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.
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