Posts Tagged ‘hospitals’

skeletal-debate

Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.

Aneurin Bevin

The ability to provide safe, cost effective health and social care, across the National Health Service (NHS) England, and other recognised agencies, is continually being driven further into an abyss.  Contribution to this situation is seen through numerous factors: the change in societal expectations of what treatments should be available on the NHS; the historic failing of successive governments to create mechanisms within general taxation, and additional charging to facilitate the continuing demands on these services; poor leadership by the Department of Health-a direct result of short-termism and political ideology-cascading down to hospital management teams.  The private funding initiative (PFI) projects that have been demonstrated have a phenomenally catastrophic impact on patient care.  Outsourcing of services to the private sector which are integral to patient care, for example portering, and domestic services.  And more recently a drive, initiated through a shared myopia of government, and hospital managers, to blindly follow a culture of “more for less”, to name but a few.

Making savings ad infinitum with the objective of maintaining the same standards, is detrimental to an organisations ability to be efficient and sustainable.  Savings are a tool used by accountants to achieve short-term gains.  Whilst “Lean” working is a viable proposition in health care “lean” is not anorexic.  The long term effects of short term savings are to drive down standards, to force errors through the cutting of corners, and to cost the organisation dearly in the future.  “Speculate, you can’t accumulate, if you don’t”: true leaders in the NHS will see the value in this proverbial saying.

Hospitals are finding themselves in such financial dire straits, that with no apparent means of raising capital for investment, in the very basic infrastructure to make them viable propositions, under any  other circumstance they would be bankrupt.  It is possible to put a plug in the bath, even if it is a round(ish) plug in a square hole; and to at least turn the flow of the, money, taps down so they are running at a steady flow and not gushing.  But this requires long term policies, more freedom from government control, and leadership: not crisis managers.

It is time for hospitals to look at becoming shrewd financial investors; to speculate wisely.  If £25million in the red, to continue saving will only drive debt.  Speculate and invest to drive productivity over the long term, bringing the debt down.  If it is a system allegedly good enough for the government to implement, then why not Hospitals?

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A friend introduced me to the thoughts of Jared Diamond, during a conversation at work, in particularly to a  lecture he presented titled “Why societies collapse“.

In his lecture he presented an interesting analogy describing contributory factors associated with the collapse of societies; an analogy relating society, to bacteria in a Petri dish.

As bacteria grows within the confined space of a Petri dish there comes a point where there is a balance between “resources” within the Petri dish (nutrition) and “resource consumption”.

Diamond suggests, to prevent collapse within an evolving society, a balance between resources and their consumption; as much as a balance between economic outlay and economic potential to prevent collapse.

“Mismatch between available resources and resource consumption” will bring imbalance due to continuing growth of bacteria. As society expands beyond the available resources and systems of economy available, as with the bacteria, society collapses.

Taking Diamonds bacteria analogy to macroscopic level in everyday life, brought me to the state of the health service in the United Kingdom (UK). Taking this to microscopic level (that is hospital level) one can begin to appreciate why hospitals are failing.

It is clear that boundaries have been reached when the “Petri dish” represents the confines of the hospital. Attributable to an ageing, expanding, population available resources are not keeping up with consumption nor is the required economic outlay to maintain the service provision being met by the economic potential available. Simply there are not enough people contributing enough to the pot.

Resources in this instance means service provision within the hospital.

Accident and Emergency departments failing to meet the four-hour targets set by Government, where-by “no-one should wait more than four hours in accident and emergency from arrival to admission, transfer or discharge“. Or the increase in waiting times for operations due to the availability of level two and three facilities and ward beds.

In order to address the collapse of this micro-society one has to look at resources and resource consumption in tandem with economic outlay and economic potential.

What can be done to delay, if not prevent the collapse of this society?

As the Government of the day used public funding to save the banks from collapse, the health service is employing private companies. And whether this is liked or not, there is little that can be done about it.

Some hospitals are having to utilise facilities at private hospitals because they do not have the resources available within their “Petri dish”. We are already seeing private companies investing in health services. Richard Branson’s “Virgin Care” investing in community health services: Circle Partnerships investing in “Hinchingbrooke Hospital“, are providing the economic outlay.  This investment is bringing back an equilibrium to resource availability against resource consumption.

Whether one agrees with the thought that these companies have entered the market to make a “quick buck” or not; the question do we want healthcare or not, needs to be asked. There will never be enough people contributing to the pot, so we will all have to pay more in the long run no matter how healthcare is provided.