The UK’s NHS meltdown may represent failure on a large scale, but many of the symptoms it presents are evident in all types of businesses in countries around the world. Therefore it is useful as a study model. So, what can we learn?

A report this week by the UK’s House of Commons Health and Social Care Committee revealed that the UK’s National Health Service requires 12,000 more doctors and 50,000 new nurses and midwives among a total of additional 475,000 workers and possibly 490,000 more carers.

I’m sorry, but I don’t believe it! I suspect that what they have done is calculate the requirements were the NHS to continue operating the model they have now, but in the digital age, that’s no kind of solution. The only answer to the NHS meltdown is finally to transformation.

I’ve had this conversation with people in the NHS and they have always assured me the response to NHS meltdown has been transformation, but when they explain what this has entailed what they describe is “change” not “transformation”. They are two very different things.

Change is when you automate an existing model. It usually produces short-term gain, which provides the business with a false sense of security. However, the initial success is mostly short-lived and thereafter decline is significantly accelerated, because the business will be moving more quickly, but in the wrong direction. Transformation, on the other hand, involves re-inventing the business, questioning it’s relevance to today’s and future markets, challenging processes, even creating completely new products and services.

If productivity doesn’t improve you haven’t transformed

I imagine someone, somewhere must have done the maths, but the UK population has grown roughly 28% since 1960. Compare this increase to that of the numbers of NHS employees. On 29th January 1981, Lord Cullen of Ashbourne told the House of Lords that in 1960 the NHS employed in total 550,000 people. By 2020 the NHS headcount had grown to 1,319,932 and that doesn’t include an additional 1.6million employed in social care. The first figure alone represents a 140% increase, which begs the question, “what are all these NHS employees doing?”

If the NHS were a commercial operation we would be seriously questioning productivity. We’ve failed to call the NHS meltdown what it is for decades because it is publicly owned and something of a sacred cow. It isn’t subject to grubby realities like accountability.

You only have to enquire at your local GP surgery to realise very few GPs work full time. In fact we have 700 fewer full time (and I use the term lightly) GPs now than we did in 2019. But is this NHS meltdown? In fact, do we really need them anyway?

Are we sicker? We’ve had Covid, of course, but I’ve not seen evidence to suggest that we are generally less healthy. In fact we are living longer, so I guess we are healthier, although this in itself is often cited as a reason why the NHS is overstretched. 

I admit, older people may need more care, but surely that’s what the 1.6million care workers are for? There are only 1.2million people in the UK over 65, so that’s more than one care worker each!

Are we more needy? We’ve seen mountains of conditions that we have all lived with for generations, given names and attracting “movements” that demand treatment. I saw a vox-pops on a news programme recently where people in the street expressed their expectations of the NHS. Had it been a Monty Python sketch it would have been funny. It’s a measure of the paranoia we have acquired when people rush to A&E each time they sneeze! Maybe we all need to “man-up”?

It doesn’t help that healthcare is highly politicised. A proportion of the NHS problem must be laid at the door of politicians who gain favour with voters by promising free healthcare for an ever-widening range of maladies. Maybe that’s the cause of NHS meltdown?

Manage expectations

Do we expect too much of the NHS? Putting aside the feeling I have that we’ve become a nation of pussies who can’t open an aspirin pack without supervision, is it just that we all have different expectations or understanding of what the NHS is for?

I bleat on relentlessly to anyone who will listen about the need for organisations to have a clearly defined “purpose”. Maybe that’s where the NHS is going wrong? We need boundaries, a bit of expectation management perhaps?

Define your purpose

What exactly is the purpose of the NHS? Is it to ensure everyone has a fair crack at staying alive? Maybe it’s more subtle than that. I bet if you asked around, even within the NHS, you’d get as many answers to that question as people you asked. And that’s a problem, because every organisation should have a “brand model” and this question will be at its very heart.

Understanding your purpose is perhaps the single most important issue for any business and it’s certainly the first step towards building a business strategy, creating a brand or starting any kind of transformation.

It’s one of the first things I ask participants in my Brand Discovery programme and I can be confident that most of them will answer with “We make widgets”. What you make or the services you provide are NOT your purpose. They are merely the means by which you achieve it and it pays any business to get this straight before they do anything.

Instead of throwing ever-more money at trying to hit an ever-moving goal-post on an ever-expanding playing field, which is the situation we are in with the NHS, every business should take a step back and define their purpose. Then, and only then will they be in a position to create a plan that will enable them to get there affordably and efficiently.

I’m not suggesting defining your purpose is easy and most businesses will plan for far more necessary initiatives than they could possibly handle. However, whether you start with a long list and whittle that back to what is realistic, or tackle it from the basics and add features that are judged affordable or practical doesn’t matter. You just need to end up with a plan that’s feasible.

Embrace technology

Without doubt, part of the problem for the NHS’s has been its reluctance to embrace technology. Again, they are not alone. There are pockets of technology in the NHS as there are in most businesses now, but they aren’t connected. In some instances they conflict with each other and training is often very poor, so they aren’t fully utilised. If they were working as they should, we would see either a reduction in employees or an increase in output, neither of which is evident with the NHS.

The principle of the NHS may be sound, but the model is clearly unable to meet twenty-first century needs. Business strategy involves identifying what these are and deciding which you want to satisfy. Only when you know this can you can start working out how you apply contemporary resources to the problem. Trying to achieve twenty-first century objectives with twentieth century processes and tools simply doesn’t work. That’s why I believe investment in most cases, including the NHS, should be directed to tech, rather than people.

The reason this doesn’t happen, of course, is that senior executives know that when something comes out of left field that means they need to reduce overhead, they can quickly and easily get rid of people. Software has been a less flexible commitment, although the growth of cloud computing has changed that.

Our NHS primary care is pathetically out-dated. There are still GP surgeries that don’t send patients an SMS to remind them of appointments yet they complain about the number of missed appointments and the waste that represents!

By now we should all be sporting wearable tech or have implants that monitor a range of health signs and feed data to a central source, which in-turn send reports to medical practitioners. 

This technology already exists. AI can even identify anomalies and flag these to medical practitioners. The problem is the health service has rejected this technology. Primary care should be about following up on those reports. If, in addition, patients feel they are below par, their GP will be able to visit their live feed to establish whether the patient is indeed ill and often prescribe treatment remotely. Imagine the time-saving, not to mention that diagnoses will be more accurate and outcomes by far improved!

Heart attacks become serious within fifteen minutes of symptoms occurring, yet it is currently taking ambulances in the UK on average fifty-one minutes to get to an emergency. Smart personal tech that we can all wear will detect an attack before symptoms appear. It will call emergency services and direct the responders to the patient. A process like this will both prevent attacks and eliminate the costly after care that those who experience a heart attack require. This will unburden hospital staff, free beds and save the cost of procedures.

Let’s start with the basics. How about a centralised database? Maybe we have to overcome our paranoia regarding data security, it’s all out there for a determined hacker to access anyway, let’s not kid ourselves. If you want a decent health service, relinquishing your data is the price you’ll have to pay.

I know that we are supposed to already have a centralised database but, that’s just another lie, we don’t. During a recent medical emergency I had to give the same basic information to three different people within thirty minutes, because none of them could access the records the previous person I had previously spoken to — a waste of time and man hours. A few weeks later I assisted someone else at their local hospital and medical staff couldn’t even access data that had just been entered on a machine in the next room! No wonder the NHS is in intensive care!

I don’t want to throw any more money into the black hole that is the NHS and I’m sure that investors will baulk at covering the cost of any business’ inefficiency, just because nobody has the sense to fix it. There’s plenty to do of course. NIMBYs, inefficiencies, restrictive practices, outdated processes, ridiculous protocols, sacred cows, Luddites, not to mention laziness and self-interest are all there to be dealt with in most transformations. It will usually get a bit messy too, with people lying, failing to cooperate, introducing obstacles and digging holes for you to fall into. After all, many feel they have a vested interest in the status quo and will resist change at all costs.

But, I repeat, the overriding issue with the UK’s NHS meltdown is the organisation doesn’t know what it’s supposed to be doing. Different departments are aiming for different outcomes. Individuals are pursuing different objectives. It’s all such a massive waste of time, people and money. And they are not alone. In fact, many businesses and organisations around the world would be far more efficient if they were only clear about their purpose.

We often hear how different divisions or departments of organisations like the NHS have been given “targets”. We incorporate bonuses to encourage employees to work towards these. However, these targets are often uncoordinated, sticking-plaster solutions and frequently not aligned to the purpose of the organisation.

In the absence of the focus that a clear purpose provides, divisions, regions or departments operate in isolation. The benefits of cooperation or combined resources are lost. There is duplication, waste and a generally poor outcome because nothing is joined up.

The NHS meltdown is undoubtedly critical, but with a bit of decisiveness they could bring the situation around, if they move quickly. Let’s face it, they are going to have to, but, while we are waiting for that realisation you can do yourself a favour by examining your organisation to see what symptoms you share with them.

Phil Darby
July 28, 2022

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