Sunday, December 04, 2005

When More Equals Less in the British NHS

The Times (UK) and other UK papers have reported on continuing deficits afflicting the UK National Health Service (NHS). For example, this Times report noted how London hospitals are delaying elective services for as much time as is allowed by national targets (e.g., outpatient appointments, 13 weeks, elective surgery, 6 months). Furthermore, "other NHS trusts are saving money by removing patients from waiting lists, a policy condemned yesterday by doctors." "Dr Paul Miller, chairman of the British Medical Association's consultants committee, said this practice was 'outrageous.'"

A Times editorial wondered why these deficits were happening, given that "NHS spending has increased by 20 billion [pounds sterling] since 2000, a 40 per cent rise." Particularly,

Money that voters expected to go to the sharp end has instead been spent on administration. Since 1998, the number of NHS managers in England has risen three times as fast as the number of clinical staff, doctors and nurses. At the same time, despite the injection of billions, NHS productivity has fallen 1 per cent a year since 1997, which itself is an indictment of those managers.
The rising numbers and costs of health care managers, accompanied by rising costs of health care, but not necessarily better access or quality, seems to be a frequent, if not global pheonomenon. (See our previous post about the rapidly rising numbers of US managers here.)

Again, part of the problem is that work in a bureaucracy tends to grow to occupy all the bureaucrats. A bigger part of the problem, as we just noted, is that many of these managers don't seem to understand the health care context, or share the values of health care professionals.

1 comment:

Anonymous said...

"many of these managers don't seem to understand the health care context, or share the values of health care professionals"

This is so true it should hardly need saying but, at the same time, so widely overlooked that it bears repeating.

Yet one of the mysteries (at least to me) is the relative absence of physicians in managing the business of health care.

I can understand physicians' reluctance to become involved in all that - after all, most chose medicine over business for their own good reasons. But nature abhors a vacuum. As the delivery system becomes more fragmented and expensive, non-physicians have rushed in to fill leadership positions and the direction our health care system is taking reflects the leadership it has. That's not all bad, but IMO would be much better if more physicians were taking part. I think the business of medicine is missing the perspective that only physician leadership can provide.

One hopeful sign is that there is a growing number of physician managers in the business of health care, even among large insurance companies (Jack Rowe at Aetna and or Bill McGuire at United Health come to mind).

But that's not nearly enough. What will it take for more physicians to step into health care business leadership roles?

--John Fembup