Today this article was published on the BBC website as David Cameron announced measures to tackle the so called ‘care problem’ within the NHS. Read the article here.
In short, Mr Cameron recommends that the public be encouraged to carry out inspections and nurses carry out regular ward inspections. There are a number of flaws in the logic here. First of all those urged to carry out inspections will already be doing so. The public will be looking because they are concerned about the environment that they and their relatives find themselves in and nurses will be looking anyway because it is part of their job. Nurses, however, are busy and will not be quite so vigilant. If they are to me more vigilant then which aspects of their job does Mr Cameron suggest they give up?
These are trivial issues, what is more important is the fact that Mr Cameron thinks that Quality can be inspected in to a system. This is an old fashioned argument that simply does not work. If you regularly inspect any system and you keep finding faults then you only have 2 options 1) Find the same fault again during your next inspection 2) spend a huge amount of time firefighting.
When Japanese products first became popular it was because of the high quality. When we in the west tried to emulate these methods we failed dismally. Why? It was because we inspected everything thoroughly and we did produce quality items but only because of the large number of defective items that we threw away. The cost was enormous.
So there are two main issues, poor quality costs, in terms of both money and health as far as the NHS is concerned and also the fat that the more you monitor a system the more expensive it becomes to run.
The answer to all of this is simple. To make the NHS work better at a lower level simply change the system. Avoid high level edicts about how things should be done, just state what they targets are (infection rates, bed occupancy or whatever) and let the people who know, those on the front line such as nurses and junior doctors, fix the system with the excellent knowledge that they have.
Call this creativity or innovation within the NHS if you like but surely it is just plain common sense?