A recurring news story in the UK in recent times has been the squeeze on NHS resources. It seems there is hardly a day goes by without a story surfacing about an NHS failure, or a staffing or capacity problem, or something to do with a treatment that the NHS can’t afford to be liberal with. They are, we are told, in a situation where they simply do not have the resources. But is that strictly true? Surely if we were to be able to say that with confidence, we’d need to be comfortable that the delivery models were as slick as they could be and they were operating at full tilt. Is there anybody who would dare to make that claim? What I will agree with is that the NHS, given its current ways of working, probably can’t do much more than it does, it is however limited by two factors, money being only one of them. The other is its management system.
In 2014 the NHS was allocated a budget of £95.6 billion. By any standards that is an eye watering sum. I can’t help thinking that SHOULD be enough. If we imagine for a moment that the UK had no NHS and decided to establish one tomorrow, and its budget was to be £95 billion – would anybody in their right mind design it to look like the one that has evolved? I very much doubt it. The current system is inefficient. Culturally it has evolved with some ingrained unhealthy attitudes, one being the apparent priority of staff interests over the interests of the customer and stakeholder. I’d argue that any organisation that starts to prioritise the interests of staff over customers will soon start viewing customers and their needs and whims as an inconvenience. It is also, by any measure, inefficient.
Now I am not saying that it does not deliver in the main a series of EFFECTIVE outcomes, however the ability to cite a range of good outcomes does not negate the accusation of inefficiency. Frankly anybody given enough resource should be able to eventually deliver inefficient effectiveness, but who can afford that? Moreover, if inefficiency is the root of the problem, then is more resource the solution, or does it just make things worse?