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Lack of resources is the opportunity


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Friday, 7 June 2013

Lack of resources is the opportunity

The NHS is doomed. If this truth has not yet dawned where you are, it will soon. When you plot rising life expectancy, long-term conditions and steadily increasing costs on the same graph you quickly reach the conclusion that the patient is terminal. If we stay as we are, the health and care bill will eventually consume the entire economy. By 2050, we will all be very old and well cared for but broke.

There are only ever three solutions advanced for the NHS’s problems: money, system change and a variety of bogus answers which can be grouped together under the general heading of platitude production.

We can take money out of the equation now because there isn’t any more. Public debt is unsustainable. The shock of seeing first-world countries struggle to contain fiscal disaster and civil disorder has driven all politicians scurrying for the safety of the centre ground. Public sector investment will be in no one’s election manifesto any time soon. (See Ed Miliband on child benefit this week for details.)

Solution two, wholesale structural change, does not work. Above all it is disruptive. It will take the new organisations another two years to get to grips with their new roles and do anything really useful.

Until then their eyes will be glued to the balance sheet and their energy sapped by organisational development and the tortuous business of forming and managing relationships with the baffling array of other players in the reformed NHS. They will spend thousands of hours meeting, planning, consulting, complying, assuring, training, learning, measuring, assessing, collaborating, co-producing, reporting, debating and agreeing – just like the organisations they replaced. If they are not exhausted, they may also find time to do some commissioning.

Solution three: platitudes. The least said, the better – unless you are the author of one of the thousands of reports that spew from the system every year. Integrated services, patients at the heart of things, better leadership, more compassion, fewer hospitals, more care in the community, better regulation, cultural change.

Ancient tribes used similar incantations to appease the gods and avert disaster, but the volcanoes still erupted and the flood waters kept rising.

There is another solution: innovation. Not the decorative kind that features in reports and strategy documents, but the radical kind that addresses unmet needs. Not the kind that involves turning up to a conference to hear what someone else has done, but the kind where you get stuff done. Not the kind that consumes millions of pounds of taxpayers’ money and achieves nothing, but frugal innovation that produces rapid returns and palpable benefits.

For almost every problem of care there is already a solution – if only we could find it or tell someone else where to look. Where no solution exists, there is a need that investors would like to know about so they can develop a solution and sell it to the world. The question is whether the public sector in general and the NHS in particular can deal with innovation.

The history of public sector procurements is not encouraging. Too big, too cautious, too hung up on evidence of the wrong kind, too conservative, divorced from real need, run by the wrong people, done for the wrong reasons, too slow to deliver.

When the NHS produces innovators, they leave and when the door closes behind them there is no way back. Talk to social enterprises, even the ones formed by ex NHS staff, and they complain about the problems of getting to the table. If commissioning is hard, being commissioned is even harder.

CCGs have a duty to innovate. It’s in the job description. If they hope to survive, they will need to learn how to do the frugal kind: identify the things that meet people’s needs and the things that are missing. If they make the right connections, someone else will do the rest.

Not having much time or money is not an excuse but an imperative. You might even call it a critical success factor.  Lack of resources is the opportunity.

Anonymous says:
Jun 07, 2013 10:23 AM
Dear all
The NHS is not doomed, as has been re-iterated many times, it is a victim of its' success. Post-Code lottery in patient care and availability of medication to prolong life is restricted by NICE, hence life expectancy is controlled by the class of the patient, not the quality of life we bring.

With all this re-structuring. I find especially in NHS England, so called managers who have no people management skills nor empathy towards patients. They deal just with numbers and predominantly appointed due to 'political' patronage, and not on their overall skills and personality. Sometimes a bullish approach is needed to get health care inequalities sorted out, however I have little faith in the senior management team of NHS England
Anonymous says:
Jun 07, 2013 10:36 AM
Health and Social Care Billed Platitudes - This post just adds another platitude - more innovation. The NHS is efficient and there's money to pay for it - its just a matter of taxation and priorities.
Anonymous says:
Jun 07, 2013 10:53 AM
I was being sustained by this weekly dose of satire, but this post is the miserable truth, and we're not laughing... please can we have our NHS back?
Anonymous says:
Jun 07, 2013 10:57 AM
Scare mongering will not help. Yes we do have an increasingly ageing population, but a significant fact often overlooked is that the elderly population are becoming much healthier and therefore less likely to have the same demands on the healthcare system in the future that the present elderly population has.

The NHS is one of the most efficient healthcare services in the world, yet efficiency does not equate to quality of care, or effectiveness of outcomes. We must specialise more, creating dedicated centres of excellence for specific procedures. We can't do everything everywhere, politicians need to stand firm when a decision to close local services in favour of a more effective specialist centres are made and not bow to voter/peer pressure. The local population must be educated about the risks of continuing to provide low volume services at local facilities.

Finally, change the way A&E works. Only serious injury - arriving by ambulance -should be allowed. Everything/everyone else should be seen at local walk-in/minor injuries units.
Anonymous says:
Jun 07, 2013 11:03 AM
Niccolò Machiavelli has aired the dangers of innovation in 1513 in The Prince:

..... there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new.
Anonymous says:
Jun 07, 2013 11:18 AM
You could add 'take more risks' to the list of ways to cope. Most drugs are given to reduce risk rather than actually to treat something. The population may benfit: the individual often does not. Let's embrace risk.
Harry Longman
Harry Longman says:
Jun 07, 2013 11:18 AM
Julian, you know too much and you say it too well. Surely a sideways move is imminent to put you somewhere less effective.
NHS Networks
Julian Patterson says:
Jun 07, 2013 11:19 AM
Anon 10:53 According to latest news reports, Sir DN is working on it. His retirement gift to himself is a wide-ranging strategic review (see HSJ and BBC for details). I do hope that satisfies your hunger for something painfully funny.
Julian Patterson
Julian Patterson says:
Jun 07, 2013 11:20 AM
Harry, a couple of steps forward to the edge of the plank is a more likely scenario.
Anonymous says:
Jun 07, 2013 11:40 AM
there are parts of the NHS out here whose job it is to look for innovation from both within the NHS and outside. Anonymous at 11.03am has it right as we are battling against a tide of 'because we have always done it that way! and who is paying for this! plus a few nutters whose inventions are not new and not innovative. As Anonymous 11.18am says there has to be a bit of risk taking, we find that in the areas where people have little hope they are more open to try new things, but NHS staff are petrified of law suits, so they are cautious to the extreme.
Robin Jackson
Robin Jackson says:
Jun 07, 2013 11:59 AM
If we had the right answer, the rest of the world would be imitating us.The sacred cow that is the NHS is long overdue at the slaughter house and the public, instead of camping out in droves in A&E with a snuffly nose needs to wake up to what a public-funded service can and cannot provide.