Not enough incentive to treat patients

There is a bit of a tizwas about whether there are people waiting too long on waiting lists and whether this is a legacy of Labour’s policy or the fault of the coalition government. Some say waiting times are going up and others point to new measures coming in from the government that will address the issue.

However in reading an article on the BBC website: NHS: Crackdown on ‘hidden waiting’ ordered by ministers there was one paragraph that seemed to stand out from the crowd. The text was this:

Ministers believe there is not enough incentive for these patients to be treated, meaning some are left “languishing” unnecessarily.

Let’s let that sit there and percolate a little while we stand back and recall what the NHS is for.

The NHS was set up as a form of national health insurance. Collectively we pay tax and national insurance and if ever we need health care in our lives in the UK it was to be delivered free at the point of charge. The NHS was designed to give the public peace of mind that even if they fell on hard times that in regards to their health they would always have access to care.

So the reason for the existence of the NHS is to provide health care to the British public.

In my book, “Beat the Cuts – How to Improve Public Services and Easily Cut Costs” I argue that the real motivation to do good work comes from within. This motivation stems from wanting to do something meaningful, wanting to work as a team, wanting to take pride in your own work and wanting to do something for others. The last of those is particularly prevalent in the public sector. That list contrasts with extrinsic motivators such as money, prestige, power and praise.

When ministers are quoted as saying that there “is not enough incentive” I think they must be thinking of the list of extrinsic drivers. My experience in all parts of the public sector is that its staff really do want to serve and provide for the public. This is very strongly true in the NHS.

So I don’t believe that there is not enough incentive. There is. The problem is that too many people only think of motivation from outside and forget the internal motivations. The consequence of that serious oversight is that they further pile on the extrinsic motivations which actually sap the internal drivers. In addition they forget to foster intrinsic motivation in the systems of management that are set up. The irony is that their statement eventually will become true. The extrinsic motivators will cease to be effective and their over application will have crushed any intrinsic motivation so there really will be not enough incentive to care for patients.

However, I am confident that we are not there yet. But we need to be careful not to ignore pride in work or the need to help others any more.



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