Having experienced success and failure in a wide variety of organisations, the former Welsh secretary spells out his recipe for an effective and efficient NHS
I was asked to write about improving efficiency in the health service. As someone who has never run a hospital you might well ask what is the point of reading what I have to say.
This is not just more motherhood and apple pie, or a less jargon-filled version of management speak that cascades through the modern NHS
Have I done anything that is relevant? I spent 10 years as a full time senior manager in business before entering Parliament, rising to chair a main stock exchange listed industrial group. I spent 10 years as a full time senior public sector employee, reaching Cabinet and shadow Cabinet level. My role as Welsh secretary included responsibility for the NHS there. I have also spent 10 years as a backbench MP, and chairing four different types of business.
I have found from going into various parts of the public sector and into various companies that there are common themes to making something work better, and some common rules on how you can turn round an underperforming activity. The similarities in the challenge are often more striking than the differences or special problems.
Good management is about using the minimum of resource to deliver the best of service or product. It is about continuously striving for improvement. It is about getting the morale of your workforce up and keeping it up. A strong leader defines what success is, makes sure that success is stretching, but then helps his or her team achieve it. Higher efficiency comes from the full engagement of the whole team in achieving that success.
This is not just more motherhood and apple pie, or a less jargon-filled version of management speak that cascades through the modern NHS. It is the distilled conclusions I have come to after being involved with success and failure in delivering more for less in many different organisations.
Let me now shock you. You can have too many managers. You will not get that unity of purpose unless managers free and liberate their reports to get on and do the job. You will not achieve success if you allow targets to multiply, objectives to become complex and for a meetings culture to develop. You need a can-do culture, where senior managers step in only when things are going badly wrong to rescue them, or to praise and reward and demand more when they are going well.
The checklist of areas to improve and the issues where costs can be cut and quality raised is the easy bit. If your senior managers do not know that already then you have the wrong ones. I remember some examples that I initiated when I was looking after the Welsh health service.
I started with a top heavy structure. I had reporting to me both a permanent secretary and his team, and a chief executive and his team. I abolished the CEO job and the office that went with it, and concentrated on the one top management structure through the department. We did not have the time or the money for the luxury of competing centres.
I asked about stock levels and supplies. I discovered there were three levels of stock for the hospitals - some were held in a central warehouse at our expense, some at hospital level and some at ward level. Why? Hadn’t they heard of just in time? I was told drugs can perish so they need careful storage, and they needed buffer stocks. I called in the pharmaceutical companies and asked if they could supply the drugs at the same prices into each hospital directly when needed. They said fine. Out went the expensive and cumbersome central warehouse, and down went our working capital.
Running a hospital is like running a hotel, with a medical activity attached. Just as some hotels exist to book people into their spa or health farms, so hospitals are hotels to book people into an operating theatre. The patient will judge their experience mainly by the hotel, as they are usually asleep when in the operating theatre. The surgery only becomes an issue for them if it goes wrong.
Cleanliness and quality is even more important in a hospital than a hotel. Any hospital manager should make patient safety the number one issue all the time. In a good factory these days, every line manager knows safety comes first and processes are designed to get rid of the risk of accident. Machines and procedures are idiot proofed to stop disaster. Good factories also stress cleanliness, as dirt can contaminate parts and equipment as well as being unpleasant for employees. If I were a hospital manager, I would want to get on top of all cleaning and secondary infection issues first. The complaints department could then be cut, and there would be less remedial work.
Thereafter is the usual grind, reducing administrative headcount, simplifying forms and paperwork, banning needless meetings and doing with fewer outside consultants, cutting energy use, and concentrating every day on getting things right first time.