TV soaps seldom flatter the NHS. Whereas fictional US medical dramas portray
staff working heroically in high-tech conditions, their under-resourced British
counterparts constantly bicker with mean and moody hospital managers. And
public discontent with the health of the NHS shows that hospital fiction is
uncomfortably close to reality.
The much-publicised Wanless Report suggests the UK health system achieves
less than other countries because "we have spent very much less and not
spent it well". It recommends a massive injection of extra tax-funded
public investment over the next 20 years.
Gordon Brown agrees and April’s Budget statement confirms that higher taxes
would provide the NHS with a downpayment of £40bn to cover the period to
2007-8. But his greatest fear is that health providers – rather than patients –
will benefit most, with new money going into pay packets or evaporating via the
infamous NHS bureaucracy. The mantra ‘capacity, productivity, performance’ is
therefore stamped on the enlarged budget cheque.
As far as NHS management is concerned, success will depend on both a helping
hand from government ministers and urgent recognition of the link between
effective people management practices and NHS performance.
At ministerial level, ‘something for something’ pay rhetoric must be backed
by political support for more flexible reward systems. Most observers agree
that nurses and NHS ancillary staff have been treated as poor relations for too
long relative to other groups of workers in our society. However, it is crazy
to defend the national pay structures within the NHS that struggle to reflect
varied pressures in local labour markets or evident differences between
hospitals in the quality of patient care. A high performance 21st century NHS
can’t be built on a mid-20th century approach to reward.
There also needs to be a focus on high performance team working. Aston
Business School’s recent study of 61 hospitals points to a strong relationship
between people management and development practices and lower patient death
rates. It suggests, for example, that 25 per cent more staff working in teams
in a hospital is associated on average with 275 fewer deaths following
emergency surgery per 100,000 patient admissions.
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The findings have sparked a rather familiar debate on whether HR directors
should be guaranteed a place on hospital trust boards. Far more significant is
the observation that hospitals are working communities that perform best when
all the team – managers, doctors, nurses and ancillary staff – operate together
to a high standard.
Only if high performance teams are integral to the process of reform will a
bigger budget help the NHS out of intensive care.
