Neil Griffiths on measuring and managing

No matter what you think of it and when it happens, the NHS will at some point in the foreseeable future receive a great deal of new information technology to deliver better clinical services and a more efficiently run organisation.

The promise is that we will finally have a solution to managers' complaints that 'they can't measure it and so they can't manage it'.

In the past, the true state of a trust's finances, or of the impact of clinical activity levels, has only become fully apparent after the event. It has been difficult if not impossible to performance manage in the sense that the management of any commercial or private enterprise would understand. It has been difficult to know whether things are going right or wrong and, when they do go wrong, those involved simply recoil from the 'car crash' after it has happened.

Same IT, different day

So will all this become a thing of the past? Don't count on it. The new IT, as well as new policies such as payment by results, will assist managers in seeing what is happening as it is happening. To continue the automotive analogy, we will get the car's dashboard working.

My concern though is that the dashboard will be working in a vehicle with the clutch pedal on the passenger side, the brake in the back and the steering wheel in the boot. We will be able to watch the car crash happen - but have very little ability to make the changes necessary to do anything about it.

At the risk of stating the blindingly obvious, if trusts want to deliver joined-up services then there is a lot of joining up to do. Given the range of interlocking services delivered by a typical NHS organisation, it's only by bringing the controls together in one place that it will be possible to manage the organisation efficiently. Central control needs to be in a real place where the information and the controls converge.

Without this convergence, the risk is that the information becomes available through technology and policy developments, but the joining up doesn't happen. This need for joining up is widely recognised. In local government, the leading authorities worked out long ago that they needed to join up services to customers, and have pulled together information collection and service delivery into 'contact centres' where they can begin to create the kind of control, service improvement and efficiency gains that consumers expect.

Resistance to central control

Within the NHS, there is a view in some quarters that this approach, while working for the majority of public and private sector organisations, is not appropriate. In the drive to devolve services to the local level, the idea of any form of 'control centre' seems counter-intuitive. The current interest within the NHS in subjects such as lean engineering, theory of constraints and statistical process control are used as reasoning that such centralised approaches are not the right way to go.

This misunderstands the application of these techniques within the industries in which they were developed. All of those industries have points where information and control can be managed. In the NHS, this would require devolving a level of control to local clinical teams, for example to ensure an optimum level of bed availability at certain times. However, the degree of interdependency between each clinical specialty, and between areas such as outpatients, admissions, diagnostics etc means that a centralised point of control is an absolute requirement.

The one and only

So what does this mean in practice? It means taking the plethora of separately run, managed and monitored functions and managing them from one place. This centre would be the single point at which all inpatient and outpatient bookings are made, outpatient clinics and theatre lists are planned, bed availability is managed, medical transcription is undertaken, discharge summaries are produced and so forth.

If done properly, this would produce a more customer-focused, better managed and more efficient organisation. Immediate savings can be realised by the functions that are put in to a centre like this, the rule of thumb being between 20 per cent and 40 per cent of the running costs of those functions. A typical large acute trust spends a total of between£25m and£40m annually on all of its clinical administrative functions and systems. This means savings of£5m to£15m for a single trust.

Only one question remains - if such services save significant amounts of money and improve services, and every other sector is doing it, why is no-one leading the way for the NHS?

Neil Griffiths is a director of Capita Advisory Services, sponsor of the Primary Care Organisation of the Year category in last year's HSJ awards