CEO’s and their most senior colleagues are constantly being drawn outwards from the organisations whilst the remaining staff, particularly front line staff, feel isolated, undervalued and lacking in direction.
Most doctors and nurses are highly educated individuals and they have to make decisions fast that management can’t seem to keep up with. Mixed with the bureaucratic style of management that the new non-medical management brings to The NHS, it fuels an overall bad style of management.
Doctors, consultants and nurses are de-moralised
Due to the heavy demand on them, the NHS medical workforce feels demoralised. Not only do they have to deal with low pay and long hours there are many ppower swings between doctors, nurses, managers and unions and they never seem to be able to find any middle ground.
Managers would feel unable to manage in fear of unions; staff unable to voice their concerns about compromised standards because of fear of their managers and the service hierarchy.
This constant shift in control in itself would de-moralise any worker regardless the type of organisation, add into this the constant demands on the workforce as a whole with new standards and targets to hit, it doesn’t provide any motivation for the team as a whole.
Not enough doctors, nurses and ancillary staff
One of the NHS’s main concerns is staffing. The UK has far fewer doctors per head of the population than most developed countries. Britain train too few a year, attrition rates are substantial as of the 5000 medical students trained each year only 80% register with the GMC after training.
Chart 1.1: Source: OECD Health Data 2002: Analysis of Health Spending
However, this difference is made up of students training in the UK and then going back to their own counties to work. Interestingly to this, the UK registers more doctors from overseas every year then doctors trained here in the UK. In five to ten years this shortage of new doctors will eventually reach crisis when thousands of GP’s retire in their 50’s.
Nurses, lab staff and admin workers are also few and far between. One in four nurses, one in three auxiliaries and one in two administrators leave the NHS every year.
In September 2000, local hospitals in Oxford ran an appeal for ex-NHS staff to return because they couldn’t run the A&E department without at least a twelve-hour wait. The reasoning for so many workers leaving every year is wages. Looking at current house prices and the rate of inflation, wages in the NHS are well below UK wage increases, and way below the 10-20% annual increase in house prices.
Level of patient care is too low
With the long waiting lists and quality of service, patient care is poor within The NHS. Hospital infection is the main reason for low patient care. It costs The NHS £1 billion a year. For an individual, it results in an extra 14 days in hospital, a10% chance of dying and £3154 spent on healthcare, More importantly it effects 1 in 10 patients and could be avoided all together by simply washing hands after dealing with every patients. If this simply but effective regime was followed The NHS could treat 500 000 more patients per year.
NHS has a history of under-funding
The NHS has a history of under funding and suffers from lack of capacity in both staffing levels and facilities in comparison with other EU countries. The NHS spends money; it does not budget in regards of GDP or the number of users for the services it provides. Good hospitals are not rewarded with a bigger budget, the opposite applies and bad hospitals are usually given more money.
In comparison to other countries, the UK has the lowest funding for both the public and private sectors. The UK’s population heavily relies on The NHS to provide their healthcare service and seems unlikely to change to a private provider.
Chart 1.2: Source: OECD Health Data 2002: Analysis of Health Spending
Effects of problems with The NHS
All these problems have effected the most important people in The NHS- the patient.
If The NHS plan is to be successfully implemented, staff must be able to air their concerns and management must be able to learn from the dialogue. Local management can be proactive in creating a process for this that is none threatening and enables organisational learning.
If management fails to take up this challenge, staff frustration will lead to a pendulum swing back to an over strengthening of union power, which in itself will frustrate the achievement of the plan.
Efficiency Through an Internal Market
In 1987, a major funding crisis hit the NHS. During this time Margaret Thatcher was in charge of the country and this was the period when their was a lot of unemployment, leaving the deficit for the taxpayer to cover. Their was an alarming increase in demand for health services, whereas the government was reluctant to spend more money on The NHS.
A white paper, entitled ‘Working for Patients’, set of number of proposals for reform in The NHS. Its principles were simple, and described splitting The NHS in half. One half would be known as purchasers and the other half known as providers.
The providers were NHS trusts, special health authorities and non-fund holding GP’s, they would look to cut spending in their activities and provide The NHS service. Purchasers were classed as the health authorities and fund holding GP’s, they would be given budgets and have to make even more savings within their budget. With having a budget, purchasers had to hit targets and figures set by the government.
Other changes included the prevention of illness. One of government’s first priorities was to decrease the demand on The NHS. GP’s were given budgets to inoculate patients against serious diseases, check-ups for the elderly and screenings.
The government also wanted to introduce competition within the health service. Lack of competition and the culture of The NHS seemed to defy efficiency. This was a problem, which seemed to effect many of the public services which were operated by the government. Privatising The NHS was not an option but putting some type of competition within the system was felt to improve The NHS.
All of these activities covered the government’s budget deficit for health in the short-term, but the effects of this scheme would be felt In the future.
Looking back at the 1980’s government polices that were introduced, the internal competition created large amounts of paperwork and bureaucracy which still exists today. This was expensive, time consuming and diverted the attention from the most important people in The NHS- the patient.
The competition created by the principles in the white paper report did not provide the best care for patients. Care trusts were expected to compete for patients in all health services, not allowing them to specialise in different types of care, this also had some geographic effects that were also felt by GP’s patients. Fund holding GP’s were also engaged in competition and did not necessarily give their patients the healthcare that they needed. The elderly young children were the groups who most felt this new system as different communities need different levels of health care, however fund holding GP’s did not seem to recognise this during the new system, fundamentally allowing their patients to suffer.
All in all, the government of that day had some good ideas for reforming The NHS, but needed I feel to test these ideas out in different areas around the country, before applying this strategy nationwide. Some of these reforms are still used today, however The NHS should never be judged against the private health care sector as they have different goals.
New Labours’ Policy for The NHS
In 1997, led by Tony Blair, the Labour Party took power from the Conservatives. Since then, the Labour Party has implemented a number of policies concerning the nation’s health.
Between 1997 and 2000, the government did not increase it’s spending on health inline with inflation as Chancellor Brown wanted to control spending and pay back the public debt. A lot of the conservative policies were still in place in Labour rule three years after they took power.
After 2000, the British economy was healthy and the government were beginning to plough money back into the health service. Chancellor Brown then announced a five-year plan to raise spending on The NHS by three times the rate of inflation.
Further labour reforms of The NHS were:
- The private health sectors investment into the National Health Service, managing NHS properties in return for management fees.
- Using private sector facilities to deal with standard NHS treatments to reduce waiting lists
- Performance tables for hospitals, individual doctors, consultants and surgeons
- Star ratings for hospitals to help patients judge high performance
New institutional bodies were set up by the labour government in 1997 to monitor and hopefully influence the UK’s healthcare. These were:
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The Commission for Health Improvement (CHI)
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The National Institute for Clinical Excellence (NICE)
- A number of other small health care agencies
They were introduced to try and make decisions about the nation’s healthcare needs, taking away the decision making away from local health authorities, who I feel would have a better knowledge of the communities they serve, their problems and potential solutions to them. I feel that similar institutions set up by the government should work with the local authorities to aid the decision not make the decision for them.
There was some doubt by economists on the government commitment to long-term spending plans, as their has been long-term underspending on The NHS for many years that has taken its toll. But the Labour government appear to be committed to long-term spending in healthcare and have hired doctors and nurses form abroad to carry out its plan.
How successful Labour have been in been improving The NHS will not be felt for a long-time to come, like the consequences of the Thatcher government was in the 1980’s, but the new policy changes are dealing with current problems.
Labour has waited too long to increase it’s funding and is not increased spending enough to cover costs it saved on years ago. Labour could also be criticised for not improving moral in its health worker force, by constantly reforming and making individuals accountable and still has done nothing to improve doctor’s conditions and the bureaucracy, inefficiency and wastefulness within The NHS.
Potential Solutions to NHS Problems
If the problems within The NHS were rectified, it would make the service more effective. These changes are aimed at:
- Reducing the amount of day to day intervention by government
- Increasing the sense of accountability and ownership amongst health workers and local communities
- Gradually introducing more choice to patients without reducing equity of access
- Ensuring the national standards of health care are achieved
I have come up with a number of potential solutions to the problems that have arisen over the years. My solutions I have considered are:
- Not solved by pumping money in alone
- New treatments and diagnose equipment
- Change the role of management
- Make money reach the patient
- Decreasing admin and management, increasing health care workers
Not solved by pumping money in alone
Money is not the answer to The NHS’s problems; it’s a case of budgeting for the demand for healthcare services and improving the service provider to increase efficiency. The government seems to just throw money at The NHS, not evaluating the services it provides. It is important the government evaluates what the budget is being spent on as this money could be wasted on unnecessary services.
New treatments and diagnose care, looking after customer (patient)
New treatments and diagnoses equipment have become available over the last 10 years and it has taken The NHS a lot longer then the US, most EU countries and some private care providers to purchase this equipment.
The newest piece of medical equipment that is being used in the US and most of the EU is the Celetron 328 BodyScanner.
This piece of equipment is similar to a brain scanner. The patient lies down and the scanner takes a picture of them, however the Celetron 328 takes a full body scan from a patient’s skeleton to skin and gives a 3-D computer generated image.
This piece of equipment is used in all A&E departments across America and some EU countries and has cut diagnoses times by 70%, freeing up doctors time, paper work and decreasing patient’s time in hospital, something The NHS could really use, but currently does not seem to be looking into.
Change the role of management
Changing the role of management is important for the future improvement of The NHS. Since doctors and nurses and highly educated individuals, it would be rational to give more control to them allowing them to take on some management decisions.
It would also be effective I feel, for hospital staff to have regular meetings allowing them to have their say about things that are currently happening in their place of work.
Changing the role of management will also take some of the bureaucracy out of The NHS, allowing a more consultative style of management which I feel would benefit the NHS allowing it to be more effectively, taking into account its culture, targets and goals.
Make money reach the patient
A simple voucher scheme may be affective, allowing the money to reach the patient. it would allow the patient to see where the money is being spent on the service they are receiving and also allow the patient to choose where they want to receive their care, not cutting into different communities budgets, allowing the money to effectively follow the patient.
Decreasing admin and management, increasing health care workers
Simply decreasing the number of admin and management within The NHS and increasing the number of health care workers would improve the efficiency of The NHS, health care workers could take on some of the admin work and their could be training opportunities for health care workers to have some management training to help aid decisions. This would save the NHS around 0.5% in management and admin costs which would be £365 million, money that could be used elsewhere in The NHS.
Comparison of UK Health Spending
Health spending in the UK is getting closer to the average for the European Union in relation to GDP. Data published by the Organisation for Economic Co-operation and Development show that between 1990 and 2000, UK health spending rose by 6% of GDP in 1990 to 7.3% in 2000. The EU average was 7.2% in 1990 and 8% in 2000. The United States spent 7.2% of GDP on health in 1990 and 13% in 2000.
Chart 1.3: Source: OECD Health Data 2002: Analysis of Health Spending
Comparison of health care provision in comparison with the United States
The OECD said that the main reason for increased spending was modern medical technology. There has been rapid growth in the use of technology-intensive procedures to treat important diseases and health conditions in nearly all countries. The number of operations, such as coronary artery bypass graft (CABG) and coronary angioplasty, increased rapidly over the 1990’s, particularly in countries that stated with low levels of these procedures. None the less, by the end of the 1990s, the rates of CABG and coronary angioplasty in the US were more then double those of the next highest countries. These differences in the frequency of the expensive procedures help to explain part of the differences in overall health care spending between the US and other countries.
Despite the extra spending in the US, OECD data show that the life expectancy at birth in the US and infant mortality is comparable with the OECD average and below the OECD median.
It’s important to point out that health spending is not the only factor that matters to national health. The risk factors to which populations are exposed are highly significant. For example, although the US has the second lowest levels of people in OECD countries who report smoking tobacco daily, it has the highest levels of obesity.
UK health spending in comparison with other countries
It is unlikely that the UK will ever be able to compete with France or Germany when it comes to healthcare. France has a competent health system which is topped up by extensive charging and private insurance schemes that seems to work very well.
In Germany where the state nearly fully funds the health service, British taxes would have to rise alarmingly. The taxpayers in Germany however are used to paying for excellent public services with very high income tax rates. UK citizens however, are unlikely to accept such a regime.
However, the average figures which can be seen in chart 1.1 and chart 1.4 are un-weighted averages; each country is treated the same regardless of its size. This is not a meaningful measure of the average level of health spending undertaken by citizens of the EU since it gives the same weight to the small and relatively low spending countries.
Chart 1.4: Source: OECD Health Data 2002: Analysis of Health Spending
Evaluation
To meet EU health spending levels the UK would have to spend £9.9 billion on top of existing NHS spending to improve the NHS’s service to the quality of care seen by citizens of the EU.
In order for their to be an efficiency change in The NHS, the government needs to look at the current equipment it uses and look to invest in new equipment to improve its efficiency. Over time new technologies will emerged that could save the NHS time, money and resources, like the Celetron 328 Bodyscanner mentioned previously in this paper and I would greatly recommend that the government invests in new technologies.
In the pre-budget report, the Chancellor of the Exchequer, Gordon Brown, stated that ‘I believe that…it will be right to devote a significantly higher share of national income to the National Health Service,’ which he posed as twice the times of inflation, which in reality isn’t enough to greatly improve the health service.
However, if the British government wants to see significant increases in public spending on health beyond 2003/04, then greater resources than the current input will be required, to keep up with the EU average. In the absence of increases in borrowing or savings found from elsewhere, any increases in NHS spending beyond 2003/04 will require increases in taxation to pay for it.
Bibliography
Books
HNC HND Business, Organisations, Competition & Environment, BPP Publishing, 2002
Journals & Articles
The Pharmaceutical Journal, Vol. 268, No 7204 pg895-899, June 2002
Media, Video’s and Audio
BBC News, ‘Britain poor man of EU Health’, 17th July 2001
Websites
www.jr2.ox.ac.uk
www.OECD.org
