Healthy Conversations
(now titled The Talking Cure)
We know that the doctor-patient relationship is changing. Sources of health information have multiplied and the GP’s monopoly on knowledge is wobbling. But as we move from paternalism to ‘patient-centred’ how should we think about professionalism and expertise? What are the advantages and challenges of patients and the public playing a more active role in their own healthcare? As the questions patients ask of their doctors become more complicated, how do conversations with doctors need to change?
NHS Productivity
at 11:25am on Tuesday, 11th September 2007
Opening the papers this morning, it looks like Derek Wanless has thrown the efficiency cat amongst the NHS pigeons. We already knew that a large proportion of extra NHS funding went on staff wages, yet according to Wanless we have seen little increase in productivity.
Improvements in smoking cessation and increased life expectancy are being countered by increasingly poor lifestyles/obesity and rising health inequalities between rich and poor.
According to NHS statistics total staffing (FTE) in the NHS has increased by 3.4% annually between 1997 – 2005, so it is going to be interesting to hear the reasons for why the front line have been unable to make substantial progress in improving health service productivity.
One of the things that strike me as problematic, in terms of efficiency, is the current way that the NHS divides up clinical and financial responsibilities between clinicians and management. Perhaps giving clinical leaders some financial responsibility for their departments would encourage the minimisation of inefficient clinical behaviours.
Of course, a much wider reform of NHS management practices will be also needed. One of the most interesting innovations is the use of Toyota’s lean management techniques, which seems to have already proved successful in Scotland. You can find a really interesting edition of Radio 4’s In Business looking at the NHS' use of ‘lean’ here.
Wanless’ findings also show the increasingly urgent need for a much more engaged, self-managing population, even if we can increase productivity within hospital/clinical contexts. The divisions between public health and acute/primary care will clearly need reconfiguration to tackle the lifestyle/chronic conditions that are an increasing threat to the health outcomes of British people and the viability of the NHS.
Improvements in smoking cessation and increased life expectancy are being countered by increasingly poor lifestyles/obesity and rising health inequalities between rich and poor.
According to NHS statistics total staffing (FTE) in the NHS has increased by 3.4% annually between 1997 – 2005, so it is going to be interesting to hear the reasons for why the front line have been unable to make substantial progress in improving health service productivity.
One of the things that strike me as problematic, in terms of efficiency, is the current way that the NHS divides up clinical and financial responsibilities between clinicians and management. Perhaps giving clinical leaders some financial responsibility for their departments would encourage the minimisation of inefficient clinical behaviours.
Of course, a much wider reform of NHS management practices will be also needed. One of the most interesting innovations is the use of Toyota’s lean management techniques, which seems to have already proved successful in Scotland. You can find a really interesting edition of Radio 4’s In Business looking at the NHS' use of ‘lean’ here.
Wanless’ findings also show the increasingly urgent need for a much more engaged, self-managing population, even if we can increase productivity within hospital/clinical contexts. The divisions between public health and acute/primary care will clearly need reconfiguration to tackle the lifestyle/chronic conditions that are an increasing threat to the health outcomes of British people and the viability of the NHS.
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Comments
The fixation with 'efficiency' is in fact highly ideological and often functions discursively to legitimize large-scale private sector interventions in the form of PFIs etc. It would be much more apt to think in terms of 'effectiveness' and 'access'. Surely its time for the public sector to develop its own standards, variables and lexicon and cease the self-undermining cross-fertilization of models and paradigms.