The efficiency football is going to be kicked around the Health Service, seemingly interminably.
On one team are the government, the policy wonks and beancounters, who now have an outright majority in parliament to execute their plan and some new moral ooomph thanks to the promise of an £8bn budgetary injection.
On the other side of the pitch are the many stressed doctors and nurses, the creaking facilities (or new ones burdened by crippling PFI or PFI2 repayments) and the looming burden of an ageing population with inexorably growing healthcare needs.
This match is why there is a steady trickle of stories in the press. Recently, for example, the “£3200 doctor’s shift” made headlines, with both sides claiming it to be a ludicrous situation (Health Secretary Jeremy Hunt says agencies are “taking the NHS for a ride”).
The latest salvo – carefully timed – is the release of a report from Lord Carter, who says that the NHS could save £5bn, a big chunk of its £20bn efficiencies target, through better purchasing and better organisational strategy.
This is gold dust for the government, because:
- Carter has spent the best part of a year working in hospitals, rather than making pronouncements from the sidelines
- And, most importantly, his interest is in structural change rather than attempting to extract ever more value from employees who are already run ragged
We like Carter’s approach, because it suggests some basic truths. For example, variance is a good indicator of opportunities for efficiency. Not always – sometimes you need to buy a truck because a car just won’t do; but if the cost of similar things is widely variant, that suggests room for improvement. Prices on basics like syringes, he found, varied by up to a third. Changing the form of medication could in some cases save 98% of the cost.
Carter’s report will be released in full in the coming weeks, and there are ominous sounds that it will also recommend upheaval to working patterns (in some quarters this will be welcomed, but in plenty, it won’t). That may well damage some of the good messages here today. But the fact remains, the value of an outside observer is clear: the ability to question established practice and ask, “why exactly do we do this?” invariably yields unexpectedly good results.