One of the key reasons that state-run bodies tend to provide less in the way of service at a greater cost is the waste that tends to build up in them over the years.
People are usually aware, though they may not like to admit it, that this is true. So you have politicians declaring at elections: "we will maintain/increase the front line services".
So what are the 'front line services'. They are the services of people like nurses, who actually treat the patients. These nurses are contrasted with the bureaucrats who do lots of paperwork which, it is implicitly accepted, involves a lot of work that is not really as necessary or important as the nursing work.
So the Labour government used to boast that it had increased the number of nurses. That is doubtless true. However, what if it also, at the same time, changed nurses into semi-bureaucrats? You could say, increase the number of nurses by 15% but increase their paperwork time from, say, 25% to 45%. In doing so, their front line time would be reduced from 75% to 55%. That, if you are still with me, would me a 26.7% reduction in their front line work, per person. So, overall, even after the increase in the number of nurses, the amount of 'front line' work would fall.
The numbers I have used are not the real numbers, just an illustration of how this is possible. Here, then, is an indication of the actual proportion of time nurses may now be spending on paperwork, given by the new Health Secretary, Andrew Lansley:
“They often spend just 50 per cent of their time interacting with patients, and in some cases as little as 35 to 40 per cent, because of bureaucracy and the shift system.”The Royal College of Nursing has repeatedly warned that nurses were being bogged down by the weight of administrative duties.
In 2008 nursing staff across England spent more than a million hours a week on paperwork, the union found, time it said could be better spent tending to patients.
A survey of nurses also showed that most believe that the administrative burdens placed on them had increased over the past five years.
The full article is in today's Daily Telegraph.
This story is a possible lead as to how it was that such a vast amount of extra money was poured into the NHS by the Labour government resulting in a relatively modest improvement in the performance of the NHS.
Posted by James Bartholomew • Indexed in NHS • Waste in public services
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The implication of the Telegraph report is that if NHS administration can be simplified not only could purely administrative staff be reduced in number, but many nursing staff too.
In Parkinson's Law, C. Northcote Parkinson famously proposed that there was no necessary relationship at all between numbers of staff and the amount of work, and suggested the growth of bureaucracies was instead governed by a tendency to multiply subordinates, and by the fact that additional staff make work for each other (as John indicated in his comment above), creating a need for even more staff.
Berglas's corollary updates Parkinson's Law, saying that no amount of automation will have any signficant effect on the size or efficiency of a bureaucracy: in practice automation, such as that brought about by a successful computer system implementation, simply enables increased bureaucratic complexity.
To cut staff numbers and simplify operations it may be that many NHS computer systems will need to be cut out too, along with the organisational controls and reporting they support.
I suspect in the end the way to eliminate NHS bureaucracy is to break up the NHS and oblige individual hospitals and practices to find their own way in the world.
Parkinson (PDF File):
www.berglas.org/Articles/parkinsons_law.pdf
Posted by: Tim Skinner at June 9, 2010 02:59 PM
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Increasing the number of employees by one (in any organisation) doesn't mean that the productive capacity of the organisation will increase by 100% of that person. There will be Personnel, Management and Training time to be allocated to that individual. Optimistically, I used to calculate that I would get a net increase of around 75 - 80%/person workload increase for every extra employee in my small business - and that was if they turned out to be as good as their CV and interview promised: not always the case. In the NHS that is likely to be lower.
Posted by: John Harrison at June 9, 2010 10:58 AM