Saving money in the NHS is an age old problem. Even when there was money to spend there was still a cost improvement/efficiency/saving programme in operation somewhere in each organisation. The usual national approach to this conundrum is:
- Promise to give more power over funding to Doctors (usually G.P.s).
- Give lots of money to management consultants in sharp (expensive) suits to help the existing managers to find more savings.
- Re-organise the bureaucracy by giving NHS bodies different names, so:
- Regional Health Authorities became Regional Offices, which became Strategic Health Authorities, and now they become Commissioning Boards
- Health Authorities became Primary Care Groups, which became Primary Care Trusts and now they will be Clinical Commissioning Groups
But despite all this heroic structural change people still get sick and medical technology continues to advance, and spending goes on rising. Putting G.P back-sides on the re-arranged chairs around the meeting table makes very little difference to the cost or type of services provided.
The way to reduce spending is to block book real expensive hotels a week at a time and make sure you put plenty of money behind the bar. Not to send the poor managers clutching their P45s on one last beano, but to gather the local clinicians together so they can really change services.
Put representatives of all the clinicians involved in caring for a particular patient group in a nice hotel a long with some high class...facilitators and give them a week to re-design how the patients receive their care and treatment. Let them at the A La Carte menu, and give them a free bar, the only provisos are that the result of the week's deliberations must be the most effective and practical care pathway they can devise in 5 days (or you send them the hotel bill) and no-one can mention money. You will not get an effective pathway if everyone is worrying about the money.
Rather than getting clinicians to play at being budget managers you will have them together where they can focus on designing the best way to care for their patients. With free reign of the facilities and the alcohol they will relax,which will allow everyone involved to have their say. This is not a new idea, the Persians would only finally agree on a battle plan if they all agreed on it whilst drunk. Hopefully our care givers will not plot to over-turn Western democracy under the guise of redesigning the Diabetes pathway. Instead, given the space and time to talk about their favourite subject, they will come up with radical change.
The other thing this radical change will do is save money. The most effective pathways will make sure the patient is seen by the right clinician at the right time more often, reducing duplication and waste which will save money.
So dig out the hotel directories and get booking.
