My impression of the NHS is that it is grossly under managed. Popular complaints about unnecessary paper work, administration & evil managers may be well founded, but the answer is certainly not to abolish all managers
Car parking is not an obvious clinical need. But all hospitals need car parks. Where & how are they to be provided? What about security - not just to deter the thieves inevitably attracted by a large number of unattended vehicles but for staff needing to go home or come in to the hospital during the dark & lonely hours? How do you allocate spaces between staff, patients & visitors? What would be a fair charging system? How to administer collection of charges?
Not a clinical function; but without it the consultant cardiologist sits twiddling his thumbs or drumming his fingers on the desk because his 10 o'clock appointment has failed to show. Meanwhile that poor 10 o'clock patient is searching desperately for a parking space or, having found one, is wandering around looking for a signpost to the cardiology department; or is stranded 500 yards away, unable to walk that far & there are neither facilities for dropping him off at the door or delivering wheelchairs to the car park
Who should be responsible for giving that patient, & the many others who, like him, will be visiting the hospital for the first time that day, essential information. Not just about car parking but about things such as the need to take, or not take particular drugs, to eat or not to eat, to empty or not to empty the bladder, as essential preparation for the consultation?
Would it not help the whole process, reduce anxiety & add to efficiency if patients knew more about what to expect? Even in simple matters like whether they will be required to undress, & in what degree? I once had the experience of a consultation with a doctor who would have liked to examine my foot, but understandably in the circumstances decided not to do so because I was wearing both trousers & tights - well it was winter & I had no idea beforehand that this might be required. If I had known, I would have dressed differently & would have been spared the embarrassment of feeling that I had done something stupid, when all I had done was dress normally for the weather
I also once had the experience of being called for a scan at 11am with the instruction not to eat or drink anything for 6 hours beforehand. Was I supposed to set the alarm for 5am so I could get up & have a cup of tea - or starve for the 12 hours or so after going to bed the night before? Somebody needs to think about & coordinate all these processes, & that is a classical management, as opposed to a clinical function
Hospitals also need to buy many things - bandages, food, drugs, sheets, paper, pencils, computers, surgical instruments. Buying them smartly & efficiently can save thousands of pounds which could be used for paying more doctors & nurses. But it is not simple; buying in bulk may mean a discount, but if you buy too much at once you have to provide safe & secure storage & implement a bureaucratic system for controlling access to the stores - not just to prevent fraud & theft but because unauthorised access to, say, drugs, could be very dangerous. And in these days of competition, who do you buy your electricity from? Again all these are classical management functions, with their own skills & knowledge base
There is no obvious reason why nurses or doctors should have to spend their time on these functions, though it would be nice if they seemed to be aware of the skills involved. The BMJ has recently been carrying articles about evidence based management without seeming to be aware of the body of literature which already exists. Take for example the business of people who do not show up for appointments; the analyses I have seen show little awareness of basic market research techniques, even of basic customer demographic analysis
The allocation of resources provides a classic example of queuing problems. Intensive care practitioners seem always to be stressing that you cant predict what will happen in any individual case; true enough - I can't say whether I will have a heart attack tomorrow - but it is easier to predict that, say, 10 people will, that 3 will need only 1 day in intensive care etc etc …
Good managers respond to all these pressures without ever losing sight of the fact that the focus has to be on providing health care to customers who will be feeling more stressed & anxious than the normal customer of Boots or M&S or Sainsburys. Managers will also learn from industries such as tv or music, which depend crucially on prima donna stars, individuals with unique skills & charisma, without whom there is no industry, nothing to manage. The doctors & nurses fill that star role in the health service, but they cannot function without the cleaners, lab technicians, laundry workers, telephone engineers, computer programmers … all coordinated by management
It is clear from this analysis that only the staff of the NHS could ever be described as public sector. All the other suppliers of essential goods & services come from the private sector. But even that is not entirely true; it turns out to be more a question of cash flow - who directly signs the cheque which pays the salary of your GP, Practice Nurse, ward cleaner? Where does the money to support that cheque come from? How do you, the patient, control or contribute to decisions about which hospital you should go to for your appointment, at what time of day? What do you eat for lunch on days when you are an inpatient? Is it fair to yield control of all these decisions to public sector employees in return for your (non-negotiable) taxes? Is this a fair exchange for the reduction of anxiety about how you will pay for a major medical emergency? Or even a minor, possibly medical concern? And even if this is fair, is it clear that the cash flow arguments require that all the staff who deal with you should draw their cheques from the public sector?
