Tag: NHS

Can The Public Sector Leopard Change Its Spots?

Can the public sector changeI went to an event very recently where a number of public sector and not for profit organisations were shouting very loudly about the joined up way in which they were working together and the great benefits that were being delivered to their customers.

On the face of it, this was exciting news but was everything as it seems? I can hear readers now thinking ‘he is going to have a go at the NHS’. Well in a way you would be right and in a way wrong. It is brilliant that service deliverers can improve and extend the range of services and observe genuine results.

So where is the problem? Well, the biggest one comes when someone reminds us that ultimately these organisations are spending our money. One of the people present who commissions services provided compelling evidence that these services were being effective. Commissioners have predictions for future service demand. This helps to ensure the amount and type of services required are actually there. The commissioner stated that demand was increasing much less than predicted which implies that prevention is working.

Well, that’s that then? Not quite. A gentleman asks politely but in a very ‘civil servant’ type of manner, what evidence he can put on the table at a meeting he is going to attend the next day. He wants facts (and lots of them) as do his colleagues (anyone with the word ‘Manager’ in their job title). We have a whole raft of people whose job it is to justify and account for spending.

The organisations are delivering new or altered services (great) but underneath they are fundamentally the same. This is a little like saying that a supermarket chain is changing and supporting the environment whilst all it is doing is stocking some local potatoes and getting rid of some plastic packaging.

We should remove whole swathes of middle management. We could then fund many more services if we could only change the way in which these organisations work. The public only turn their attention to accountability when the services they seek are not there. When GP visits are easy to make, when libraries are still there and functioning well, when refuse collections do not result in piles of waste on the street, we are all happy.

For a small example of how this can work see my article Ban The Boss – see the BBC’s Business Doctor at work. Its an hour long programme but well worth it.

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PM aims to tackle ‘care problem’ – oh really?

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?

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