If there’s on thing on which everybody agrees, it’s that healthcare in a civilised country matters greatly. There the similarity ends. In the ideal world, everybody would get first class treatment, where, when and how they need it, and money would never be an issue. In the real world, there is inevitable compromise about what is provided, to whom, how it is funded, and who pays. No, scrub that – ultimately we all pay, one way or another, but how the burden of funding is distributed and supported has proved highly contentious issue around the globe.
My perspective is largely around the British system, having spent years working with NHS trusts in varying forms – and especially acute (hospital) trusts. Running these organisations, typically with budgets running to £200+m and with over 3,000 employees and untold numbers of sick patients passing through, is a complex and tricky business, not least because hospitals are as siloed as they get. For example, each specialism is run semi-autonomously by a combination of clinical and managerial staff, whereby staff may not interact with people from other departments at all but for issues relating to a patient’s pathway, which might be GP referral/consultant appointment/tests/consultant appointment/ further tests/ decision to admit/ MRI/ pre-op/ admission/ procedure/ recuperation or any one of 500 routes through the hospital.
Many of the financial issues are down to government, specifically the PFI deals that financed new hospitals, some of which were redundant before they were open. The deals suited the Treasury because it kept the debt off the public balance sheet, but the reality is that it imposed a huge burden on acute trusts and meant that many simply cannot break even, no matter what the Department of Health thinks. Yet savings are expected and patients are still being referred for treatment, which we all agree should be the best available.
As if the patients and buildings were not enough to contend with, boards also have to contend with constant meddling by government in performance and management issues, the exacting standards of regulators, input from a broad spectrum of stakeholder groups, and the frequently distorted view of services printed in some corners of the press. Put simply, I would not want to be a Trust Chief Exec without a multi-million remuneration package!
There is any amount of best practice available for treatment, but when all is said and done it is a very human and organic process, liable to unpredictable twists and turns. Patients behave perversely; doctors, nurses are pressurised and occasionally make the wrong diagnoses or prescribe or give the wrong treatments in the wrong doses.
Which is not to say that malpractice should ever be condoned. 2012 will indeed be a major year for the service, facing challenges from all sides, some of them completely unnecessary. Cuts are impacting on the provision of services. Inevitably it is a quart into a pint pot.