There’s no shortage of advice being dished out to the new old health secretary with the start of a new government. Most of it boils down to more people and money, and most of it misses the point.
I’m absorbing Geoffrey Moore’s “Dealing with Darwin” at the moment which is brilliant on what form of innovation works best, given the current stage in its industry lifecycle. The NHS is mature, depended on daily by millions and much loved. It doesn’t need any more patients/customers, and it doesn’t need to treat/sell them any more (quite the opposite). It has no competition.
So why on earth did all the political parties try to woo us with more promises for patients? The NHS problem is workforce and capacity, and it needs one thing above all, efficiency. Every policy needs to be seen through this lens. Special treatment for over 75s, regardless of clinical need? Less efficient. More inspection and tighter targets? Less efficient. Longer opening hours and 7/7 working? Less efficient.
It needs fresh thinking. “10% improvement is hard work. 50% improvement is child’s play.” I forget who said it but the profound truth is that for the level of change we need a cheese paring approach is not enough.
You doctors are generally hard-working, caring folk. You find it difficult to delegate, so you take on too much and then moan about it. We engineers are generally lazy, delighted to let other people or machines do the work, and get back to playing, or dreaming. That’s why fewer and fewer people work in manufacturing, but you have more and more fun things to play with.
You might think “efficiency” sounds dull, cold, calculating. Call me uncaring, but I see it the other way round: efficiency lets us care. Inefficiency means tens of thousands of patients are turned away by GP receptionists every day. Inefficiency keeps millions on waiting lists. Don Berwick calls efficiency “a moral imperative.”
Even better, efficiency is fun.
That’s what all our work is about. The winners in this game will be those who look for opportunities, not certainties, those who know the difference between investment and cost, those who take decisions for themselves, rather than leave their fate in the hands of others.
I’m optimistic that general practice can lead the way, as there’s a sprinkling of such people. I was with one CCG leader last week who said, “General practice is in a crisis. We must not let this crisis go to waste.”
Founder, Chief Executive
GP Access Ltd
PS Loved this joke I just found but I must declare an interest: my father is a priest and my wife a doctor. Did I mention that I’m an engineer?
An engineer, a priest, and a doctor are enjoying a round of golf. Ahead of them is a group playing so slowly and inexpertly that in frustration the three ask the greenkeeper for an explanation. “That’s a group of blind firefighters,” they are told. “They lost their sight saving our clubhouse last year, so we let them play for free.”
The priest says, “I will say a prayer for them tonight.”
The doctor says, “Let me ask my ophthalmologist colleagues if anything can be done.”
And the engineer says, “Why can’t they play at night?