Sun 14 Jan, 2018

Brian Finlay

I have just read a stream of tweets from Scottish Labour, Scottish Tories and SNP about the current situation and performance of NHS Scotland. Now, I got really frustrated as I have just gone through both the English and Scottish NHS systems in the past week due to sustaining an injury whilst in Blackpool over the New Year. This blog is not to compare the two health services at all, but how politics of performance management and the use of scientific management to set targets is wrong and not appropriate for healthcare.

The NHS in Scotland is entirely devolved which means it is under complete control by the Scottish Government. The Scottish Government receives its budget from the UK Government via the Barnett formula which, as we all know, is cut in real terms by Westminster. For anyone to think otherwise and believe politicians like Ruth Davidson that it hasn’t needs to be more critical. I’m sure, whilst everything is being cut under Austerity, that the Conservatives are not feeling generous and giving the devolved nations more money for their budgets. In the grand scheme of things NHS Scotland performs better than the other three NHS’s in the UK and this has been widely reported. However, with ‘increased pressures with Aussie Flu and icy conditions’, which is a direct quote from several NHS staff I spoke to in The Queen Elizabeth University Hospital, non-emergency operations have been cancelled due to lack of beds due to the increased demand. Opposition parties are having a field day attacking the Scottish Government and, however some of the points brought up maybe just and fair, using the NHS in a vulnerable position to gain political points. The SNP are using their usual tactics of using the performance of the Welsh NHS against Labour and NHS England against the Tories. This can create a bit of a pantomime arguing back and forth at the expense of the public loosing faith in the NHS and creating unnecessary concern. A practical approach would be to create a winter action plan should be the solution; with a cross party committee immediately.

My experience in both NHS England and Scotland was very positive but in Blackpool’s Victoria Hospital I was sat waiting on an x-ray and got chatting with a few patients on trolleys. There was a very elderly lady in on a trolley that had been in that corridor for around 16hrs and was still waiting to be seen. The corridor was lined with trollies and their families standing around. Most of these were older patients who looked very unwell and many just sleeping. I never witnessed this in Glasgow but the service I personally received on my injury was equally as good in both NHS England and Scotland. I was seen and diagnosed in roughly the same amount of time in both hospitals. The staff in NHS England informed me the ‘huge line of trolleys waiting in corridors was very common during winter and had been like this for years’.

My blog, and what I believe is the underlying problem with the whole NHS political football debacle, is the use of performance management and Taylorism to set targets. These are academic concepts from Management, Business and Human Resource Management. The criticisms of these concepts are that they were essentially designed to improve productivity and optimise the performance of staff; referring to the speed they work at and quality of work through forecasting production required for demand. They have also been designed in a capitalist setting to encourage profit maximisation and reduce cost and wastage. All sounds great; but the NHS is not, or it certainly should never be, part of profit driving ideology or be a capitalist entity.

The NHS is there to service the needs of society with quality healthcare, free at the point of use. So it begs the question why targets are set by Governments using scientific management and process used for means of production? Putting highly skilled NHS staff under pressure to deliver targets is counterproductive as we cannot predict how performance is going to be from one day to the next. The detrimental implications on staff having targets they cannot meet in times of high demand can include work related stress; human error in their work; absenteeism and staff wishing to leave the profession. This is a sector that doesn’t pay well and has limited perks to attract applicants but can provide a lot of intrinsic job satisfaction; that can be eroded under stressful and pressurised working environments.

This winter we have seen increased reports of flu, and more recently Aussie Flu, is around double of last year and increased orthopaedic referrals due to icy conditions; which have been over a longer period of time than that last year with several long bouts of frost. These static targets do not take into account fluctuations in demand but provide ammunition for opposition parties to pick fault. Each patient going into an NHS hospital is entirely unique and may require complex care and unique support for getting out of hospital. My experience with occupational health was eye opening as I was the only patient that could be sent home that morning with no additional support required due to mobility or people living alone. This can cause short term ‘bed blocking’ and again impact negatively on targets through no ones fault in that NHS trust. These contributing factors are entirely circumstantial and cannot be planned into target design or forecast from one year to the next.

Quality of service is the most important factor that NHS staff should be able to focus on and it should be assessed and analysed by qualitative measures; with the patients and their families in a sensitive manner. Hard facts, figures and statistics don’t give the full picture of the experiences of NHS patients and, just as importantly, the opinions of the hard working staff of the NHS is crucial to understanding the dynamics and the needs of each NHS trust. Senior NHS management should work with cross-party committees to negotiate spending for each trust and emergency funds must be on reserve for periods of high demand.

I can however hear now the cries of right wing politicians bellowing ‘this is all well and good but there is no magic money tree’. Well, I see the manifestations of that magic money tree everyday in areas like: low levels of corporation tax; huge amounts of arms and nuclear weapons funded via Westminster’s ‘defence’ obsession; desperate ‘supply and demand’ bribes for the DUP from our Conservative Government; preparations for a Royal wedding and State visits from Donald Trump whom were desperate to get a trade deal from and finally the huge initial costs of the Brexit divorce bill that Scotland never voted for.

All that aside, I’d plead with all MSP’s and other elected politicians, to stop using this as a way to win political points but as an opportunity to look at the bigger picture and put the NATIONALISED health service as a priority and other costs, like defence and the monarchy, lower in the pecking order. Stop putting pressure on our NHS staff with outdated performance management and Taylorist scientific management production style targets which leave no room for divergence during period of high demand.

On a final note I’d like to thank all the NHS staff, but in particular all the friendly and dedicated staff I encountered at Queen Elizabeth University Hospital in Glasgow and Victoria Hospital in Blackpool. My thrice fractured ankle and shifted talus bone are making a grand recovery because of your commitment to the NHS and excellent service I received.

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