Care by Design understands the fundamentals of organisational development, service management and leadership for the 21st century public sector organisation and communities.

Credit Crunch in the NHS

McKinsey’s report on saving money in the NHS may make some people think that the action required by NHS staff is one of bottom line cost reduction. This will only make matters worse not better. Also, we have known for years that too many people take up a hospital bed when they don’t need it; it didn’t take the credit crunch to highlight that.

Now, more than ever, is the time for health and social care communities to be working together to look at the patient flows and value streams (we call them pathways) and understand what adds value from the point of view of the person using the service and receiving care. To take account of the frustrations of staff in waiting for things; duplication; lack of continuity and communication and rework and feeling disengaged and disempowered.

We have a system based on ‘push’ when it should be ‘pull’ — a key LEAN principle. We look at ways of fudging the figures and ways of working to meet the Vital Signs and PA targets. Instead, we need to look at how, through the full engagement of EVERY PERSON in the system a culture of ‘delighting the customer’ can be created; a culture that manages its productivity because it wants to and knows it is prudent to do so; a culture that understands that by designing safe, reliable services it will also deliver high quality services that naturally minimise waste.

We need a mind shift in how we manage the future; a future that is exiting because it is about delivering excellent services that everyone can be proud of. A future that must see greater unity between health and social care, working to a common purpose of supporting independence; personalised high quality care that delivers value for money. A focus on every person as deserving the best and dissatisfaction of anything less. As Marcel Proust said ‘The voyage of discovery is not in seeking new landscapes but in having new eyes.’ We need those new eyes now. 

The NHS can beat the credit crunch and become an even greater success if it breaks old habits and adopts a new approach; managing the system to deliver best value care at the right point in the pathway and releasing the potential of its entire staff — every single one — and truly engaging patients and the public in the process.


Published 1st November 2018