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I met an interim last week who suggested to me that what the NHS needs most right now is a renewed debate around the need for a failure regime. It struck me that it is probably what my household needs as well around the kid’s bedtime. As my wife keeps reminding me, my 3 year old son will continue to play up unless we follow through with our (hitherto empty) threats to genuinely put his toy cars in the attic unless he brushes his teeth and gets into bed. That threat of adverse consequence is often a key driver of behavioural change or performance improvement – alot of my current work is coming through in acute cost reduction and transformation, but there is a significant number of trusts that have comparable or worse problems than my current client base, but a limited acknowledgement of their problems, an indifferent attitude to the consequences of inaction and little interest in the potential value that could be added by interim resource. In this new era of competition, commercially minded trusts should prosper, and those trusts with historical performance issues may find themselves facing more problems caused by declining income as patients vote with their feet and take their ailments elsewhere. But those trusts need to know there are consequences to failure, and that Monitor will have the teeth to completely remove a board and force a merger with another trust or even worse – close a hospital.
The Hinchingbrooke franchise set an important precedent, and has sent out the message that the private franchise model will be considered and used in the right circumstances. The encouraging result is that a number of trusts are being forced into having that difficult discussion now about their future viability. A contact at Monitor suggested to me that any trust struggling to see where their CIPs are coming from in year 3 should be starting to think about the merge / private franchise now, and not in two years time.
Fear of failure and the implications should drive performance improvement, raising productivity, clinical quality and standards of patient care. Perversely what might really help is a hospital closure, so that those near the bottom of the performance rankings know it’s a very tangible threat, but unfortunately I think we’re unlikely to see it come to pass, the coalition’s plans for health reform are already the subject of great scrutiny and a hospital closure would be a political death knell. The growing dialogue about franchise or merger is at least a step in the right direction, and for the good of the wider NHS hopefully will be a sufficiently unpalatable scenario to drive genuine performance improvement in 11/12. Your thoughts as ever are appreciated.
Steve Melber is Senior Consultant, Health at Interim Partners.
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May 26th, 2011 at 7:15 am
Some approximate comments……
The NHS has the 4th highest employee headcount in the world after the Indian railways,the Chinese army and Wall mart.
The working practices in the NHS amongst all staff are reminicent of the 1960’s-demarcation,union militancy,protectionism,no notion of what a customer is,no accountability,no flexibility.
The NHS budget has tripled over the last 12 years with zero improvement in productivity.
The McKinsey reort of a few years ago said that a reduction in heads of 12% could be effected with no detriment to services.
The tenancy of the average £200k CEO is very short,the role is symbolic as they have no power to change what happens in a hospital.
No nurses or doctors ever get sacked for incompetence,no one is ever held personally responsible-its always a systemic failure.
More people die of MRSA than are killed on our roads.
The standard of healthcare in the UK is so bad that we have 2.3 million people who are medically unfit for work and hence draw benefits from the state.
No developed country in the world spends so much time in its health provision organisation on
discussing/lamenting/reorganising/and lurching from one crisis to another.
One obvious major consequence is that the total UK recovery cuts are summing to less than 1% because the NHS,a massive % of overall state spend continues to grow its spend thus outstripping any cut in spend elsewhere.So the recovery plan isnt working.
No government yet has had the guts to change the 70 year old broken NHS model to one of the best e.g. France,Canada,Germany