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What the NHS needs is more bureaucrats

It’s a familiar cry – the NHS needs staff at the front line and fewer bureaucrats and administrators.  Or as it was put to me the other day, with a little re-writing for political correctness – “we need fewer chiefs and more ‘native Americans’”.

I’d like to propose an alternative view – the NHS actually needs more behind-the-scenes resources to operate more efficiently.  Of course, other things being equal you want the people you employ to be doing the doctoring, nursing or other work directly helping patients.  But they may not be able to do as much doctoring and nursing if, say, they can’t find all the relevant information about a patient or they’re having to fill in forms and deal with paperwork.

I’ve thought this for a while, based on various voluntary roles covering both primary and secondary care.  Some recent experiences have provided more examples but have also suggested some complications to the picture.

The NHS is behind the times in the use of IT and doesn’t seem to have the most efficient management and organisation.

A decade ago I went into an Apple store and was greeted by someone with an ipad who had all the details of me and my issue and pointed me directly to where I could get help.  In responding to our local Trust’s Quality Account in 2013-14, I was questioning why there was a priority on improving the quality and availability of hard copy medical records rather than digitising them. 

We do now have electronic patient records in our trust and even some access to patient records between GPs, the ambulance trust and the hospital.  But it’s still at a rudimentary level often with problems getting the right information at the right time and in the right place.  I have been trying since the summer to get access to the documentation, held on internal systems, of a project I’m working on.  There are also long delays in getting the necessary IT reports to enable efficient processes.

While much of the administration is great (such as some wonderfully detailed minutes) there are also delays, emails unanswered and things just not happening.  In primary care, feedback from patients typically praises GPs for their skilled and compassionate care but complains about administration.  This is systemic and not about individuals, most of whom are great and working in very difficult circumstances (and the biggest complaint about GP practices is not being able to get an appointment, which is hardly the fault of the poor receptionist, who bears the full brunt of the patient’s displeasure).

So, based on my anecdotal experience, I think there is a need to consider greater investment in back-office services.

I suggested at the start that my experience had revealed complications to me.  Since I don’t have any solutions to propose, I will do no more here than outline the questions.

The first is the value of having some clinical knowledge and experience to undertake many non-clinical roles.  I have found it virtually impossible to follow discussion in some meetings because of the use of abbreviations and the need to understand local processes (as well as referring to people’s first names only – ‘Jo said’, ‘you need to speak to Fred’ etc.)  People from other specialist backgrounds can get basic clinical training.  Or clinicians can get training in things like management (as they do in our trust).  Which approach is best, making optimum use of scarce clinical resources, or does it need a bit of both?

There are often status differences between clinicians which can get in the way of smooth and efficient operation.  This has long been reported on, often in terms of managers being unable to get their way in the face of baronial consultants.  I suspect that the extent of this varies within and between trusts, but it still exists.

Then there is the context of the health setting.  It is not the same as many more regular industries.  By its nature, clinical work tends to be reactive.  The patient has to come first, especially if their condition is urgent.  So, the smooth, mechanical approaches of other sectors sometimes have to be distorted in health, (which seems frequently to lead to clinicians dealing with issues in their own time).

So, managing all this in the health sector is tricky.  But weakness in one part of the system (such as through lack of investment) or the elements not working well enough together, impacts on the whole, and on the care patients receive.

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