Partha Kar

How do you serve seven people omelettes but with only four eggs?

Take a moment. There…can you hear it? No? It’s the voices of the few who are fervently championing the cause of ‘working differently’.

The hard facts of the balance sheet, however, are striking hard and the ethos of working differently is being undermined.

But why is it so? Is it about the money itself or could working differently working close the gap?

Staff costs

Whichever way you cut it, staff cost is an issue and a pressure. Solutions could be to reduce the costs itself by cutting staff or reducing salaries.

Cutting staff involves asking the remaining ones to work differently (ah yes), sometimes going beyond the call of duty. Problem? By dropping the salaries or changing the dynamics of work life balance, staff don’t play ball.

What about hiring cheaper options? Divisive, inflammatory arguments rage about efficacy and th role of others. Bang goes the improved team work required to deliver efficiency or innovation.

Moving the goalposts

It was a Herculean task to get the workforce to deliver what they were previously doing…now there are add-ons. Seven day services. How do you serve five people omelettes but with only four eggs? Well, you whisk them all together and cut the omelette up to make it look like five complete ones, but then suddenly two more orders come in…

Patient power

The world is now a different place. Blogs, articles, social media, patient leaders, patient representatives ensure patients have a voice, and with that comes shifting of expectations.

The dialogue of want and need gets blurred: do patient leaders speak for the many or for a few? The debate continues but one thing is for sure, a realisation starts to dawn that not everything is deliverable. It creates frustration, angst, and clashes with clinicians. Cue morale issues, cue burn out.


Beyond patient power, there is evangelism. Guided by personal experiences, a few patients have championed, quite rightly, the issues of poor care. But has it resulted in funds moving to niches rather than where the system needs it?

Nurse staffing on wards have been emotive, and it costs.

Charities shout “outrageous” and campaign for their own areas. The reactionary responses from policy makers help a few but takes money away from the many.

Lack of headroom

Many clinicians agree that there is waste in the system. To clear that, to make a fresh start, you need headroom. But there is none. Examples? To help deliver better flow in hospitals, you need better community support. Where do CCGs get the money for that when you are spending it on existing services?

In the world of type 2 diabetes, to save money, you need to invest in prevention and structured education. Where is the money for that when you are spending it on the tariff needed to pay for end organ complications, such as heart attacks?

So there we are. Is the voice for change strengthening? Think tanks, health economists, politicians of all hues, managers, the public are all starting to query the resources required.

So where do we go from here? The screws are tightening and there is an impending sense of everything building inexorably. Hospitals are jammed in summer and autumn and you can see frayed staff everywhere.

No amount of spin and cheery messages can drown them out anymore.

Got any ideas for the future? I’m all ears.

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