Published:25/04/2002, Volume II2, No. 5802, Page 11 12
You get good value from Derek Wanless, it has to be said. No doubt chancellor Gordon Brown knew that when he commissioned him to research the future funding requirements of the NHS. One year down the road, with a 164-page report bursting with strategies for a Utopian NHS come 2022, Mr Wanless has certainly delivered the goods. As, too, has Mr Brown.
When - delayed by the vagaries of London's traffic - I managed to arrive late for an interview with him, he saw the dilemma.
Offering gallantly to look at transport policy next, he first said we had 20 minutes. Then, when I asked for a full half hour, he agreed to 25 - the sign of a seasoned negotiator. Promising not to say too much as time was limited, he got stuck in straight away, as you would expect from a man who made his name in banking, where time really is money.
Derek Wanless is the latest in a line of management gurus brought in to tell the NHS where it is going wrong - ICI's John Harvey-Jones and Sainsbury's Sir Roy Griffiths, among them. Each comes away with their own personal impression. For Mr Wanless it was the less-than-perfect IT arrangements in the NHS.
'I come from an industry where IT spend is very high - about 17 per cent of the money that is spent is on IT. But when you look at it, the US spends 6 per cent of total health spend [on IT], Europe, 3 per cent or 4 per cent. We were spending just 1.5 per cent.'
That failure, he believes, is wasting staff time and, in turn, reducing productivity.
'We went into hospitals and saw people literally writing on the back of envelopes, saying, 'This is a ward of people; I have drawn you a picture; this is what has happened to all eight of them.'' It would be so easy, he suggests, to have a screen showing eight beds, which you simply click on to reveal the patient's details and medical condition over the last eight hours. His two other overriding impressions were the sheer variability of service provision around the country and the lack of a patient-centred view.
'The system hasn't ever been designed around the patient, whereas almost every business these days is having to design itself around whatever you call them - customers or clients or whatever.'
Actually, Mr Wanless, the NHS is, on the whole, still talking about patients. But how does it become more patient-centred?
'That means, on a local basis, deciding how you use the facilities best - when it is that your patient will want to come, how do you use buildings or equipment as many hours of the day as you can?
'People have got to think imaginatively, to use the resources they have got as effectively as they possibly could be used.'
By now, Mr Wanless is not only sounding like he is reciting an Alan Milburn mantra, but really sounding like him, too. There is a hint of an accent coming out, as he gets more into his subject. It is, if I am not mistaken, from the North East. Not another one of the Milburn mafia, surely?
No time for that: we are now on to flexible working practices - a central tenet of his report. There is nothing new about nurses having prescribing powers. 'But what about the doctors?' I say, pointing out that he lists the British Medical Association in an appendix to his report as a professional body, rather than a trade union.
I suggest that doctors, along with farmers, are the remaining bastions of good old-fashioned British trade unions. Unfortunately, he is far too intelligent to rise to my bait.
'I wouldn't wish to share that view at all, ' he replies, carefully choosing his words.
In any case, he explains, the health service is a growing industry, rather than a protracting one, where unions are trying to protect their members' jobs.
'Flexible working shouldn't be seen as threatening. It is about making sure that we use the skills doctors have got more effectively over the whole service. I think doctors themselves have to see that.'
But Mr Wanless admits that no other country he visited had introduced flexible working and skill-mix at national level, with healthcare assistants doing what nurses now do, and nurses what doctors did.
On the one hand, he is calling for local decision-making; yet he wants more centralised IT. I am confused - and say so.
'It is not that there has to be one system that has got to be built centrally, ' he explains. 'What is needed centrally is a set of common standards.'
He accepts that there may be a need for some centralised purchasing, but the important thing is that all the systems can talk to each other and pass records about individual patients between each other.
'If I fall over tonight and get taken to accident and emergency, I would like them to be able to access my medical records and be able to quickly know if there are any other problems, or whether I am taking any drugs.'
Not all patients would be as happy to have their information stored in a computer as Mr Wanless, with all his on-line banking experience, clearly is. What lessons might the NHS learn from banks about encouraging patients to go on-line? 'It might work, ' he suggests, 'if people - customers, patients - see benefits out of it, and of, course, they have got the right to see their own records.'
He doesn't pretend it will be a simple IT job. 'Banking is easy compared with health, ' he says.
'Money is coming in, money is going out; you might want to transfer it - that is not difficult.
You have got some information on customers on file, but it tends to be easily put into boxes.
'Where you have got medical records, obviously it is a much more difficult. I am not trivialising the task.'
We have got five more minutes left - hardly enough to do justice to social care, my next area of questioning. 'We are giving you your full 25 minutes, ' he chuckles, before I can protest.
OK, so when did he decide to widen his remit to venture into this minefield?
'We had been coming across it everywhere we went, but it was a strong message in the consultation process that you can't do healthcare properly unless you also look at social care at the same time.'
He extols the virtues of the Swedish model, where local councils foot the hospital bill if they cannot care for a patient within five days of the doctor deciding the patient should be discharged.
We then touch on star ratings - he thinks they should be broadened to give a wider view of performance as a whole - and round the interview off with a quick debate about what the overall spending levels really mean.
But he defends the decision by Gordon Brown to allocate a whole 0.1 per cent above what the Wanless report said health service managers would find 'a considerable management challenge'.
'Whether it is the same figure or 0.1 per cent higher, my comment would be precisely the same. As far as I am concerned, it is in the same ballpark. It is at the top end [of what is risky].'
With that, time is up.
'You have had 27 minutes, ' Wanless quips, adding: 'Haven't you done well?'
Which is not a reflection of whether it has been a good interview; but that I got two more minutes than he had bargained for. l