No way to run a health service

In and amongst all of the fun I’ve had in business, I’ve had experience of our health service on many occasions.  Apart from boring personal ailments, I have also been through the life & death process with family loved ones (precious and humbling experiences) and was privileged to be married to a truly dedicated state registered nurse.  I’ve also had my life saved on 2 occasions by teams of dedicated professionals.  So, I can sing the praises of the best aspects of our National Health Service; but I have also seen at first hand the parts where it has never been put right from the very beginning, has gone astray and has been ruined by factional infighting, politicians and dogma.

Image courtesy of Business Leaders Learning


So, what’s this got to do with a business blog?  Where to start?  Over the second half of the 20th century business really learned to create and deal with mass markets.  It learned how to ascertain the needs of the customer and to meet those needs, invariably at lower and lower cost, whilst still providing value.  I know it isn’t always perfect but the progress that has been made is remarkable.  How is it that companies can get ever more profitable whilst selling at lower and lower real price levels?  It’s experience, constant learning and competition; if you have competitors snapping at your heels you get better or you go to the wall.

Now, consider our NHS; how many of you know that at its inception the cost of providing this comprehensive service free at the point of delivery was simply not known?  It was a leap of political faith and governments of the day have been trying to fund it ever since.  Demands made upon the NHS are growing exponentially, the costs of modern treatments are sky rocketing, people are leading more unhealthy lifestyles and simply living longer.  Not much of a business plan, was it?  And, since 1997 money has been lavished upon the NHS (more than doubling) but it has produced little or no net efficiency gains.  Not much of a management performance either.  Now, tell me about a business that was planned and run like this over 60 years ago, that still survives and is slavishly protected by government of all sides of the political spectrum?

One of the reasons many businesses succeed is that they are focussed upon a clearly understood goal; they may have a mission statement, a vision, a clearly understood strategy and a well-defined core process.  Take a look at the M & S plan on their corporate website ; fairly clear and concise, you know what they do and are going to do. Now try to find anything comparable on the multitude of NHS websites.  OK, you can find ‘NHS Choices’ which is filled with detailed information but the real key facts are opaque e.g. try finding out how to interpret Hospital Standardised Mortality Rates (HSMR).   In most businesses it is the core process that gets the attention; waste is eliminated, cost reduced, throughput speeded up, quality is improved and the customer satisfied.  Profits produce efficiency and satisfied customers

Teamwork is one of the real Achilles heels of the NHS – factionalism rules.  For example, even before the formation of the NHS, the Royal College of Nursing has been desperately attempting to raise the status of its members to compete on equal terms with doctors and consultants.  They have succeeded in part but at what cost to the patients they are supposed to be caring for?  Yes, the nurses have succeeded in raising their training, qualifications, status and salaries.  However, it has been a zero sum game with patients frequently losing the personal attention that used to be an essential part of the nursing role.

Targets are a concept borrowed from business (at the behest of politicians), clumsily applied and without an apparent thought as to the unintended consequences.  You want a maximum of four hour waits in A&E?  Simple; take resources from elsewhere where there are no targets, put patients into a medical ‘limbo’ and, if the timing is really critical, just keep them in the ambulances that are then prevented from hastening to other emergencies (and the ambulance service can worry about its own targets).

Of course, these are only a tiny few examples of what is bad in a vast organisation but our entire health system is neither operating in the patients’ best interests nor is it using efficiently the vast sums of our tax money poured into it.  It seems structurally incapable of focussing upon the needs of its customers and suffers too much from the continued central interference of our politicians.  What to do?  Outsource the lot.  Tesco Care, Your M& S Care anyone?


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