Part 1 was not the most popular read on this blog-book (currently at position 28 in the EB-HR league table). I guess partly because the UK’s NHS (National Health Service) is of little concern to international readers but also – who wants to read about cancer – management or totherwise?
Treating patients badly is not the sort of subject for a bit of light relief or jokes. It was probably the most serious piece I have written and it named names because there is no point pretending you are interested in evidence-based management unless you are prepared to hold people to account. It is definitely not for the faint-hearted.
When I wrote that piece back in October 2010 I called it Part 1, hoping that I would never have to write Part 2, because surely the management tumour that had engulfed the NHS might show signs of shrinking and go into remission under a new Government? Little did I realise how soon I would be called back to duty. This story about doctors having to prescribe water for patients, because such basic care was absent, demanded action but I am already worried that there will be many more parts before I am finished. Or maybe the NHS will be finished before me?
Can you imagine what would happen if any large, commercial concern treated its customers in this way? How quickly would we be baying for the blood of the CEO of Wal-Mart or Tesco if checkout operators ignored us and said they were too busy? How soon would riots break out if you pulled into a gas station and the counter clerk couldn’t be bothered to activate the pumps? I cannot, for the life of me, understand why NHS CEO, Sir David Nicholson is still in post today if accountability is to mean anything (Update May 2013).
Of course pernicious, systemic problems of this order do not suddenly appear overnight; the primary source of the cancer can usually be traced back a long way, deep within the system . My particular interest is in HR strategy, especially in super-large organisations like the NHS (1.3 million people) and Wal-Mart (2.1 million), so I have been studying what has passed for HR strategy in the NHS for many years.
Let us go back to the early 1990’s when a relatively young, ambitious and fast-track civil servant called Hugh Taylor was given the task of writing an HR strategy for the NHS – it was pitiful and senior UK civil servants today know no more about this crucial aspect of modern management thinking than they did then. It does not stop people like Hugh Taylor rising through the ranks to become Permanent Secretary at the Department of Health though and being knighted; having shown complete incompetence in this key aspect of his management role.
We might want to criticise the nurses and healthcare assistants who failed to provide water but what about the attitude of the doctor who thought he (or she) had held true to the tenets of his Hippocratic Oath by writing a prescription without ensuring the problem would be resolved? Why didn’t he just grab the nearest glass, turn on a tap and then put in place a system to ensure it never happened again? Is that the sort of physician the NHS has been breeding all these years? The NHS has declared that it is learning from companies like Toyota, copying aspects of ‘lean thinking’, but they have obviously misunderstood the whole concept if they cannot get the basics right.
Based on a long view of the evidence before us neither the Government, the NHS management nor the medical profession are capable of running the NHS at the level and cost required today. If they all worked for Wal-Mart or Tesco they wouldn’t be there any longer – not because of hard-nosed management techniques but because they would not have any customers – we would all have gone elsewhere, if we had a real choice.
Despite all of this the British public still love the NHS because they distrust the profit motive in healthcare and most of the time they get the care they need. But they don’t all know how much it is costing or how unsustainable it is. When they have to return to waiting lists of 18 months their attitudes will no doubt change but by then it will be too late to put it right. So an HR strategy based on the best commercial management principles, yet not motivated by commercial gain, is probably the best alternative. These are the sorts of questions finally being asked by the evidence-based management community (my own contribution, Chapter 13, critiques the nonsensical approach to leadership development in the NHS) and nothing will change the direction of the NHS until its most difficult people issues are properly addressed.
By the way – to all non-UK readers – if you think this management cancer phenomenon is unique to the UK, to the NHS or to healthcare – think again.
4th July 2011 – The true size of the cancer is now becoming more apparent
For personal development linked to this topic visit the Consummate Professional Series