Professor Michael Porter of Harvard Business School is coming to Britain to talk to political and NHS leaders. The label “American business guru” tends to provoke a tissue rejection from the NHS, but let’s listen for a minute to what he’s saying, (Dave West in HSJ) He is not advocating “the wrong kind of competition” which has driven ballooning US health costs. He is not arguing for privatisation. He is not cosying up to Tory friends.
His focus on value means asking some highly challenging questions to his hosts, upsetting the policies of both Coalition and Labour.
- Why does so much go into inspection? It won’t achieve the gains we need.
- Why the trumpeting of patient satisfaction? Whether people are nice to you is not the same as an outcome
- Why is patient choice an end in itself? It’s not the same as quality and value.
Many of us have been saying the same for a long time. When Michael Porter says it, will they listen? Here are the tests:
- Do they slash the budgets of CQC and Monitor, and put the money into innovation?
- Do they scrap the Friends and Family test, and put the money into measuring outcomes?
- Do they drop the cumbersome Choose and Book, and put the money into clear, simple and statistically sound information on providers?
Porter writes about secondary care and from what I have seen, little so far on primary care. But for a taster of what he might find were he to look, some figures from two similarly sized GP practices on the question so crucial to patients, how soon can I see my GP?
At practice A patients wait an median of 15 minutes to speak to a GP and are always offered an appointment the same day. NHS Choices shows “Experience of making an appointment 78.9% good or very good” Stars 1.5
At practice B the average patient has waited 14 days to see the GP. NHS Choices shows “Experience of making an appointment 71.2% good or very good” Stars 3.5
The difference in performance is a staggering multiple of 14 times. The difference in the same vague and confusing survey result, an inconclusive 7.7%, moderated by an incomprehensible star rating. We also happen to know that at Practice A, stress has fallen and profits have grown, while B is stressed, struggling and desperate for change.
As Porter reminds us, better quality and better service cost less.