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September 12, 2024 - 8:30pm
The independent report published today by Lord Darzi is damning, but for those who work in the NHS it will come as no surprise. The NHS is in “critical condition”, a claim which has been frequently reiterated in some form throughout the last few years in the mainstream press. Here, the main takeaway is that productivity has not risen: despite simultaneous funding and staff increases over the last five years, waiting times have reached all-time highs.
And while Lord Darzi himself has made clear that staff are working harder than ever, there is a fear among NHS employees that they will be blamed by the Government. There has to be an acknowledgement of the on-the-ground issues causing this lack of productivity.
It is not uncommon to go on to a ward and spend 30 minutes trying to find a working computer. Once you find one, the keyboard invariably doesn’t work, or you cannot log in because of a software issue. This is a reality with which most NHS workers have to deal on a daily basis.
IT outages from cyberattacks in June served as a reminder of how vulnerable the systems upon which the NHS relies are. Such outages bring non-emergency administrative work to a standstill. Though Health Secretary Wes Streeting has today acknowledged that “the NHS is 15 years behind the private sector” on technology, Prime Minister Keir Starmer has reaffirmed the notion that no extra investment will be made without reform. It is hard to see how IT systems in the NHS can be reformed without getting the basics right first, which will require funding in the interim.
Doctors’ time is often plagued by non-clinical tasks, taking up time which could be spent seeing patients. My colleagues and I at the hospital, for example, often have to escort patients around to have scans or administer medications ourselves because porters and nurses are physically overwhelmed with the volume of tasks they have. Doctors do this because it is in the best interest of our patients, so that they are seen and managed as soon as possible.
This is not an issue of staff productivity, and an increase in the number of NHS staff to deal with these issues will not alleviate the volume of patients coming in unless there is also an increase in the physical capacity of hospitals themselves. Healthcare systems require a raise in funding each year to deal with increased complexities and health burden. What’s more, recovering from a decade of funding cuts requires adequate investment to overcome this gap.
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SubscribeI think I’m done with Unherd.
Why?
So a doctor who works in the sector gives his opinion on how to improve productivity in the health service (all ideas that seem entirely sensible and apolitical) but because it doesn’t coincide with your preconceived beliefs you’re throwing a hissy fit?
I’m seeing this pathetic attitude in the comments more and more these days unfortunately. Anything that that isn’t a tub thumping endorsement of the online right (rather than the right in general) is condemned by numerous posters lamenting the fact the site isn’t an echo chamber
Agree completely.
Why do you think he’s upset that the essay isn’t far right enough? I was actually mystified by the comment. I have no idea what’s he’s upset about.
Because you only see these cry baby comments on here when the article is by a more lefty writer or proposes a more left wing solution, which in this case is more spending
You omitted to mention the online left.
When the articles are more right wing you don’t see dozens of pathetic posts threatening to cancel their subscription though.
Although I agree there’s almost nothing between the woke and anti woke crowds, the same attention seeking nobodies with nothing worth saying
Rather, you have to read a variety of sources to develop a sound view on issues + avoid the rubbish ones like the BBC.
If you have a login, suggest “The NHS is not underfunded” on this subject, over at Unherd’s fellow heathen site, the Spectator. That, and the comments underneath, nicely complement this piece.
In my opinion, that’s rather more insightful. Point is, though, neither of these two articles give you the full picture. It’s always going to be some inherent bias in there.
Just for information purposes: in the early 00s, the Labour government committed £20billion to the introduction of a comprehensive IT system that would link all healthcare providers (hospitals, GPs, etc.) and importantly – patients themselves – to up-to-date and secure but accessible health records.
Suffice to say, that £20billion was entirely wasted, much of it on external IT consultancy fees.
Will this Labour government do any better with public money? I really doubt it, because it’s not actually about money, it’s about management and attitudes. How do i know this? I worked in the NHS for 35 years before taking early retirement, worn out by the inability to get anything done.
There’s plenty of great people working in the NHS, and the doctor writing this article may well be one of them, but the legacy isn’t being understood in this article. Change can happen, but first the will to change has to exist, or be engendered. Good luck with that.
I remember thinking at the time shooting for an all-singing-all-dancing IT solution for the administratively backwards NHS was far too ambitious. There were plenty of hospitals elsewhere in the world that used off-the-shelf IT systems and that would be a good first step. Once every hospital was on an IT system you could look at hooking them up and adding other providers.
“£20billion was entirely wasted, much of it on external IT consultancy fees”
This rings true.
Circa 2003, after the foot and mouth outbreak, I spent a soul destroying year working as a software developer for Defra, building an animal movement tracking & licensing system.
They’d used a team of Accenture consultants charging £2K+ per day (each) to produce a specification for the system, before turning it over to their in house developers, and myself (also a consultant, but not on that huge whack) to build the system.
Accenture must have been charging by the volume of paper in the spec, rather than the quality, because after about 5 or 6 weeks we found both ambiguities and outright contradictions between specified system components.
The spec we’d been given was never going to fly, but by the time we realised, they’d moved on to their next government handout.
I suspect that the NHS National Programme for IT (NPfIT) you mention was a fiasco, and nice little earner for the big four, for similar reasons.
Although it is gauche to reply to oneself, there is also an anecdote that I would like to share from this period that demonstrates why we are doomed:
The site I was working at was Guildford, Surrey, and had some on site parking, but if you turned up late you’d need to park in the surrounding streets, and walk to work.
I like to start early, so I always got a parking space.
This should be the mildest of incentives for people to get to work on time.
No. I was pulled aside by boss, to explain that my starting work early wasn’t fair on the other employees, and would I mind arriving late now and then.
I kid you not, this is how the civil service works – for their benefit, and not yours.
My son was told the same. It put people out. He was not allowed to work at his own good pace because it might reflect badly on others. My cousin’s wife briefly working in Morrisons has recently suffered the same – called into the office and told to slow down. She’s Polish. She cannot work at the pace expected she says. She was doing several others work for them.
It has a name – producer capture.
As someone who was involved with this project it was obvious from the start that it was going to fail because they were trying to introduce a centralised system. They are still trying to do it. However, with the 42 new devolved ICS if they have any sense they will instal on off the shelf package e.g. Israeli, Singapore system which doesn’t have to be centralised. The only thing that needs to be centralised is the personal health record.
Good to hear an update, although not the fact this is still being grappled with whilst systems in other countries have long since become embedded.
The technical aspects are one thing; another barrier is the people on the ground who just don’t buy into it, being averse to change and anything which looks like they’ll have to account for the quality of care delivered (or not) which should be integral to any healthcare IT system.
1. Four words: do less but better.
The NHS should be dealing with significant public health issues, national matters. It is overwhelmed by individuals’ needs, many of which are neither lethal nor incapacitating.
2. The article comes out with the usual mantra about hard work. Hard work is not the same as efficient work, nor of effective work.
3. Provide funding to the most effective providers, whether they are in public or private ownership.
4. Be honest with the public. Current funding levels are completely unsustainable. Cut the funding now before the NHS takes over the entire economy!
What utter garbage. And that’s from everyone involved here and not just this article.
First up this ludicrous claim that NHS staff are “working harder than ever” while productivity “has not risen” (in other words, it’s actually dropped). The only way these can both be true is if the average quality of work is actually dropping over time. But perhaps it is …
Now we have the threat of NHS employees being blamed. Well someone damn well should be blamed if productivity is dropping even as ever more resources are piled in. Someone – and probably a quite large number of people – within the NHS is responsible ! Private industry (i.e. the rest of us) have no problem dealing with such situations.
Then this new report. Compiled in record time you’ll notice – less than 2 months over the summer holidays. What government report ever gets completed *from scratch* in that time ? You just know they wrote the summary and conclusions first and then filled in the preceding sections to support them.
And then the demand for *even more resources* to fix the IT problems. They’ve had more than enough resources over decades. If these people could fix the problems, the already would have done so. And these are all easily fixable problems which are fixed in most other organisations.
Finally, it is most certainly *not the job of politicians* to fix these things. These are operational matters for the NHS to deal with. If they cannot, name and fire the people responsible. If the NHS is failing, it is primarily because NHS leaders and managers are failing.
Frankly, I’d cut the NHS budget until they start getting their act together. We’re locked in a vicious circle of moral hazard right now. Failure is actually rewarded and not punished.
In case that sounds very harsh, I’ll repeat my assessment of the NHS: an organisation with some some world class individuals and parts, but which is absolutely not a world class organisation. It could – and should – be so much better. And the good people working within it are just as much the victims of its failure as its users.
Or perhaps managers are simply impotent in a system dominated by the medical profession in which they lack any real power.
That could also be a factor.
Thinking about this article last night, I remembered this quote (I heard this ex GB olympic athletics coach give this talk 30 years ago).
Read this and ask yourself which type of people the NHS is run by (and largely for). And then which type of people you would actually want running a multi-billion pound business.
Extract from “Winning” by Frank D1ck
There are two types of people in this world, valley people and mountain people. Valley people seek the calm and comfortable ground of shelter, safety and security. They may talk about change but do not want to be involved in it, especially if this means breaking from the routine of what has worked okay up until now. Their concept of achievement is not losing, so playing for the draw to them is all that’s needed. Their concept of fitness is being fit to survive. They are the people you meet who sentences begin with; “I would have”, “I could have” or “I should have”. They are the most people, who have many explanations for not making it themselves but only one for those who have – LUCK. They talk about the risk of losing and yet they are losers – they just do not know it.
Mountain people have decided that valley life is not for them and seek to test ambition on the toughest climbs. They know that there is a rich satisfaction in reaching the top and the fight that’s needed to get there. They live for the test of change and enjoy the resilience required to bounce back from the bumps and bruises that come with the mountain territory. They not only talk about change, they deliver it. They take the risk of winning because to them there is no such thing of a risk of losing. People can lose without training or practice, it comes quite naturally, so where is the risk in that? They know achievement is not always reflected in a gold medal but is always measured by the excitement of knowing just how much further their best shot takes them when they take the risk of winning. Achievement is balanced on the finest of edges but they know that. Whatever the outcome of the contest, they are always accountable for the result. They are winners and they know it.
This has been written for mountain people, people like you. It is about people who succeed, who achieve, who win and who intend continuing to do so. Each of us has mountains to climb, they may not all be Mount Everest, but they are still your mountains. They can arise in our family and social life, in our business life and in our personal life. You know what yours are!
I wish you all the success you deserve, not only in climbing your next mountain but in climbing all the mountain ranges where your ambition and dreams will surely take you.
I kind of agree – though it does sound rather like the kind of talk retired mountaineers give to sales people at expenses paid dinners. The salespeople lap it up of course – because that’s how they see themselves, their sales targets their expensive watches and their contempt for those who don’t chase such things.
I’m afraid you just don’t know what you’re talking about. All power was taken from doctors a long time ago. The management ‘in charge’ know very little about what goes on on the ground. The gap between ‘decisionmakers’ and clinicians is vast and where an awful lot of the inefficiencies come from.
‘The system’ is in NO way designed by doctors.
I’m a consultant with elective and emergency care experience in the NHS for over 35 years. I’m not a great fan of what the medical profession has become, but I know enough not to blame them for the state of the NHS – which IS dire.
Then I’m not surprised you disagree. You have a vested interest. Interestingly, some of what you say actually confirms what I have said.
In effective organisations there is not that gap between managers and those delivering the service that you describe. And I did not say that doctors designed the system – only that their power is such as to render management impotent.
How easy, for example, would it be for management to fire you if they determined that your performance was not up to scratch?
So you’re saying I can’t disagree with you because I’m a doctor and therefore ‘have a vested interest’?
You’re actually claiming that views expressed about the NHS by some one who’s worked in the NHS for >35 years don’ t count because … they work in the NHS?
You’re not a serious individual.
I’m not saying you can’t disagree at all. Of course you can. But the views of different stakeholders in the NHS need to seen in terms of the whole system – and that includes an awareness of vested interests, professional ideology etc.
I would go further and say that politicians will be failing if they simply take the views of the most powerful group in the NHS as the truth about the NHS. They need a far deeper analysis.
Reading between the lines, there is a complete misallocation of resources here – the result of long term drift and a failure of management.
If a doctor can do nothing for extensive periods of time because he can’t find a working computer then it makes sense to shift money from doctors to computers.
If patients are waiting for hours on end in ambulances outside the hospital because there are no rooms for them inside the hospital then it makes sense again to shift money to where the bottleneck is.
More crucially, a radical look is needed into the whole way the system operates, and how it can have been allowed to drift into this sort of chaos.
My second career, if one can call it that, that been in NHS after two decades in RN. Some differences of course but two similarities – the esprit de corps in a crisis and another perhaps how bad the centre is at procurement – the MoD wasted millions too.
The NHS infrastructure remains too Dickensian in too many places. Darzi right about the lack of capital development. There is truth in lack of facilities means staff deployments can be sub-optimal. Not having sufficient cubicles in ED to see patients quickly one I’m regularly faced with.
The criticisms about NHS IT are valid, but the national data we capture of huge, unique IP value. The struggle has been to get everywhere onto systems where that longer term value can be mined and monetised.
Having scanned Darzi’s report I’d agree the service is not ‘operationally’ over managed. Quite the reverse. I don’t know how the managers do it. But there seems to be quite a Regulatory and Oversight tail with more marking homework than doing it. He refers to a rebalancing needed and that seems correct.
A tax based system is efficient and doesn’t have a tail of insurance bureaucracy, but the question may be how personal responsibility then plays in. The problem with ill health is usually none of us completely clean on our own choices so we should be cautious about getting judgemental about others. Nonetheless whilst it’s characterised as more ‘nanny state’ we have too much ill health we could prevent, or at least delay and crunch more into the v end of life.
“…recovering from a decade of funding cuts.”
I suggest the good Dr Butt goes to see one of his psychiatrist colleagues who specialises on treating the delusional.