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Meeting NHS Management Challenges

Posts made in September, 2014

Price and Service Signals: Challenge and Opportunity

By on Sep 22, 2014 in EquiPOISE - Blog | 0 comments

22 September 2014 Chat to a GP practice manager about missed appointments, patient complaints and crowded waiting rooms.   Pop into an A&E somewhere near you on most nights: just sit and watch.   Listen to nurses’ tales of patient reactions in the wards and along the corridors. There are two common threads:  rising service expectations and the complete absence of any cost-benchmark. Expectations first.  Ours is an advanced western economy.  It is, today, dominated by services.  They constitute as much as 80% of GDP, according to some estimates.  Service orientation is, by extension, tangible everywhere.  From holidays to restaurants, and chic boutiques to (yes) smiling, service-trained lawyers.   The benchmark of acceptability is relative and rising.   It is a tide  which leads us all to expect ever higher standards in most scenarios.   So, the patient in the surgery or ward arrives with pre-set consumer-society expectations of how s/he will be treated.  Like it or no, that’s the way it is. Except in most contexts, the service layer and brand align typically with a price signal.   McDonalds vs. The Ritz, Aldi vs. Waitrose,  Kia vs. Mercedes – in all cases our expectations software is engaged and runs.   And most consumer marketing assumes that this model (solidly founded on extensive social psychology literature) will function. But at the surgery or A&E?  A little gentle research among your non-medical friends will rapidly expose great uncertainty about true costs.  (I.e. salaries plus fixed overheads plus variable treatment costs plus contribution).   In my experience even best guesses are often only 10-20%. Now imagine. A patient exiting A&E patched up at 4AM.  Or leaving hospital after major surgery and a few nights’ stay. At reception s/he receives a comprehensive invoice – over-stamped ‘Paid by H M Government’. Price-signalling theory would predict a serious and beneficial reaction in the way people demand, consume and respond to our healthcare services. Politically impossible of course.  But worth a reflection?...

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Scotland’s ‘No’: Now Back to Budget Business

By on Sep 22, 2014 in EquiPOISE - Blog | 0 comments

22 September 2014 Whatever your view of Scotland’s ‘No’, you’d probably agree that  politicians of all stripes manipulated the NHS shamefully.  Like a magic totem, at times during the closing phases of the referendum campaign it seemed the only topic.   If, though and regrettably, few concrete facts or issues were in play. But now it’s back to business.  Money business. North of the border, NHS Scotland and the Edinburgh Government together face some very serious decisions.  If leaks are credible, they confront a looming gap of £450 million.   Meantime, heading south, the growing English ‘black hole’ is estimated to be multi-billions deep.   But no one wants to go there this side of the 2015 General Election. So, based on the recent referendum, it is fair to predict a whirligig of buck-passing and mutual recrimination. Instead here’s a couple of novel thoughts for our political class: First, when you’re in deep holes already, stop digging. Second, put the facts and options in play clearly, constructively and objectively.   Treat people like adults.  Let them decide.   Surely what’s good enough for the Union as a whole is good enough for the NHS? Flying pigs anyone?...

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