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Hospital: showing how efficiency savings lead to inefficiency

03 Apr 2017

Professor Neil Mortensen

On the front of a recent issue of the BMJ there was an illustration comparing the appointment to top NHS trusts of a crop of new chief executives from abroad with football team managers. No doubt there will be an increasing market for high flying CEOs in the future and while they may not command the salaries of the premier league bosses, some will still be taking home half a million before tax. That’s four times more than most consultants and ten times as much as many of the hospital staff. It’s a very difficult job of course and trusts will want to attract the best. Ask this new breed of managers, as they did in the BMJ piece, for their solutions to NHS woes, and for their reactions to the NHS compared with their previous home patch, and they note poor IT, too much bureaucracy and the need for more efficiency. Yes: efficiency savings – isn’t that what recent health ministers think will fund the transformation of the NHS? Doing things better, which also means doing things more cheaply, is classical management consulting speak. Re-engineer the process, cut out waste, get the troops motivated. Easy.

Well, I was in turn angry, sad, depressed and very proud as I watched the recent BBC series Hospital on a Sunday evenings. It is set in St Mary’s Paddington and the four episodes gave an honest view of managing the bed problems of a major acute hospital. The patients were savvy, delightful and, well, patient. They had to be, because the hospital was constantly full to bursting. The knock-on effect of course was that there were no beds for planned and semi-emergency surgery. The bed manager was trying so hard she was exhausted. And then our surgeon colleagues were experiencing what we have all had to do but in spades: find a patient to discharge, wait for an ITU bed, juggle the existing lists. Sit around and wait. Get frustrated or angry. Age quickly and look knackered. And crucially, go back and – on behalf of a broken system – explain to the patient and his or her relatives why there is another delay. The surgeons were honourable, dignified and still committed. What a terrible waste and what a way to misuse your star performers.

Because there seems to be no easy solution, it is all accepted as just the way it is. It makes a mockery of the efficiency savings and productivity mantra of our CEOs. We must face up to the reality of this situation and be vocal in our support of our surgical colleagues, otherwise no one will pursue a surgical career and our brightest and the best will seek opportunities elsewhere rather than taking on that most difficult task of all – delivering care to the highest possible standard.

The blog is based on an editorial in this month’s Bulletin:

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