Articles

Can the NHS be more efficient?

In Public sector, UK productivity, Uncategorized on June 21, 2010 by Tim Aikens

I think the NHS does a great job!  The cost per person in the UK for health care is substantially less than health care in many countries and about 50% of what it costs in the USA.  So why is there all this pressure on the NHS to be more efficient?  The last time I was in a ward, waiting for my son to ave an operation, I saw notices exhorting efficiency and looking at doing things better.  Yesterday I read a comment from a nurse that the NHS was already cut to the bone financially and there was nothing left to give.

Yet when I am in a hospital I am uneasy. It seems to me that the front end of clinical care – the doctors, nurses and their support staff work very hard but  is there more.   A King’s Fund report calculated that NHS productivity had actually fallen in the first 10 years of the last Labour Government.  So what is the real truth? I don’t know, but my suspicion is that bureaucratic regulation is at fault.  The number of non clinical staff has grown as fast as Jack’s beanstalk!  The demands of government for reports, statistics and compliance with ever more targets means that an NHS Trust has a lot to do that actually adds no value to the patient on the ward!  One of the main problems is the way the NHS manages it’s budgets.  By ringfencing budgets across departments, a good game to play is budget ping-pong.  Patients are shuffled across departments and units so that the originating unit does not have to bear the cost of complex tests and procedures.  The result is that procedures often have to be repeated and end up wasting more money (albeit the department best a ping-pong may save something).  There is money to be saved in the NHS, but it is in the ‘back office’ not the shop front!

I have seen several advertisements for management consultants and organisations to come in and help the NHS save money.  I think they make one huge mistake.  Top of the list of requirements is that the individual or organisation must have ‘extensive experience of working with the NHS’.  I am reminded of that old saw – ‘if you do what you have always done, you will get what you always got’!  Bringing in people who know the NHS well are going to be limited in their creative thinking!  The NHS needs to do three things:

  • focus on the back office and bureaucracy.  This may well mean making representations to government to change the way the NHS is run.
  • engage with people from different industries and organisations who have some new ideas and a novel take on what might be possible.
  • insist that every activity is challenged in terms of the value it adds to the health of the nation.

I believe the NHS can become more efficient, but does it have the will to break out of a historical mould?

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