Sir David Nicholson has it but not quite

Evan Davis interviewed Sir David Nicholson, the Chief Executive of the NHS on The Today Programme on Radio 4 about Nicholson’s projection that the NHS will be £30bn short of funds by 2020. (Listen again here for 7 days).

As they were talking about the £30bn funding gap the interview went like this:

Evan Davis: So this means reconfiguring services, finding savings in the way things are done now so you can deliver as good a service at a lower cost.

David Nicholson: Yes. We want to provide a better service , of course, and for most of the rest of the economy that’s exactly what people do. The dichotomy that’s often said in the NHS about you can’t improve quality without spending more money is simply not borne out by the reality of what happens, and certainly not in the rest of the economy. So, we think we can do both of those things.

He has nearly got it, but it doesn’t go far enough. He says that that the idea that you can’t improve quality without spending more money is a dichotomy and that he wants to do both (improve and spend less money). I would go further and say that the only real way to spend less money is to, first, improve services to the patient. That is the only sustainable way to save.

Davis asks for an example and Nicholson talks about three ways to do this:

  1. Centralisation and specialisation. With the example of stroke services in London moving from 31 hospitals to 8 with much better outcomes.
  2. Prevention. Providing services in the community for people with long-term conditions and the elderly that prevent admission to hospital.
  3. Efficiency and productivity.

There is an option totally missing from that list and it is one that would come before any of those. It is, again, to improve care of the patients at every point in the system, while still taking the system as a whole into account. So this would mean that every doctor, nurse, cleaner and other members of staff would have ideas to improve the service to patients every day. They would test those ideas and implement them. At the same time the senior staff would be monitoring and communicating the service to patients and the system as a whole.

This would be done before we start another round of reconfigurations and shuffling the deck of organisations. Imagine if every one of the million or so staff in the NHS had one idea this year that made things better. The majority would be very cheap to implement and taken together would save millions. And what if they had an idea a week? One per day? And what if they worked together in teams to learn from each other’s ideas? Now you are talking about saving the billions that is needed. Then when you came to reconfigurations, not only would you have a much simpler system to change but you would have a body of staff who are skilled and experienced in making changes that improve patient care that in turn save money.

A quick note about “efficiency and productivity”, if you aren’t doing the right thing by patients then doing it efficiently and productively won’t help much.

Sir David is almost there but as usual in the NHS, as has been happening for decades, he his jumping to macro changes when instead, focusing on the core purpose of care for the patient, is more effective than more large changes.



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