Dev Lall

12 New Year resolutions to improve the NHS

1. Streamline equipment. Ten surgeons in a department should not mean ten different varieties of hip prostheses are stocked. A choice of two alternatives of such expensive clinical equipment is sufficient and guards against supply problems with either one. This resolution could extend to accessory equipment, sutures and dressings and would bring economies of scale nationwide.

2. Remember, that because an operation can be done, doesn’t mean it should be. Obese diabetics aged 80 confined to wheel chairs due to breathing difficulties are not ‘entitled’ automatically to knee replacements. Same applies to plastic surgery for ‘psychological distress’ caused by body parts which are too large or too small.

3. Standardise purchase orders for non clinical supplies across entire Health Boards, Trusts or Local Authorities. In fact, even buying the same paper and envelopes throughout all departments in the same hospital would deliver savings and be a good place to start.

4. Remember that cost and value are very different entities whose relationship may not always be obvious, immediate or temporally related. Consultant time dedicated to Supporting Professional Activities is seen as a waste of money due to a failure to recognise the importance of teaching, research and quality improvement projects. Providing it means trainees score the hospital highly on influential GMC surveys. Universities listen to this and send medical students to ‘good’ hospitals where high quality teaching is valued. These students bring money.

5. Re-introduce prescription charges. This applies to Scotland, Northern Ireland and Wales where prescription medication has been free since 2011, 2010 and 2007 respectively.  In England, payment is made for only 10% of prescriptions. The other 90% consists of medicines for children and those entitled to free prescriptions. While ‘free for all’ is politically popular, there should remain a means tested rate of payment for those of us in the top 10% who can afford to pay. We should use but not abuse the system.

6. Stop monitoring and auditing the use of theatre time, trying to find out why it is increasingly inefficient. Acknowledge the time is spent waiting for same day admissions, performing huddles, repeatedly checking name bands, having surgical pauses and post procedural debriefs, as we are mandated to adopt into our daily practice. I’m not against these, check listing improves patient safety and helps prevent human error, but they take time. And time is cost. There are financial costs and opportunity costs. As procedures embed the latest in safety and best practice, they take longer. This is not inefficiency but reality. Remember too that faster does not always equal better.

7. Medium Term Employment Contracts. It is very difficult to get fired from the NHS. You can be sick as often as you like and receive various levels of warning, reprimand and phased returns. Claiming stress in the workplace prolongs this. Employment contracts up for review every five years would allow the chronically sick and dis-interested slackers to be relieved from continually hampering the organisation. Getting rid of the dead wood would improve productivity no end. We all know who they are but their managers seem powerless to fire them.

8. Redress the balance of non-clinical to clinical staff. An organisation whose sole purpose is to treat the sick really should have more than 50% of its employees engaged in doing so. The same contracts as mentioned in Resolution 7 could be useful  here.

9. Begin to cut your coat according to your cloth. Although rationing is unpopular and  viewed as unfair, decisions around healthcare must be based on clinical need and not on arbitrary vote winning declarations of speedy delivery.

10. Start to value staff and incentivise them to work smarter. Borrow from business with ‘employee of the month’ rewarded with a parking spot or an early finish one Friday. Finished all your work half an hour early because the team worked fast and efficiently? Go home half an hour early instead of being redeployed to a late running team to help mop the floor. This will help reverse the drain of goodwill. There is no incentive to work harder if the reward is to be given more work. There is no incentive to work faster if you are paid for the duration regardless of productivity (and when going really slow overnight means you have the next day off).

11. Acknowledge and praise challenging work and excellent outcomes and your investigation of complaints and poor outcomes will be better tolerated.

12. Begin to invest and manage for the long term instead of fire fighting until the next General Election. I can only dream.

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