The health service needs to learn lessons on locating its services from supermarkets
The health and social care bill is an irrelevance to the real troubles facing the NHS in England. It is obliged to save £20bn by 2015, faces flat-line funding and is avalanched with demand.
Fiddling at the margins of 'who commissions what' won't create the enduring efficiencies needed. The big money is in the wholesale reconfiguration that gives MPs a heart attack.
Reconfiguring the healthcare model, a legacy of charitable giving, political interference and happenstance, is the conundrum.
We pay for too many badly run hospitals, in the wrong place, doing the wrong things. Solution? As the NHS is edging towards a business model, using the techniques of business might not be such a bad thing.
For instance: the service the public is most attached to is accident and emergency. But move it or close it and the roof caves in. Just like when the high street grocery store closes if a supermarket opens out of town. Closures unnerve people and turn them into protesters.
However, if we asked the same protesting public a year later they'd say, it's great – everything you need in one place, at fabulous prices and the car-park is free. They are unwittingly describing the isochrones calculations used to plan where a supermarket is located, which puts all the good stuff in one accessible place. The NHS has to copy these techniques.
Coalescing around excellence make sense. Supermarkets have created popular, fresher, cheaper, more diverse high streets: but have done so out of town. The NHS must do the same thing: out of town super hospitals and the equivalent of Tesco's corner shops – 'NHS-Extra' – locally.
Too many GP practices are too small, will not pass Care Quality Commission inspection or satisfy basic disability access criteria and cannot cope with the volume of care we plan to transfer out of hospitals. Reconfiguring an integrated system piecemeal is impossible, so learn from the retailers. Primary and secondary retailing is developed hand in hand, and health must take the same strategic view: vertical integration, with secondary care owning primary care. The 'NHS-Extra' Darzi centres were the future.
Centring excellence means keeping the people skills but changing where they work. Staff who think they will lose their jobs rail against reform. They need reassurance, and if they need to relocate the NHS should pay for it. The private sector does this – they understand the value of talent. It is a lesson the NHS has still to learn.
The future is not about closing hospitals. Demography tells us we need all the beds we can find. When services shift, switch the remaining beds to care of the elderly. Lease these wards to private operators to run them on behalf of the NHS. This outsourcing would remove the property cost risks, makes inspection easier and could infuse the sector with higher trained staff.
The private sector is ruthless with executives that don't deliver. Hospital boards that give us dirty, unsafe, overspent services should be axed. No argument, gone and barred from future public service.
Philosophical debates about the private sector waste time and drive us back to an era when external providers were unheard of.
A thoughtful solution is to use the techniques that make great companies great. Learn from them to deliver great services, in the right place, by the right people, time after time.
Roy Lilley is a businessman with over 40 years experience and an independent health policy analyst
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Read the complete post at http://www.guardian.co.uk/healthcare-network/2011/nov/03/nhs-meet-tesco-health-bill-roy-lilley
Nov 03 2011, 05:00 AM
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