As regular readers will know, transforming the NHS so that it can provide excellent healthcare to people in the UK at an affordable cost is something which has exercised my mind for a long time (see, for example, here and here). And I am involved, at a local level, in trying to help unlock this.
Now don’t get me wrong. Many parts of the NHS are excellent. In an emergency they generally work brilliantly, at least in the short-term. And many of the doctors and nurses care deeply about looking after the patients.
However whenever I walk into any NHS hospital, clinic or office** there are several things which immediately strike me:
- the obscene level of waste
- the absence of appearing professional
- the number of staff who seem to spend their lives wandering around doing little or nothing
- the appalling environment
- the apparent lack of both money and the will to put any of this right.
And that is despite the fact that the NHS should already have shed-loads of money to do everything we would want it to do if it used it wisely.
The other day I had to visit a local private hospital, and the contrast with the NHS was almost as stark as it has always been. No, it wasn’t perfect. For a start it was far too hot, but it was clean and looked professionally welcoming. Yes, there were plenty of staff around, and they all appeared to be doing something with a purpose. You had a degree of confidence that everyone knew what they were doing and why and that they cared about their patients.
This is more what the NHS should be like. But how to get there?
I keep thinking about this and here’s my three step plan for the paradigm shift which the NHS requires, from top to bottom.
Step 1. Get someone at the top who can successfully run a large, quality, profitable corporation and who is able and willing to tell the politicians to butt out and stay out. Someone like Richard Branson, or perhaps Alan Sugar (no, I don’t care that you dislike them; they’re good at what they do). Someone who will have a vision of how the organisation should be and will implement it regardless of push-back from any level — if you aren’t going to do the job, get out.
Step 2. Tackle the appalling level of waste. This includes finding efficiencies — improved ways of doing things — at all levels. And that means everything from reducing bloated layers of managers and administrators, through cupboards full of medical supplies which have to be thrown out because they go out of date while other departments can’t order the very same thing, to turning down the heating.
Yes, really! Turn the heating down! NHS hospitals, clinics and offices are always far too hot; when people who are usually cold tell me it’s too hot then you really are wasting money! Just this one thing could save the NHS millions.
And while you’re saving money, fix the buildings: even if you can’t build new hospitals (because of time, money or space) you can at least make the ones you have into a habitable environment. Fix the leaks etc. Stop the draughts. Buy some paint. Because they will save you even more money in the long run.
Do those two things and you will start to see a culture change. But to complete the paradigm shift you need to do something just as fundamental the the outlook and attitude of all the staff — from the most world renowned consultant surgeon to the lowest lavatory cleaner. So that means …
Step 3. Everyone needs to take on board four basic beliefs and habits:
- Cherish the patients. They are why you are doing what you do. They’re not just important they are your whole raison d’être. They deserve the best.
- Put yourself in the other person’s shoes, whether they’re a consultant, GP, patient, nurse, administrator or ancillary worker. Think what effect things will have on them. And then treat them as you would like to be treated.
- Work as a single team. Everyone is equal but everyone has different skills. It doesn’t matter if you’re a patient, the most renowned surgeon or the ward cleaner, everyone has an important role which has to be valued as important to the patient’s recovery. (And part of that means valuing people and paying them decently.)
- Be empowered. If it is right and needs doing, do it. This has to come from the top by giving everyone freedom (not bullying), and it has to come from the bottom with people grasping that freedom. Unless there is an over-riding reason not to do something, just do it.
No, I don’t pretend it will be easy. That’s why you need the right person, with the right attitude, at the top. Without that one person it will never work because the politicians will keep meddling and the all the vested interests will see the top as weak and keep playing their own games. And then the patient (remember him/her?) is forgotten.
Yes, initially there will be a lot of scepticism and probably a morale hit. But as time goes on, as it begins to work and people start to buy-in, morale will increase and you’ll win lots of crusaders.
But it will take time. I went through this in a multi-national corporation in the 1990s and it took the best part of a decade, lots of head-banging, a lot of people being retrained and several rounds of redundancies for those who couldn’t or wouldn’t adjust. So I’ve seen it done; I was looking up from the bottom wondering WTF was happening; after a couple of years the penny dropped and I too changed. I know it can be done.
So David Cameron and Jeremy Hunt, do you have the balls to do this?
I’m not holding my breath.
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** This also applies to some GP surgeries although most are better as they are small stand-alone businesses which have to keep afloat.