Thursday, 28 October 2010

The NHS – the good the bad and the ugly

Although the recent government spending review has provided ‘protection’ with a budget set to increase annually by 0.4% over the next four years, the NHS is still tasked with £20 billion in efficiency savings.

The NHS therefore continues to operate under close scrutiny and this is my personal snapshot of how things are looking right now.

The Good
Over the past 18 months I have worked with several NHS clients on service improvement projects, mainly in stroke and cardiac care.  During that time I have been extremely impressed with the quality of clinical expertise demonstrated in the Hospital Trusts and the commitment and dedication of clinical and administrative teams in the community.

These people genuinely and deeply care about their patients and continually strive to provide the very best outcomes possible. Whatever your political persuasion, and whether you measure ‘targets’ or ‘outcomes’ – we must acknowledge that survival rates and quality of medical intervention of patients continues to improve. I could quote many examples of the ‘extra mile’ travelled by NHS staff on behalf of the people in their care and have been humbled by the hours, way over their contracted agreements that some staff work. But….

The Bad
With every organisation, but particularly in the public sector (in my opinion) – there are three types of passengers and the NHS is no exception. These passengers, often managerial or administrative, challenge the positive outcomes and efficient practices of an ideal world. There are those who demonstrate ‘The Peter Principle’  where an employee rises to their level of incompetence. There are those who are genuinely committed, but do not have the background, intellect or capability to do the job for which they are employed. And finally there are those who fly just under the radar while taking home a reasonable salary for minimum amount of effort and substandard results. I have just two words to say about this. Performance Management.

The Ugly
These really are tough times for those working within the NHS. I suspect and hope that clinical teams will be adequately funded although poor IT support will continue to create a huge burden for them. According to the Chartered Institute for Personnel Development, workers in the state sector take an average of 10 days sick each year, 3 days less than their private sector counterparts.

The Trades Union Council general Secretary, Brendan Barber said ‘Many public service sector jobs are stressful at the best of times but now, with everyone across the public sector fearful for their jobs and the extra pressure of having to do more for less, it’s hardly surprising that the health of many workers is under threat.’

So the NHS employees are now facing what their private counterparts have known all along – that a job isn’t necessarily for life. For some, they are working on the ostrich principle – let’s carry on as though nothing is happening. Maybe that is the best way. The other, and more worrying approach is the ‘status epilepticus method of management – also know as ‘rabbit in headlights’ mode – not helpful.

We need to get this consultation process finished as soon as possible – and get on with what we do best. Look after the patients entrusted to our care.


Jan said...

This hits the nail on the head precisely. Unlike the private sector, performance management in the NHS is a tortuous road to travel. Hence the mediocre stay in post, the incompetent are often moved sideways and even upwards and the lazy continue. The committed, competent few are left feeling overwhelmed and undervalued and they are often the first to move away, leaving the rest to carry on unchallenged. Obviously this is a personal view but one formed from over 25 years as an NHS employee

Finchers Consulting said...

Thanks for your comment Jan. I really hope that the committed few will hang on in there!

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