16th January 2023
The are many problems that are effecting the efficiency and effectiveness of the NHS.
For many people, the NHS is something that cannot be challenged, cannot be criticised.
It’s the sacred cow.
This is partly why we are in the position we are.
We must change this attitude. NOW!
A quick Blog post can’t hope to address all the problems, but it can be a start and highlight some things that could be done VERY QUICKLY.
Here are 8 things that can be done now.
- Nightingale Facility’s - Clearly one of the major problems affecting hospital operation is accepting patients into A&E. Often they are unable to process incoming patients as they simply don’t have the beds & space, and the flow through hospital wards can be hampered because patients that no longer need medical care IN HOSPITAL and could be released with their bed becoming free, have to remain in hospital because patients are unable to manage at home or inn the community with or without carers or other social care. Establishing Nightingale Facility’s near hospitals that these patients can be transferred into and looked after until suitable plans and support is in place would free up beds and allow a better flow of patients throughout the hospital.
- Drunk Tanks / Observation Facility’s - If you live in ‘party towns’ or ‘party city’s’ (these days it’s most town’s & city’s) you already know that one of the things that desperately need to be established are drunk-tanks,to reduce the huge numbers of people that turn up in A&E Depts that are drunk or walking wounded or require lower priority care/observation. If they were established near A&E departments or in town/city centres this would lead to a big improvement in the efficiency of A&E Departments who can concentrate on those in genuine need. Ambulances could also get back on the road after dropping off people at these facility’s. If you have attended A&E on Fri-Sun evenings you already know this.
- Removal of Non-Jobs - One thing that gets a lot of publicity in the news and social media is the recruitment and employment of what seems like an army of non clinical roles, and, quite frankly, roles that seem to be made up or not required, that add little or no value. In fact they usually remove value. Some degree of non clinical roles will always be required, but it must be reduced to a minimum. Made up jobs need to be removed. Those doing these roles already need to be shown the door, and future recruitment for these types of roles needs to be stopped. Another activity that could be done in 1-3 months.
- Workforce Plan- Cleary the NHS need to establish competent Workforce Plans covering various time phases, probably a 6-Month Plan, a 5-Year Plan and a 10-Year Plan, covering demographics of the population, demographics of staff, skill requirements, qualification requirements, available medical treatments, physical resources etc. The old saying ‘FAIL TO PLAN, PLAN TO FAIL’ is almost always true and is certainly true in this case. These Plans could be established and operational in 1 month, that’s what would happen in the private sector.
- Independent Pay Body - It seems to me that Independent Pay Body’s are a good thing, and if all party’s can agree to the principle, then their recommendations should always be accepted. I believe that recommendations should be made each 6 months because, as we have seen recently, changes in the economy and in particular interest rates and inflation can happen very quickly. The principle though is that recommendations are accepted.
- Pay Increments - In the private sector, pay rises and sometimes bonus payments are often funded in part from efficiency and productivity improvements, savings and profits. We should consider incentivizing staff by having pay increments that are part funded as an across the board payment, and then an additional part being performance related, based on efficiency, productivity and cost saving. Performance gains, savings and self funded pay increments. Got to be the way to go. Like most organisation, there is clear inequality in salary across the range of staff, of course there is, there is bound to be, but applying across the board percentage increases to salary just increases this inequality. Pay settlements need to be structured in such a way that lower paid staff receive a bigger increments and higher paid staff receive lower increments, the exact structure to be agreed by the Independent Pay Body.
- GPs - Covid is over, we are now living with Covid, we will be forever. It’s time for GPs to stop working from home. It’s time for GP’s to stop working part time. It’s time for GP’s to get back to their practice’s, and for face to face GP appointments to be the default again, and not the rarity. We also need to ensure the framework is there that plans, trains and retain GPs and other medical professionals. A standard time of service after training should be enforced in contracts.
- Minimum Service - we quickly need to ensure that minimum service levels or even strike restrictions are enforced onto key medical services. The government are looking at this now.
This will not be enough, but it will be a start. And any journey begins with the first step. The answer CANNOT simply be throwing more money at a failing organisation and carrying on as we have always done.
A failing business in the private sector would reform, change processes, reduce waste, make better purchasing options, train staff better, get better management, remove superfluous jobs, remove bureaucracy, set better targets and make managers in fact all staff accountable for their performance and failure.
So should the NHS, before we pour more money into it.
Thanks for reading.
Graham
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