Kindness and patience

Kindness and patience

I’d like to think the £walled Times picked up on my theme, yesterday morning…

‘… productivity doesn’t seem to reflect the fact there is more money and a lot more people in the NHS’.

The Treasury have certainly cottoned on. That’s why they’ve refused an ask from NHSE of around a £billion to help out with the cost of the strikes and backlogs.

NHSE have scaled back their efforts to reduce waiting lists… giving No10 a problem… coz… reducing the numbers is one of the PM’s five promises, ahead of the up-coming election.

The Times reported, in round terms:

• 16% more more doctors than 4 years ago;
• nursing numbers up 15% since before the pandemic;
• spending up £20bn in real terms.

According to the Times, NHSE has brought-in McKinsey to figure out why the Service is managing lower treatment volumes.

I find it hard to believe NHSE don’t know.

The last time the NHS called in McKinsey was 2009. They produced a deck of slides.

The upshot, 12 key points;

  1. Reduce the tariff to enable SHAs ‘to push through efficiency savings’…. get people to do more for less.
  2. Renegotiate the GP contract… to drive down costs.
  3. Cut the number of GPs, they’re inefficient… the least productive had 77 appointments a week and the average was 126. If the worst improved the same number of patients could be seen with 3,500 fewer GPs.
  4. Reduce elective surgery, ie., stop doing tattoo removal, hysterectomy and tonsillectomy.
  5. Reduce routine outpatient referrals.
  6. Reduce variability in o’patient referrals.
  7. Cut the number of district nurses by 15%… by increasing the average number of visits from 5.6 to 6.6 a day.
  8. Increase clinical productivity; the least productive 10% of doctors and nurses see a fifth of the patients seen by the most productive 10%.
  9. Increase the number of day-cases.
  10. Reduce the variation in prescribing [by PCTs]. Spending ranged from £85 to £192. If they all moved closer to the average… £151, they’d save £600m a year.
  11. Reduce spending on supplies by £1.9bn. Eg; GP supplies could be 15% cheaper if they used national procurement.
  12. Cut the sq’m per-bed ratio and sell off spare land.

At the time people didn’t know whether to laugh or cry.

I remember it well. It was a while before McKinsey got back in the tent and when they did they pocketed £600k for seven-week review into NHS tech leadership…

… which is still hopeless.

In my legendary fairness, for which I probably should be beatified… it’s probably true to say, all the dozen points, had some salience. McKinsey were saying if all the rest were as good as the best, a lot of stuff would be better.

We know that but the NHS has never had the leadership, the time nor the investment to make it happen.

Quite why NHSE have decided to spaff our money on McKinsey, again, tells me there’s no one there old enough to remember what happened last time… or NHSE really don’t know the ‘why’s’ of productivity decline.

I do:

• fewer hospital beds available for non-COVID-19 patients than pre-pandemic
• increasingly difficult to discharge patients, which clogs up the system and is a drain on staff resources
• The NHS employs greater numbers of (hospital) staff, but higher rates of sickness mean that a non-trivial portion of these is effectively lost: higher levels of staffing on paper don’t translate in full into higher levels of staffing on the ground
• a larger workforce is now needed to deliver the same amount of care
• staff productivity is significantly hindered by ongoing infection control measures and pandemic-induced fatigue
• patients who missed-out on care during the pandemic are now presenting with more complex, difficult-to-treat conditions
• there’re signs that population health has deteriorated more generally

I know coz… this was all in the recent IFS report (Page 22) and NHSE could have had it for free… I did.

Add to that the shambles that is even basic IT, dilapidations in the estate, the fact the NHS hasn’t been able to draw breath after Covid, or system capacity is one of the lowest among comparable countries… and you have the answer.


Depending on this winter, Covid will work it’s way through the system, staffing will recover and waiting will come down.


… the numbers are misleading … one person can be waiting for several things and the biggest chunk of population waiting, are for diagnostics and a lot won’t need any further treatment.

More money, more staff, a huge effort on IT, investment in the estate, sure but mostly the NHS needs more time, mature management, understanding…

… realistic expectations and above all… kindness and patience.

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