THE BLOG

10 Resolutions the NHS Must Make Now

13/01/2015 11:06 GMT | Updated 14/03/2015 09:59 GMT

Although free at the point of delivery, the NHS is not a 'free for all' and though treatment is not rationed, it must be rational. Having spent 15 years in the same job, at the sharp end of the NHS, I have seen fancy ideas and initiatives change policy and procedure, trying to trim the cost of the service. As the NHS continues to deliver a Waitrose-esque service on an Aldi-type budget, the overspend increases. Basic business-sense fundamental management is ignored allowing costs to rise and the giant beast of a machine grinds more and more slowly, becoming less and less efficient.

I've voiced my concerns, my ideas, my solutions, and my suggestions but no one appears to listen or to care. Perhaps someone, somewhere, will read these 10 easy, no cost resolutions and be brave enough to try them out.

Streamline equipment. Ten surgeons in a department should not mean ten varieties of hip prostheses are stocked. A choice of two alternatives of expensive clinical equipment is sufficient and guards against supply problems with either one.

Remember, just because an operation can be done, doesn't mean it should be. Obese diabetics aged 80 confined to wheel chairs due to breathing difficulties are not 'entitled' to knee replacements. Same applies to plastic surgery for 'psychological distress' caused by body parts being too large or too small.

Standardise non clinical supplies across entire Trusts, Local Authorities and Health Boards. In fact, even buying the same paper and envelopes throughout all departments in the same hospital would be a good place to start for economies of scale.

Remember that cost and value are very different entities whose relationship may not always be obvious, immediate or temporally related. Supporting Professional Activities (SPAs) are seen as a waste of money due to failure to recognise time for teaching, research and quality improvement projects means trainees score the hospital highly on GMC surveys. Universities listen to this and send more medical students to 'good' hospitals where high quality teaching is valued. These students bring money.

Re-introduce prescription charges in Scotland, Northern Ireland and Wales where prescription medication has been free since 2011, 2010 and 2007 respectively. Here in England, actual payment is made for only 10% of prescriptions. The other 90% consists of medicines for children and those entitled to free prescriptions. While 'free for all' is politically popular, there should remain a means tested rate of payment for those of us in the top 10% who can afford to pay. We should use, but not abuse the system.

Stop wondering why operating theatres are so 'inefficient'. They are not. Instead acknowledge that adopting the latest in safety and best practice, (performing huddles, repeatedly checking name bands, having surgical pauses and post procedural debriefs) takes time. I'm not against these; check listing improves patient safety and helps prevent human error, but it takes time. And time has both financial and opportunity costs. This is not inefficiency but reality.

Medium term employment contracts. It is very difficult to get fired from the NHS. You can be sick as often as you like and receive various levels of warning, reprimand, additional support and phased returns. Employment contracts reviewed every five years would allow the chronically sick and dis-interested slackers to be relieved from continually hampering the organisation. We all know who they are yet their managers seem powerless to fire them.

Redress the balance of non-clinical to clinical staff. An organisation whose sole purpose is to treat the sick should have more than 50% of its employees engaged in doing so. The contracts mentioned above could be useful here.

Decisions around healthcare provision must be based on clinical need and not on arbitrary vote winning declarations of speedy delivery. Cut your coat according to your cloth and stop wasting money chasing meaningless targets.

Start to value and incentivise staff to work smarter. Acknowledge and praise challenging work and excellent outcomes and your investigation of complaints and poor outcomes will be better tolerated. Borrow from business with 'Employee of the month' rewarded with a parking spot or an early finish one Friday. Finished all your work half an hour early because the team worked fast and efficiently? Go home half an hour early instead of being redeployed to a late running team to help mop the floor. This will help reverse the drain of goodwill. There is no incentive to work harder if the reward is to be given more work.