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May 12, 2006
Efficiency.
There is a huge row in the area in which I live over the proposal to close several "cottage" and one larger hospitals, move various service currently available at three or four centres all to one and to cut clinical staff in the process. It is all being done to cut £40 million out of the Gloucestershire Primary Care Trusts budget and to "improve efficiency". As usual, the definition of "efficiency" being applied by the bureaucrats making these cuts is "cutting the costs to a minimum" and has nothing whatever to do with improving the delivery of health and medical care. There is huge anger in the county over the fact that all the cuts are being made at the delivery end - no papershuffling, meeting attending, bean counting, form generating and checking "manager" will lose their jobs - only nurses and clinical staff.
It is proposed to close several Accident and Emergency Centres and concentrate these at Gloucester and Cheltenham leaving the Forest of Dean and the further reaches of the County (we might be small but we are an odd shape and rather scattered) faced with the prospect of long journey times to receive emergency treatment. Maternity services are all to be focussed on Gloucester Royal Hospital which is not the most convenient place to get to for anything and given that it will now also have to cope with the closure and movement to that site of pediatrics, mental health and the day care treatment of children with longterm health needs, and you have a recipe for disaster - or at best chaos. Successful and well managed units are being axed here to give the bureaucrats more power and the public less choice and even longer waiting lists.
THis situation really sums up the problem which afflicts not just the NHS but every public service at present. To many bright accountants brandishing MBA's and similar "business" qualifications are now running services and functions they do not have any concept of the actual delivery of and can judge things only on the cost. As has been said many times before, they can tell you the cost of every paper clip, but they have no concept of the value of anything. Thus, in their pursuit of "greater efficiency" they use the rule of Efficiency = Cheaper.
This group of number driven bureaucrats and econocrats have no concept of what it costs at the delivery end in terms of pressure on the ever decreasing numbers of staff qualified or actually in post to deliver any service. They express admiration and "grateful thanks" for the efforts staff put in to provide the service, but they then look at the figures and wonder why "customer" satisfaction is falling, "consumer" confidence has evaporated and complaints keep rising. They wonder why, when they do hold "public consultations" - a euphemism for "we wanted to tell you what you want or can have" - they are invariably surprised at the depth of anger and loathing they get from the public and almost invariably pass the blame for their mismanagement and ignorance to Whitehall. Mind you, the problems do originate in Whitehall, where the same concept of any "administrator" is able to "manage" any function and doesn't need to understand it in order to doso - just "manage" the numbers.
The problem is, of course, that the gap between expectations and delivery is getting wider - precisely because the delivery is being reduced to make the numbers "efficient", and action which does not translate into better services. One of the commentators on the radio phone in I was following this morning as I drove to work, made the point concisely. He pointed out that the senior "managers" in the NHS - and he identified himself as someone in the NHS - earn the same money as the senior consultants, doctors and nurses and this spreads across the board with Diary Secretaries - the ones who manage the Waiting Lists - earning as much as the Nurses (who are so over stretched that they are to be cut in number so that they can be more efficient). The Health Secretary's claim recently that the NHS Waiting Lists are now lower than ever before is just one example of how "efficiency by numbers" works. The Waiting Lists are lower than ever before because no Waiting List is longer than eighteen months. If you haven't had an appointment within eighteen months - you are simply dropped from the list and your Doctor must reapply for you to be placed on a fresh one! A nice little fraud which if tried in commerce or industry would get you a visit from the Fraud Squad!
Every industry, every public service and every part of commerce is increasingly being taken over by the bean counters whose idea of efficiency is not "are we delivering the goods". Their own numbers speak for themselves - the NHS is now populated by about 600,000 medical staff and technicians and about the same number of administrators, managers and bureaucrats. As the latter group grow in power, the cost of delivery escalates astronomically and the deliverers are reduced "to save money". This is happening in several public services including the police, fire and rescue and the ambulance service. It is even being done to the Military where ever Regiment, every Naval Base, every Airbase is now run by civilian "managers" who count the cost of everything and make sure the troops never have the equipment they need. What is forgotten by those who argue that this is more "efficient" and "cost effective" and "frees the specialists to do what they do best" is that, when I have a Doctor running a hospital, in a crisis he or she can get down to A&E and help deliver medicine! No space wasting bureaucrat can ever do that!
Administrators are a necessary evil - but they do not have the knowledge, skills or background to run major services, commercial enterprises or industries - and they should never, under any circumstances, be allowed to "manage" uniformed or medical services. They simply are not capable of being useful in a crisis and they cost far to much for what they are capable of doing. At the end of the day, all you can expect out of an "Administrator" or Non-technical "Manager" is that they can make some tea for the people actually putting their klives on the line in a war, or fighting a fire, or dealing with a riot - or, in the NHS, performing life saving surgery or giving medical attention. They simply cannot be taken out of their cosy offices to fill the gaps they have created in the delivery end and that makes them absolutely useless as managers or supervisors.
It's time to put the technocrats back in control of these services and demote the bureaucrats to the broom cupboards and filing cabinets they do understand. Then, and only then, will we will see an improvement in "efficiency"!
Posted by The Gray Monk at May 12, 2006 06:03 AM
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