Maybe BUT the necessity for the hospital facility should be completely evaluated first.
Once this is established the focus of any evaluation would then automatically be on financial management because for a service to be critical to the needs of the community, underutilisation would not normally be a factor.
All too often, the automatic reaction is to close something or reduce something or sell the land it sits on. This is such a short sighted approach and, I think, a very British disease across industry in this country.
Financial management is usually the key to success and this is not just by 'counting beans'. Financial management requires a cultural change across the whole organisation and across all skills and structures within.
Subjects involved in cultural change could be: Waste, consolidation, rationalisation of procedures, welcoming independant healthcare providers, mixing skills, selling skills and innovations, understanding across the organisation of the financial impact of actions, more thorough commissioning of services with stringent penalties for under performance, not always buying the cheapest and therfore forfeighting quality, introduction of ISO: 9001 and 14001 across the organisation and treating every NI contributor as a shareholder.
The problem we have with public services is thay they are used as a political 'bat-ball' eveytime a government wants to score points. Change is good but the culture must come from within and the resulting changes must be given time to embed and be evaluated. A good, organisationwide quality management system would provide the cycle of continual improvement and evaluation.
The NHS is a monalythic beast that harbours too many institutionalised groups and ideals. It is a huge vessel to turn around in a storm. For these reasons alone, GP Commissioning will be seen as the catalyst for rapid and objective change.
I notice in the news that some of the hosptial trusts in financial crisis have some lovely brand new hospital buidings. Clearly, these were built with the future in mind. Clearly, these buildings in reality were too expensive BUT they are here and the focus must now be on saving them. Perhaps (and lets be a bit crazy here for a moment) the better-off trusts should share their wealth? This would be money from within and therefore less of a drain on the public purse.
Surely the NHS is currently one giant vertically integrated organisation that can balance it's books by sharing divsional wealth? In the meantime, the struggling divisions or trusts can learn to control their debts. This would lessen the debt passed on to the new commissioning structure.
Food for thought...
June 30. 2012
The author raises some valid points about culture & politics -the NHS does need to change, but must allowed to do so by the DH & each Government.
It must become far more focused on its purpose - the clue is in the name "National Health Service".
First, it must have a top-down / bottom-up Culture totally dedicated to providing High Quality of Service.
Second, it must focus on creating & sustaining our Health as well as restoring it when we become ill.
Third, it must operate to & deliver National Standards of Care, with universal policies of Acessibility being achieved.
Then, it must be given the certainty of rolling 5-year Funding to cut out the damaging aspects of short-term decisions when a slightly longer perspective would deliver a far greater outcome.
A system of Fair & Rigorous Consequences must also exist & the tendency towards bullying or coersion removed.
Yes, this may lead to Trusts being broken into smaller more manageable organisations & services or even Hospitals closed. But, let these decisions be transparent, even-handed, evidence-based, and demonstrably in the best interests of the local Population.
Remove the Politics (government & professional) & it cannot be beyond the wit of man to design & deliver an integrated, sustainable, high quality Service focused on improving the Health of our Nation for £100Bn per annum.
July 01. 2012
"Remove the Politics (government & professional) & it cannot be beyond the wit of man to design & deliver an integrated, sustainable, high quality Service focused on improving the Health of our Nation for £100Bn per annum."
Unfortunately everyone plays the political game, time and again. Power, money, position, and so on. Each challenge becomes an exhausting fight often with poor outcomes and casualties along the way.
July 17. 2012
In a system where we dish money around, if a place can't sustainably live within the money allocated to it, then it can't survive in the long term
..but no but!
The problem happens where there is a failure in a health economy. So Hospital A leeches money for a reason that can't be cut (say a PFI contract - where you'd still be paying if you shut down the hospital) so there's not enough money to pay for hospital B.
Hospital B can be cut - so is cut. That's system economics for you.
As for the 'take the politics out' argument. Politics is all about human nature. So if we can guarantee that absolutely everyone will think and act as logically as Spock, then we can take the politics out. Otherwise we can't
July 18. 2012
Oh dear - here's one that doesn't fit our glorious commercial model ideal. If the organisation goes out of business the public will have to do without the product.
Ask the local public what they want to happen. Lansley stated that everything we do should be around the patient. Then sort out the financial position and stop whinging and whining about academic health economics and get on with the real world, which is the people!