Now that’s better! These are the sort of initiatives that the NHS needs to become efficient and save money.
I maintain that the NHS already has shed-loads of money to do everything it needs to, and which we, the patients, need it to. But it also has shed-loads of waste — and in that I include a superfluity of managers and bean-counters — plus far too much political interference.
Initiatives like those in the linked article are sorely needed, and are in my opinion (one part of) the way forward. But they should not have to be coming from above or from the National Audit Office. They should be coming from the “workers” (for want of a better word to cover clinicians, nurses, admin staff, cleaners, etc.) at the grass-roots level, who need to be empowered to do things; to make decisions; and make changes like this without fear.
However empowerment like this needs some radical paradigm shifts, and it is a two way process. The managers have to allow the workers to be empowered; inded the managers have to encourage it by trusting people! Equally the workers need to embrace that empowerment and make it work while also trusting the management. And the barriers around all the vested interests and private hegemonies (in which I include the trade unions) have to be broken down.
There also has to be a paradigm shift in attitudes. I see too many NHS staff (mostly on the admin side) who appear not to give a toss about either their jobs or the people they serve: they are inefficient, unhelpful, rude and lackadaisical; too many appear, frankly, not to be up to the job but there because the Job Centre has told them to be. Others are interested in doing the bare minimum to survive the week and draw their pay, and bugger anyone else.
Certainly not all NHS staff are like this — it would be hugely unfair of me to suggest they are. Very many are excellent, dedicated and caring, but so often hamstrung by the rest.
These poor attitudes have to change or they will sink the organisation even further. And the waste is something we now cannot afford, if we ever could. This change can be done; I’ve seen it done in a multi-national company where the company’s very survival was on the line; we changed or we got out. It wasn’t easy, or comfortable, and it will take a bit of time. But a determined CEO with a vision and some balls can do it.
It has to start at the top with a vision clearly explained and ruthlessly chased down. But it has to be embraced by everyone from the top to the bottom. And those who don’t want (or can’t) change have to be moved aside and if necessary replaced by people who can and will change: either by retraining those whose jobs are no longer needed or by some very selective hiring. (This is not an exercise in job/people cutting unless absolutely necessary.)
It will also need some very long, hard and critical looks at expenditure, waste and job requirements. Everyone has to take responsibility for reducing waste and being flexible; “we’ve always done it that way” is no good any more. Management have to set clear, workable, cross-organisation policies and enforce them.
There will have to be properly specified and managed IT efficiency projects. They will be big projects, needing a range of top class IT industry professionals who have to be listened to and trusted. They have to be properly funded, and the money will have to be released by the efficiency savings they generate along the way.
Do all this and it can be made to work. It will take time: probably at least 5 years and maybe 10. But you will end up with an efficient and effective organisation which fulfils all it needs to, at a reduced cost.
Yes, it will be uncomfortable and difficult for many, if not most. I know; I’ve been through it; I didn’t think I could change, but I did. So yes, it does work and people will change. If you want proof, ask anyone who worked for IBM throughout the 1990s. Ask Lou Gerstner, the CEO who made it happen and saved the IBM Corporation from self-immolation.
Yes, that means the NHS needs a top flight CEO. One with a vision and a lot of balls. One who will not be bullied or cowed by the politicians, the unions or the vested interests within. One who will run the organisation as a company; a company where every employee is a shareholder whose job and whose end-of-year dividend is on the line. And a company where every patient is treated as a valued customer who can (and will) take their business elsewhere.
Can it happen? Yes, it can, but it will need something else too: politicians with the vision to allow it to happen and who can invest in some long-term thinking, rather than short-term expediency. But isn’t that what we pay our politicians for?