the Great Grey Wolf

Drains it all away

What’s next for the NHS to worry about?

Well, you’ll have to be like the Great Grey Wolf. Five-feet long, plus two feet of black-tipped bushy-tail. Weighing-in at 145 pounds.

The great beast sniffs the morning air… which way is the wind blowing. He’ll need to be upwind to stalk his prey.

Which way is the wind blowing for the NHS? I detect, towards the ‘P’ word…


Across public services, productivity is down, and globally health systems are struggling. It’s a big problem.

The nay-sayers and protagonists will ask; ‘Why isn’t the NHS cracking more people through the system?’

The monochrome Amanda Pritchard, boss of NHSE got tangled up in the productivity trap at the Health Select Committee.

She said;

‘… there’s a misunderstanding … about the state of productivity… it’s measured in a way which doesn’t fully reflect … what happens at acute trusts [investments to improve care quality] or, crucially, it doesn’t reflect what’s happening in community care, it doesn’t count… virtual wards.’

Err… we’re measuring the wrong things? Why…

… just asking for 1.4m friends who come to work every day, flog their guts out, only to be told they aren’t productive… when they are… we just don’t measure it.

Stephen Powis, Med-Dir-NHSE, looked more bewildered than usual…

‘… sometimes’, he said, ‘… where we make productivity gains is not where we measure productivity.’

Be generous. Ignore the basics… if you’re ‘making productivity gains’… how do you know… if you’re not measuring them!

Note to Prichard and Powis.

The correct answer is;

The University of York’s Centre for Health Economics found; NHS productivity increased by 16.5% between 2004/05 and 2016/17 compared to productivity growth of only 6.7% in the economy as a whole.

In 2017, ONS statistics showed NHS productivity grew by 3% in England, more than treble the 0.8% achieved across wider the UK.

And, by the way, GP practices delivered a record 34.3m appointments in October, excluding COVID jabs – almost 220,000 per working day


… given the right environment the NHS has skills, talent and people to be more productive than most industries, but not if it’s battling austerity, Brexit, a pandemic, strikes, no workforce plan and five secretaries of state in 18 months.

The Institute of Fiscal Studies joined in.

They describe ‘myriad factors’ impacting productivity;

• Fewer non-covid beds
• Discharge log-jam
• Socialcare collapsing
• High staff-sickness… lower resilience
• More complex patients
• Infection control measures

It’s work noting, the number of people waiting to be assessed for a care home place has risen from 395,000 to 434,000.

The upshot, the four ‘C’s;

• capacity,
• complexity
• collapsing social care
• and everyone is completely knackered.

Productivity doesn’t exist as a ‘thing’. It’s the product of a system.

A manifestation.

Edwards Deming said; 95% of the performance of an organisation is ‘attributable to the system’. Five percent is the individual.

A poor system is demotivating, saps morale, knackers people and that puts the precious 5% at risk.

Extra effort is discretionary. A gift from the workforce.

It’s dependent on the employer putting the right people in the right places, the right kit, removing ‘annoyances’, autonomy, saying thank-you and developing people.

NHS productivity was judged as the outcome of the collective tunnel-vision about targets.

Now, they’re out-of-date or sidelined. Does it matter?

What gets measured gets managed but be careful… gaming targets became a preoccupation… and the targets ceased to function as an indicator of productivity.

Now, we have endless ‘priorities’. Nothing to align them to.

What’s the NHS’ mission? Quick access? Quality experience? Right-first-time? Speed of exit? Outcome?

What are we trying to do?

The answer, I guess, is ‘everything’… and that’s not a good answer… but it’s the only answer.

If we had a better idea of what we want, we might be able to measure it.

To improve productivity most organisations reach for the button marked ‘technology’.

That said, even with glittering technology… one doctor can only see one patient at a time. One nurse can only take one set of observations at a time and one care worker can only wash one bottom at a time.

We can make the doctor’s bedside ‘dwell-time’ shorter and help support better decisions with technology.

We can automate observations to self-record but the nurse still has to ask, how are you feeling… and no,

We can’t put yer-granny in a car wash.

Besides ‘clean-glitch-free-systems’, making work easier, productivity is a distillate of knowledge, experience and invisible work… like thinking.

The simple act of paying positive attention to people has a great deal to do with productivity.

The workplace reality, versus employee expectations, compounded by management-(mis)understanding of what’s really going on.

People generally come to work with optimism, to be the best they can and for the satisfaction that comes from being productive.

It’s what we do to them when they arrive…

… that drains it all away.

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