Time to ditch assumptions of poor productivity
Posted on 15 February 2013 by Tom Kane
‘Success is about more than the number of hips replaced or targets met. Hospitals are not factories. People are not just “conditions” or “episodes”.’ Bravo! You could have taken the words out of my mouth.
Except that they weren’t from me, or the BMA, or the Royal College of Nursing, or Unison. They weren’t from a doctor frustrated by the relentless demands of the target culture, or from anyone working for the NHS. They were from the health secretary.
Much of Jeremy Hunt’s speech, at an event hosted by the think tank Reform this week, reads like a rejection of the ‘NHS is woefully unproductive’ arguments we often hear from politicians, think tanks, and the more conservative newspapers.
It’s a line of thinking that’s had a lot of currency in recent years. Last December, a paper in the Journal of the Royal Society of Medicine bemoaned a downward trend in ‘consultant activity levels’, apparently demonstrating ‘a heightened need for productivity improvements’. (Crucially, the researchers included no measure of quality in their analysis.)
In fact, the claim of poor productivity was central to the government’s case for the current reforms to the English NHS. Putting the case for the Health and Social Care Bill in 2011, Andrew Lansley controversially cited estimates that hospital productivity was declining by 1.4 per cent a year. Fast forward two years and his successor is arguing that compassion is far more important than factors that are easier to measure. ‘The old management adage that “what counts is what’s counted” could not be more wrong’, Mr Hunt said.
He went on to outline a plan for a new Chief Inspector of Hospitals, who ‘will draw the multitudinous inspection regimes together and focus them on what is really important’. It remains to be seen whether these plans will achieve this aim, or if they’ll have the opposite effect and simply add another layer of bureaucracy.
But the words used to announce them were refreshing. We might well quote them the next time it’s claimed that doctors aren’t sufficiently ‘productive’.
Tom Kane is deputy chair of the BMA consultants committee
Mid Staffordshire inquiry
NHS system reform