NHS…is it me , or are we just missing the obvious?
Let me firstly apologise for a post which seemingly has little or nothing to do with the general theme of things, however the events of the last 3 months, combined with today’s Radio 5 live morning debate show, have brought me to this point. The subject as per the title is the NHS, and more importantly the future of the NHS. I appreciate that I have no medical training and no clinical understanding but what I do possess is experience at the “customer” end of the NHS, common sense and a lifetime of looking at and improving “situations”.
In the vast majority of the discussions about the NHS that appear in public and the ones I have had in private, in the main, contain the same or similar statements including but not limited to ” its all the Tories fault, they never put enough money in”, ” investment in the NHS has never been greater”, ” we need more money”, ” all nurses are angels” and ” there are too many managers”. These are all things that can be debated ad infinitum and depending on your particular political persuasion you will believe one side or the other, but that is not the point of this post. Lets look at a more fundamental level.
There are some facts that I think no side can dispute. The population is getting older, and therefore the NHS will have to continue to provide more services as time goes on. The NHS is not free at the point of use, it has been pre-paid either by the recipient of the treatment, or someone who has paid all their life and never used the service (rare, but i’m sure you understand the point). Sickness or injury does not respect a standard work week.
If you take these 3 basic facts, and then look at how you would rebuild the NHS for the current environment, pretty quickly you would come up with 2 fairly basic statements, based on some well proven assumptions as follows:
1 It has to be a 24hr, 7 day a week service which at any time can deal with the demands consistently
2 It has to be run as efficiently as possible, because the costs are born by every citizen
Now, if you look at these 2 statements you can easily find many examples of business’s which operate with either or both of these assumptions. Many of these businesses have become world class and market leaders, and in fact if they don’t continue to strive to be better they very quickly get overtaken by the next hungry competitor. My list would include Amazon, Google, Ryanair, Nissan Sunderland, Cisco and even my local Tesco’s.
This all sounds obvious, so what got me mad this morning, whats new to bring about a reaction? The simple answer is NOTHING!! We are still discussing and fighting over the same meaningless, fringe, pointless concepts now, that I was hearing 20 years ago. We are still looking to plaster over the cracks and then hope that this gets us elected. We are looking at point scoring to stay in power, and more worryingly we are still looking at protecting the outdated and outmoded working practices of the last 60 years!
As an example, it is clear that the latest round of Junior Doctor dispute is centred around a change in working practice. Is it centred around a better technique for improving the outcomes of children’s surgery? Is it centred around the number of trauma staff who attend an incoming stroke patient? Is it centred around the way in which cutting edge medicine is used? NO, its centred around why SATURDAY and SUNDAY are different to the other 5 days of the week, and why doctors should get more money because its not Monday to Friday!! You can wrap it up anyway you want but that is the current argument.
I mentioned my circumstances over the last 3 months at the start of this article. On the 23rd May my mother in law had a large stroke and was taken to hospital. Her trauma care was fantastic, her outcome on this occasion is very positive so far, but what has subsequently shocked me beyond belief was the almost prehistoric way that the hospital is utilised, how the work is divided and how the patients can be treated. How the unionisation of the workforce subsumes the common sense of any class leading commercial business, and how many opportunities to work with patients and relatives are seen as challenges to the “system” and best to be ignored or just looked down upon. (Anyone who has travelled with a large transatlantic American Airline recently would undoubtedly recognise this kind of treatment)
I appreciate that in every walk of life there are good and bad, and yes (unbelievably to some), that includes medical staff. This post is not about them, but it is about how they are working, what they expect from the job and more importantly what are the people who run the NHS doing trying to move the furniture around whilst not realising that the whole building is the wrong shape and size. How expensive would Nissan cars be if they still made them by hand, in a small factory, in Tokyo? How difficult would it be to build a class leading cruise ship in a boat builders in Whitby who are used to building coracles?
When will someone have the common sense and I dread to use the word courage to realise that what the NHS needs is not to keep throwing a bit more paint at it, but to get to the root cause of the issues. How long can the BMA and the nursing unions be blind to the fact that their outdated thinking needs to change. The ridiculous week days and week end thinking, in healthcare is redundant (as it is with any other 24 hour, seven day a week business) IF the NHS is to survive for the next 20, 30 ,40 years then it can not do so working within the same archaic frameworks that it has done for the last 60.
So what should be done. Firstly I would be inspired by the thinking of Steven Covey and forget what we have now, but start with the end in mind. How do we want this service to look in the next 30, 40, 50 years. More importantly does every stakeholder want the same thing, because surely they want the best patient care, delivered sustainably for the projected population. But do they all want this? In fact, we can test this. If that were the case then surely the BMA would be arguing that the new doctor contract should be based on the world leading, six sigma based, Nissan Sunderland shift system, or the CAA/EASA developed Flight Time Limitation rules developed to make sure pilots are as safe as they can be, working only the hours that the CAA/EASA deem they can do. But in fact the doctors want to be allowed to work “overtime” , because on Saturday and Sunday they get paid more!!! Surely aren’t these 2 things totally outdated concepts in the delivery of highly skilled and highly dangerous professional roles, or would you want your pilot to work like this, or your car to be built by someone who works like this ?
I know I am not the smartest person around, and I appreciate that many governments have hired many smart or super smart people, but in the end they all seem to be missing the obvious…………..or is it me? Is getting elected actually more important than the NHS because that’s what its looked like for the last 30 years.