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Anyone who has worked in a large organisation will tell you there are pockets… where, ‘we could do this-or-that better’.
The same is true of the NHS.
Decades of under investment have left the NHS in a pencil and paper slum, screaming out for innovation and the sorts of technology, taken for granted in most high streets.
Amazon runs its empire based on bar-codes. Think what that simple technology might do for the NHS and a digital patient journey.
Something else we all know; the NHS is forking-out a fortune in overtime and weekend working and £millions for over 1.60m episodes of care in the private sector, to help reduce waiting lists, and…
… something I know for sure; is how b!@@$& irritating Silly-Boy Streeting is with his Dandini, magic-dust ‘solutions’ for the NHS… because you write to me and send the press links!
His latest, a senseless attack on middle-class labour voters. He is either too young, or too stupid to understand the embourgeoisement of the population, the decline in traditional manufacturing industries and trade union membership that got Blair into power in 1997.
The trend of a large swing from Conservative to Labour, was stronger amongst the better-off. To extend Labour’s lead from the polls into the polling station, will need a Blair-size swing… 12.7 points from the Tories.
Larger than the 10.2-point Blair managed in his landslide and higher even than the swing achieved by Clement Attlee in the historic 1945 post-war Labour victory.
I was reminded by a midwife, Streeting is a rare example of a birth condition;
‘natus est in ore eius pes’.
Born with a foot in his mouth
Dandini’s nonsense about using more of the private sector?
They don’t have any more capacity to give. They can only use NHS doctors and private hosptials are making a nice-few-quid out of premium patients stumping-up, to circumvent waiting-lists.
Whatever the moral-high-ground objections about the use of public money, watching the BBC Panorama, about Shire, coming unstuck... I’m not at all sure if it’s a good idea to crack-on without a lot more safeguards.
Last year, across the whole sector there were 6,000 emergency transfers of care from private hosptials to the NHS.
Dandini’s next big idea is to get the NHS working overtime, evening and weekends. Doing operations to cut waiting.
They already are. It’s the overtime bill that has, in part, pushed NHSE finances into the red.
NHS funding, resources and treatment volumes are inextricably bound up.
Will knackered staff turn-up? Paying more pushes many higher Bands, like theatre staff, into the next tax-bracket. Make NHS overtime tax-free and Dandini might have a chance.
Operations don't do themselves. Productivity is not sewing up a patient as fast as yer granny can darn a sock.
Productivity needs; primary-care, community care, outpatient appointments, diagnostics, scans, tests, car parks, clerks, porters, catering, supplies, estates, laundry, management, rota, scheduling, maintenance, cleaning, clinical waste, coding, medical engineering as well as theatre staff, operation department practitioners, nurse-teams, anaesthetists, surgeons, recovery, ITU, ward-staff, discharge lounges, transport...
Plus, the other dozen skills, talents and professions I’ve forgotten.
Plus, equipment variations for over a dozen specialties.
Plus, the disruption to schedules caused by emergencies.
Plus, competition from kid’s football, weekend family-life, study, dates, chores, shopping and knackered-ness.
Investing in helping make operating departments more efficient is a grown-up thought.
Over 10 million operations a year are performed in England, in about 3,000 operating theatres. Depending on the type, the average theatre would see over 1,200 procedures a year.
Just under one in five are emergencies. Investing to separate them out is a start.
There's a national target of 85% theatre utilisation, measured by time-spent giving clinical-care.
The target set below 100% to allow for patient preparation, recovery, changeovers between operations, cleaning procedures, moving kit around and unavoidable cancellations.
Work, examining touch-time (procedure length) as well as downtime started before covid and was revealing opportunities to improve theatre productivity.
The Getting it Right First Time programme is doing detailed and fruitful work, looking at whole-system implications for better productivity in theatres.
OECD comparisons are interesting. Up-sum;
'... fixed budgets provide poor incentives, incentive payments accelerate activity but soon outstrip budgets and result in incentives being lowered and efforts tailing off.'
Fixing system management and capacity, the inevitable conclusions for sustainable improvements.
It is complex stuff. Written in joined-up writing. Probably too much for you-know-who.
The NHS has experts, good people, who just need the investment, time and space to do great things.
There’s over £8billion over three years, from 2022 to '25, to protect and drive up additional elective activity.
Can somebody ask Dandini if he plans to keep that in place?
The situation the NHS finds itself in needs serious policies, not gimmicks. Clear thinking, not rehashes of failed ideas.
The situation the nation finds itself in needs serious politicians who understand the problems and can demonstrate the clarity and maturity needed to see us through.
If Dandini is the best example of what Labour have got... I don't want any.
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