There comes a point when numbers get so big as to become near incomprehensible.
Almost five million people are waiting for health treatment in England alone. Almost 1.2m of them have been waiting at least six months for ‘vital appointments’. Some within the NHS say that in reality that number is far, far greater – perhaps no one even knowing the true number.
I’m currently in recovery following an operation that (hopefully) finishes off my extended exposure to the NHS last year. I’ve been in the fairly unusual position of being an in-patient both at the very height of the pandemic in April 2020, and its low point a year and a half later. By no way am I an expert on the NHS but I would say I’ve now built up a degree of patient user experience that I didn’t have two years ago.
So – as a kind of innovation challenge: where would you start with tackling the NHS problem?
First of all – what actually IS the problem? My experience has been uniformly excellent, only ever let down by a creaking admin that admittedly became much improved through technology during the pandemic. However it seems to be true that once you’re ‘in the system’ the system largely works for you. However gaining access to that system , especially if you’re not an emergency, is a hopelessly disjointed experience. And many of the people working within it are simply exhausted – even before the pandemic NHS workers were taking an average of 14 days off sick every year, compared to 4 for the average UK worker.
Perhaps the biggest problem for the NHS is that you can’t have a sensible conversation about it. If you criticise it in any way the assumption is that you want to privatise it.
League tables have been used to support arguments that the UK health service is one of the best in the world – and also that it is a failing system. For most actual users it is neither of these things, so the obsession with deifying the NHS and its employees is actually unhelpful for everyone. The truth is that the NHS is sometimes great, often not so great and sometimes just plain bad— and it’s nowhere near close to the best healthcare system in the world.
Perhaps because we are dealing with multiple problems we need a multiplicity of solutions. In short though, problem solving should be a priority for the NHS – rather than disruptive innovation. As Greg Satell writes in a different context, we have the power to shape our path by making better choices. A good first step would be to finally abandon the cult of disruption that’s served us so poorly and begin to once again invest in stability and resilience, by creating better, safer technology, more competitive and stable markets and a happier, more productive workforce.
The most famous quote (wrongly) attributed to Henry Ford is “If I had asked people what they wanted, they would have said faster horses.” We don’t need faster horses is the cry of would be innovators everywhere. But in the NHS, faster horses are perhaps exactly what we need right now.
The NHS is observably an environment where efficiencies desperately need to be gained – and on tight budgets a lot of that will have to be through marginal gains and frugal person centred improvement – a sort of healthcare jugaad. Jugaad is a Hindi word that roughly means ‘solution born from cleverness.’ It’s usually applied to a low cost fix or work-around. In a culture where people often have to make do with what they have it’s an improvised or makeshift solution using scarce resources.
I’m not saying that we should rule out innovation altogether and only focus on the basics; but a greater emphasis needs to be placed on harnessing and developing ideas and spreading them across the system. NHS employees will tell you of something working on some wards that have been shut down because it doesn’t fit in with the overall ‘plan’. In any complex system there is often a drive to scaling up which destroys some local innovation. ‘Small, localised and spreadable’ is often more sustainable.
It’s also clear when talking to staff that many are victim to the very large number of administrators in the NHS and the urge to keep changing things. Many talk of process changes ‘all the time’ – something that has , necessarily, accelerated during Covid. The effects of this constant change trickle right through the system: employees wake up wanting to do something good and then find there are new regulations and new rules that act as a barrier.
Of course there is a whole other set of problems outside the immediate control of the NHS.
If the primary problem is demand, then that needs to be tackled. We’re living longer, getting fatter and people now have more chronic and complicated diseases. The Office for National Statistics attributes just 5% of total UK Government healthcare expenditure to ‘preventive healthcare’. We need to remove the politics from healthcare and have a sensible conversation about how much of GDP we are going to commit to not just treating problems, but preventing them in the first place.
The NHS has myriad innovation programmes, challenges and accelerators. It’s not for me to judge any of these. However it’s clear that right now there’s a capacity issue meaning the people, services and systems who would stand to benefit most from innovation end up missing out.
So perhaps it’s time for the NHS to focus employees on becoming better localised problem solvers who can work on existing real-world issues that staff and patients face every day.
Revolutionising the NHS is less likely to come from some grand plan and more likely to result from local trojan mice changing small things in big ways, attacking new problems, and spreading new ways of working. Not winning wars but infiltrating new territory.
All of that requires a less abrasive form of politics, a more forgiving internal culture, and a little less hero worship. Not easy to achieve, but absolutely worth fighting for.