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HOW TO FIX IT
The NHS lurches from crisis to crisis. In order to handle the
Coronavirus epidemic, it has given up its role of providing healthcare in favour
of its own self-preservation. The slogan SAVE THE NHS says it all. GP's, for
example, now keep themselves safe by working three-day weeks of low hours for
higher pay. In the meantime, they miss opportunities for early diagnosis of
cancer, lung and heart disease to give just a couple of examples. Waiting lists
for treatments are the longest ever.
It's said that we don't have enough doctors and nurses at a time
when the number of staff employed by the NHS continues to increase. Official
statistics1
list the number of staff in England as 1,193,666 in May
2021. This is 3.1% (35,926) more than in May 2020. But the government claims2
that: "There are record numbers of doctors and nurses working in the NHS in
England. Provisional figures show that as of January 2021, there are a total
of 123,813 doctors and 301,491 nurses working in the NHS".
Added together, these figures show 425,304 doctors and nurses
from a total of 1,193,666 = 36%. It seems reasonable to ask what the other 64%
are doing.
We also hear constant cries for more money. Yet official figures
show that planned spending3 for the Department
of Health and Social Care in England was £212.1 billion in 2020/21, up from
£150.4 billion in 2019/20. This includes more than £60 billion of extra funding
for the Department of Health and Social Care 2020/21 response to the Covid-19
pandemic. There is, clearly, no shortage of cash.
Yet we hear constant cries for more money while denying that
business principles could play a role in a 'social service'. I believe
that both of these ideas are wrong.
They underline that, by focusing on its own wants and survival,
the NHS has lost sight of why it exists.
I believe that we can and must apply basic business principles
to our public health service. This is how.
Start by agreeing a
definition of why the service exists. For example, to deliver
health care to everyone in the country who needs it (patients).
Ask where
this is delivered. For example, in people’s homes, surgeries, clinics,
hospitals, treatment facilities and research establishments. Call these Care
Units.
Then accept that
some patients need transport to these Units.
Describe key
workers as those who transport patients to/from Care Units and those who
deliver care in the Units. Call these workers Directs. All other
workers are Indirects.
Define the desirable
percentages of each Group e.g. 80% Directs - 20% Indirects.
Including ambulance
and related workers,
the NHS has approx. 52% Directs and 48% Indirects.
Clearly, there are far too many Indirects. Note also that these are often paid
more than the Directs.
Understand that the
only Indirects who are really needed are those who support the Directs. Then
interview every indirect worker in the NHS asking:
"As you don’t
transport patients to Care Units and you don’t deliver care in those Units,
explain why you are paid by the NHS". Fire anyone not giving a satisfactory
answer.
Do this for two
years and compare the outcomes (including costs) with those at the start of
the process. Repeat every four or five years.
Sources
1
https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/may-2021
2
https://www.gov.uk/government/news/record-number-of-nhs-doctors-and-nurses-in-england
3
https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget
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