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Forget professional rivalries, focus on the passion of frontline NHS staff

Andy Mullins and Peter Osborne
PA Consulting Group Guardian Public
7 October 2009

The last 10 years have witnessed unprecedented levels of government investment in the NHS. This has helped to deliver notable improvements – more staff and equipment; improved infrastructure; significantly reduced waiting times and better care in coronary heart disease, cancer, stroke and mental health. Our life expectancy has also continued to improve.

However, this has not always been achieved through sustainable, more productive ways of working and there is conflicting evidence on whether productivity overall is improving across the NHS.

Without improved productivity and progress in tackling key determinants of ill health, such as obesity, even higher levels of funding will be needed over the next two decades. Such an expensive NHS could undermine the current widespread public and political support for the service and raise questions about its long-term future.

This is a fundamental challenge faced by all health systems, not just the NHS. The current economic crisis just means that we will have to deal with this rather more swiftly and decisively.

One of the baffling things about the challenge ahead is that talk to any NHS professional and they will give you a hundred ways of improving productivity and efficiency, whether it be minimising preoperative bed days, encouraging more effective GP prescribing practices or tackling excessive intervention rates.

We seem to know what we need to do to improve productivity but we seem unable to deliver system-wide tangible, sustainable results.

So how can the NHS ensure that productivity begins to rise significantly and avoid becoming an unaffordable health service? In our view there are four things that we need to get right.

1. Ensure that clinicians and frontline staff are at the forefront of the drive for enhancing quality and productivity.

Too many NHS organisations are dominated by siloed, top down cultures and professional rivalries. We require a new level of trust to be developed between leaders and frontline staff, between managers and clinicians and between different professional groups. Leaders, both clinical and managerial, need to harness the passion, energy and creativity of staff. This requires a combined focus on quality and productivity. To do one without the other will lead to either further cost pressures or a decline in services for patients.

Education will be key here. We train our clinicians and then trust them with our lives; we should also train them to lead and then entrust them to lead their departments and their finances.

2. Harness the natural power of peer pressure by improving the design and sharing of productivity metrics to help focus on the real priorities

The NHS is awash with data, but insufficient meaningful information about performance. We know that when relative performance is clearly understood it drives improvement: this was one of the big gains achieved by the Audit Commission when it started to publish comparative analysis of the cost of local council services. Indeed in health, Professor Sir Bruce Keogh, the NHS Medical Director, achieved significant improvement in the quality of heart surgery by publishing surgeon metrics.

Little of this comparable information is readily accessible in health and we rely on fragmented and inconsistent local initiatives. The NHS needs to mine the nationally available information and publicise productivity and quality metrics in accessible forms for all to see. Increased visibility on a focused set of issues creates peer pressure for improvement.

3. The NHS needs to learn the lessons from how competition and cooperation in the supply chain in the private sector can exist together.

The last 10 years has seen the NHS successfully adopt some positive elements of market competition, helping to drive up patient experience, choice and quality. In the private sector, even in fiercely competitive environments, we also see co-operation across the supply chain.

As the NHS market matures it will need to learn these lessons and that will mean organisations working together to agree how best to shape themselves for the future.

4. We need to break the public's attachment to 'bricks and mortar'.

The next few years will require us to look very hard at the way in which we deliver health services. This will mean some tough decisions to change or even close some services. To do this we need to change the public perception of the NHS to a provider of services and promoter of better public health and not simply the local hospital.

It is quite extraordinary the attachment we seem to have for our local hospital when it is threatened, despite the fact that its services may be poor or even unsafe. The only way to do this is to have clinicians create the case for change and lead the debate within communities.

If the NHS is to survive the current economic crisis and meet rapidly increasing demands then it will need to raise the productivity bar. The NHS must put clinicians and frontline staff at the forefront of the drive for enhancing quality and productivity and learn to cooperate as well as compete when focusing on outcomes and patient experience.

If the NHS can get these things right it can secure its long-term future and continue to enjoy public and political support.

Andy Mullins leads PA Consulting Group's public sector health services. Peter Osborne is a healthcare specialist at PA Consulting Group

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