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Time to ditch assumptions of poor productivity

Posted on 15 February 2013 by Tom Kane  8 comments

‘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

Posted in:  Mid Staffordshire inquiry NHS system reform

Tags:  consultants targets raising concerns performance

Comments

  • Dr John Warre

    18 February 2013

    Personally I felt we were on a downward path when practice managers were first thought to be worth more than practice nurses.

  • Dan Munday

    19 February 2013

    I remember in 2005 the then Health Secretary, Patricia Hewitt, proudly announcing on the Today programme that the government had decided that it was wrong to pursue targets, because targets were causing hospitals to focus on the wrong things. John Humphreys asked "what is going to replace them then". Ah, they had not thought of that it seemed. There followed a display of fancy footwork as an incomprehensible future policy was described, which sounded suspiciously like the previous one, except the T. word was missing.
    I would expect more of the same in the new caring NHS.

  • Paul St John-Smith

    19 February 2013

    I am concerned that spending so much time filling computers with data in order to achieve a large number of targets for the various funding, commissioning, revalidation,appraisal, and quality systems/bodies, is nowadays any NHS TRUST's priority ( Whatever the claim or aspiration stated by management) because it takes up much of our time and effort. More of the same imposed by government,is likely to lead to a downward spiral of increases in document/computer field filling at the expense of actual clinical time spent.
    Unless such commissioning and quality targets are massive reduced this is inevitable. Ironically it may turn out that the TRUSTS with the best scores on targets etc may be the worst clinically. Now there is a paradox!

  • zaw min

    19 February 2013

    I come from a culture where we have an old saw: There are three places that should not be busy - law courts, hospitals and cemeteries. So much for productivity.

    It also seems peculiar to Western society the obsession with counting anything and everything that can be counted, breaking a record for no reason other than doing so.

    Growth in profits to pay off PFI debts (the Third World Debt now in the First, the chickens coming home to roost à la the IMF/Washington Consensus) almost exclusively from efficiency savings basically means laying off staff, and the shortage thereof never gets properly addressed, diverted instead to compassion which smacks of a political red herring, desperation and bankruptcy of policy.

  • Nick Yates

    19 February 2013

    Francis seems to suffer from the Baby and Bathwater " problem - if there are not enough beds to meet the need and a decreasing number of nurses to care for those admitted, reductions in clinical care levels, staff morale and continuing care are inevitable in a management climate that is number and financial target driven with little compassion and attention to quality of care. I think most of us came into the profession for the latter and those with long memories date Mr Clarke and the fag end of Thatcherism as where the rot started

  • Dennis Wilkes

    21 February 2013

    Since I became a Public Health specialist in 1992 I have always been struck by management's ability to "know the cost of everything and the value of nothing".
    The chickens have come home to roost.

  • NDugar

    21 February 2013

    Quality comes from
    1. Properly qualified experianced & trained personell doing a particular job--(and not trying to replace with cheaper labour)
    2. Staff workload being defined & monitored--high unmanageable workload will result in corners being cut
    3. Team working--today's medicine is highly specialised & fragmented. Good team working & communication between doctors in different specialities can significantly improve care.

  • alihossein estekibardeh

    3 March 2013

    Right honour Mr Hunt is forgiven to think small and pretend to be big. If he feels we offer poor quality he should then look into the publication few years ago where it was shown teh NHS is one of the highest quality services versus investment.
    It is unusual for being a lobbyist for the private sector and almost missing the deadline for being removed from your post to be lobbing to destroy one of the best and efficient health services in the world. This is synergetic recipe for disaster. We must stand firm and protect our competence in our system!

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