Sometimes it seems quite difficult to explain why the National Health Service fails to produce the quality service intended. There is a series of causes and effects. If you define just one cause and effect, you do not explain the whole thing. But here is just one part of the chain: the National Health Service wastes its own human and material resources on a vast scale.
This is a widely reported story in today's newspapers. This version is from BBC Online:
The Healthcare Commission found 45% of the theatre time in England allocated for day surgery was going to waste.
and further on,
The report, which examined 313 day surgery units in England, found one in 10 cancelled more than a third of the available operating theatre sessions and many patients had their operations cancelled at short notice.
In The Welfare State We're In, I looked at the story of how Capio, when it took over a hospital previously run by local government, significantly reduced the waste of time caused by cancelled operations.
Of course, government officials and those who still believe in state-run services will say, "OK, fine. I accept there is a waste problem here. We just need to focus on it and sort it out." Unfortunately this is a tempting and widespread self-deception. It takes us back to another part of the chain of cause and effect.
The waste arose in the first place - and has persisted for decades - precisely because the NHS is run by the state. The fact that hospitals are run by the state means that they do not have the right incentives to use their resources efficiently. A private hospital only makes money when the operation takes place. It has every reason to make sure everyone required for the operation is present. A state hospital can actually be better off when an operation does not take place.
"OK, fine. We will put in better incentives," say those who still want the state to run our public services. There is great reluctance on the part of many people to accept that the state is so bad and wasteful in its operations - and persistently, despite the best efforts of very clever and well-meaning people - that it is vain and silly to tell oneself and others that a solution has been found.
Those who believe the state is a good manager are like those who believe that Moggins the cat, can bark. First one of them goes to Moggins and say, "Bark for the public good". Moggins lies down and takes a nap. Then along comes a new minister and says, "No, no. I can make things much better. I can make Moggins bark. I have a new integrated barking programme driven by positive incentives." So the new minister says to Moggins, "I will give you half this meat now and the other half after you have barked". Moggins jumps up enthusiastically and eats the meat offered.
"OK, now bark and I will give you the rest!" Moggins looks longingly at the rest, circles a while, winds her tail around the minister, miaows in way that is as similar to a bark as she can manage. Then she becomes fed up, strolls off and turns her back.
And so and on it goes. We have had many successive health ministers, all clever people and all promising to make the NHS work well. And what have we got as a result of all their efforts? Operating theatres unused for 45 per cent of the time.
Isn't it about time we considered getting a dog?
The Healthcare Commmission press release is here.
Posted by James Bartholomew • Indexed in NHS • Waste in public services
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Scarcity of resources? What scarcity? Tax revenues keep rolling in, rolling in, no matter what you do. There are no gains from reducing the time taken for operations, no penalties for increasing the time taken. The revenues just keep flooding in. People act on this _reality_.
Posted by: Sudha Shenoy at July 12, 2005 03:24 PM