elsewhere
  • But NHS managers are not armed with such information
  • Instead, one reads of hospitals claiming to be working at 98% capacity (how does one even calculate such a figure?), presumably because their staff are ‘working their socks off’, exhausted and demotivated, their beds are all full and queues are getting longer and longer – so it’s an understandable claim:
    • But one also reads of staff that spend lots of their time form-filling rather than being with patients which they much prefer – how much time? – and who uses that data collected, for what?
    • And how much time is spent occupying hospital beds by patients who could be recovering at home, where they would prefer to be, if adequate social care was available? – factual evidence is needed, not anecdotal
  • Typical, reasonable questions, but no clear answers as far as I know  
  • So we suggest the following first steps towards the big changes needed?
    • NHS managers at all levels evolve a set of productivity measures they and their teams can monitor, covering their specific task unit and key factors under their control
      • They don’t need, or want, blizzards of measures and associated targets
      • A set of around 10 measures per manager should suffice, enabling them to cut waste, optimise use of existing resources available to them and invest for even better results when cash is available
    • The overarching aims of each set should be to prompt action where most needed:
      • To meet public expectations of the NHS 
      • To establish and maintain a motivated workforce 
  • To help do this, it is worth considering the following list of public expectations for NHS service and quality levels taken from a long letter to The Times by a Dr A Inwald:
Outcomes the public wants of the NHS – ‘Inwald’s list’

  • 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
  • The above list covers most of what the general public would like when needing treatment by their local NHS services
  • It’s probably also what most NHS staff would like to offer them


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