The Blog

What Is Wrong With The NHS?

I would not advocate privatising the NHS or trying to charge people for its services. There is little to be gained and much to be lost. There is no perfect health system on this planet and the NHS is the UK's own grand version of an imperfect system.

The NHS does a great job when it comes to keeping the UK population alive, treating chronic long term illnesses and providing thousands of jobs for hardworking doctors, nurses and staff.

However, in my opinion, when it comes to customer service and convenience the NHS does not do so well, not just in the UK but across the world.

According to The King's Fund, NHS quality standards have slipped to their lowest level in more than a decade. This is hardly shocking as we have become accustomed to reading doom and gloom headlines in the media, but clearly the situation needs to be improved.

The reasons for NHS customer service challenges are wide and varied, however, I believe many issues stem from it being a public service. History has shown that public service is not always the most efficient way to deliver productivity. In particular, there are three key areas to consider:

1) Committees:

There is a plethora of committees at every level of the NHS. These committees have often been given tasks that are unintentionally mutually incompatible. One example of this is with sharing patient information to those who need it.

Billions of pounds have been spent on technology to make patient records available on a computer. It would seem obvious that hospitals and urgent care centres should be able to access at least some elements of a patient's records in emergencies but there is a profusion of committees spending huge quantities of time and money to protect patient information.

Very rarely do these NHS committees agree so there is a constant back and forth about the same issues.

2) Employment Contracts:

Believe it or not there are some positions in the NHS that have 6 months fully paid sick leave starting from day one. A newly employed staff member can (and occasionally does) leave work half-way through their first day and stay away for 6 months on full pay - only to reappear jauntily as soon as the sick pay runs out.

It is hard to manage staff. To have the very difficult discussions involved in disciplining and possibly terminating a poorly performing employee requires very serious personal commitment - usually the type of commitment only engendered by a direct threat to one's own welfare. This is never the case in the NHS. No-one's livelihood is ever really dependent on firing someone.

Consequently, there is about a 0.01% dismissal rate per year in the NHS. While I know there are a lot of hardworking devoted employees in the NHS it is very hard to believe that 99.9% of any workforce - particularly one as large as the NHS - is entirely free of malingerers.

While I think Jack Welsh's 'differentiation' principal where he mandated that his senior managers in General Electric let go at least 10% of their staff in any one year is a little harsh, the evidence of its effectiveness on productivity is indisputable.

3) Activity & Reward:

The final nail in the coffin of productivity in the NHS is that no staff get paid in proportion to the effort they put in. At every level of the NHS staff are generally paid the same whether they process 100 patients or sitting chatting amongst themselves in an empty out-patient department.

It is no wonder that staff morale is poor. When you're having to take up the slack left by a (perhaps very small but significant) percentage of colleagues who would be fired in any other environment, are not paid any more for working twice as hard, and every decision is committee'd into blandness, it is hard to stay chipper. The ones who do are true saints.

How do you fix the NHS?

I think leaving it alone is the best idea. Having worked in it as a clinician and a commissioner I truly don't think it can be 'fixed'. Universal healthcare, free at the point of care is an amazing achievement and is the envy of governments around the world. While many people complain bitterly about access and customer service this is not the only consideration in a public health service. The health of the people of the UK is favourably comparable to the best in the world. The cost of the NHS is one of the lowest percentages of GDP and many thousands of people are employed on good salaries to deliver this service to us. So be proud of it in sickness and in health.

I think the best way to manage convenience and customer service is to encourage and celebrate the parallel private healthcare system that has always existed in the UK. This would relieve a significant amount of the pressure on the NHS and offer choice for those that wish to exercise it.

Emerging low cost GP providers like London Doctors Clinic chain in central London are specifically designed to provide accessible and affordable convenience to visitors and commuters in London.

I would not advocate privatising the NHS or trying to charge people for its services. There is little to be gained and much to be lost. There is no perfect health system on this planet and the NHS is the UK's own grand version of an imperfect system.