h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

'However, the NHS has been getting less productive. Over the past decade, productivity has been falling by an average of 0.2% a year' this according to the BBC news website. What the hell does this mean? How is a health service supposed to be 'productive'? Is this insane, or am I missing something?

Producing corpses?

Sounds encouraging.

more managers and clerical staff, keeping files and recording KPI and hitting targets, paperwork! paperwork! paperwork!, more money for paperpushing and less for Dr.s and nurses, but more paperwork for them

Simples.... decide waht you want to demonstrate with the statistic, E.G., we want a statistic which shows a decrease in Productivity, then you find some aspect of the service, which is quantifiable in some way, which when put into any one of several standard statistical treatments, gives the number you want... Then you've convinced yourself of what it was you wanted to be convinced of, and you've only got to say it with conviction for everyone else to believe it

Could be measuring just about anything... Treatment hours per £1 spent?
Inverse relationship between death rates and per £42 spent?

Analysis of 'customer satisfaction surveys
GP-reported,/doctor/consultant-reported improvements/reduction in waitin list time, treatment waiting time, patients sewn up per hour etc., etc.,
etc., etc.,
One of them would almost certainly be able to show pretty much whatever you wanted it to show I'd imagine
Its probably based on something straightforward like amount of 'patient hours' per unit of spending...

Am I on my own in thinking it is beyond ridiculous that the NHS success be measured by it's value it money? I mean, I know it's to be cost-efficient, but really...

I can see a relationship between money spent on the NHS and results of healthiness of the populace who use it. Hard to measure in the round as it involves all sorts of complex things involving quality of life. But that's value for money. But using the word 'productivity' seems a bit silly.

The main problem is the government keep chaning plans and projects constantly so people in PCTs have to stop to see how the government want them to do thnigs now...if the government just let them get on with it 'productivity' might improve.

Surely the fundamental problem in this context is that the NHS per se doesn't 'produce' anything. Measure success rates, infection rates, cleanliness, patient satisfaction, fine. But why the hell measure the NHS on a thing it doesn't do? It does rather smack of asking a question to which you don't want the answer.

Because, Iimagine, in this case, the term 'productivity' as it doesnt' really equate to what the NHS does (they're not making things... producing things*), its thereby easier to generate the fog of war, I.E., define the term, as it relats to the NhS in wahtever way you want, and then change this as you want, and then alter it to fit whatever bit of stats makes it look best... Keep them lean, keep them mean... but most of all, keep them confused...

I guess the explanation is that the NHS is much, much better than it used to be, thanks to a great deal of investment. My understanding is that NHS support and satisfaction is at pretty much record levels. However, the argument from those who know more about this sort of thing than I do is that the NHS is better than ever before, but it's not better by *enough*, given the amount of money that's been put in.

If you want an analogy, you could do worse than Manchester City. Tremendous investment, the best team and league position they've had in years, and yet... with *that* level of investment, that amount of money spent, shouldn't they be doing even better? That's arguable, both in the case of Citeh and the NHS.

But the NHS has problems... an ageing population, obesity and other lifestyle problems, new and expensive drugs, demands increasing year on year, vociferous campaign groups for particular illnesses/treatments (some groups funded by drug companies), and huge number of conflicting priorities. We want local decision making and accountability, but not a postcode lottery. We want good local hospitals, but we want specialist centres to concentrate expertise for rare/difficult conditions. We want more, more, more, more from our NHS, but we won't put our hands in our pockets to pay for it. Because the NHS - and recent massive improvements - are taken completely for granted by a population (and I include me, sometimes) who doesn't realise just what it's getting.

A combination of massive cuts, another proposed ill-advised top-down reshuffle, and a weird ideological fetish for private sector provision - even when it delivers terrible value for money - is a further problem. We've had a distorting obsession with 'patient choice', when most people regard it as irrelevant. As a patient, I just want the best available, please. And I want an expert to tell me which is best.

Can't really add anything to that. Good points, well made. Not enough praise for the NHS, in my view.

'it doesnt' really equate to what the NHS does (they're not making things... producing things*)'


I don't have any great love of defending bureaucratic bean counters, and, I don't really know much about your NHS, but, I would think that as long as we live in an economy in which the score is kept by means of money, productivity has a meaning in any sector. Take the example of a hospital. Janitors are paid a certain amount and they produce clean rooms (one hopes) and, if they clean more rooms just as effectively in the same amount of time it took them to clean fewer last year, they've increased productivity. Doctors get `paid a certain amount and they produce patients who have gone from admission to discharge. If they produce more patients in a given time . . . etc.

I wouldn't think it would be that hard to see how productivity applies to a medical system. If doctors and nurses are sitting around playing cards while patients are being patient in the waiting room, they are not being a productive as doctors and nurses who are assessing and treating patients.

naa... because that isn't how they'll measure it. Within the UK, all things are taken to a certain point; so , rather than saing 'waiting times have reduced by X', it'll be wow, 100% of patients seen withing waitin gtime targets. Of course, depending on how you set the targets, when you measure them from and when you measure them too, its easy enough to meet that just by altering the numbers.
We did a bang up job in the UK, in the 1980's, (actually might have started late 70's, can't quite remember), when a lot of hospitals in the UK, saved a fortune, and improved performance, and no-doubt, productivity too), by getting more cleaning, within hospitals done, quicker, for less money. Of course, at the time, when these cleaning contracts were privitised out, they reduced the standards expected of the cleaning done in each hospital, and so made it easier for the private companys to meet these targets, by hiring unqualified staff on bottom pay levels, to do a job which wasn't as complete or as satisfactory w as what was being done before, but no doubt it was better, far far better, in the new system, as it was cheaper. And so long as you don't count the patients who incur mortality or morbidity from nosicomial infections, thats fine.

HHaving said which... the main problem with the NHS has always probably been the same one... your taking your chances; I had a pretty lucky experiance when I was killed, and then treated by teh NHS, struck lucky, got the right doctors, etc., then got the wrong doctors and was perminaltly left disabled as a result. but all in all, got a fab job... Just recently I have seen some apauling medical inabilities offered by doctors, to family members, and also friends, none of whom were even diagnosed correctly by the medical staff, yet in at least two cases I diagnosed corectly myself from only half the information the docs had to work with... Why?... less well trained? naa, I think they're still trained the same, I think a lot of it comes down to targets, the X minute consultation, the X number of consultations per day, per hour, per whatever, and the what are often in many hospitals very limited resources for certain aspects of the treatments and care being given...

I get very fed up of hearing phrases like 'we can't keep chucking money at it endlessly', as I really can't see any reason why we can't. name one. why not. If we can endlessly throw money into other things, with no mention of cost, or measuring outcomes etc., and which of course are often of a very less useful nature, I can't see why the NHS shoudl get a special treatment and be made to have to dance to a special 'justify yourself' tune all the time Just seems weird,

I'm actually in agreement with your expectations, 2legs: we have a similar political health care situation here at the moment. For the bean counters, elected and otherwise, it's all about 'measurable outcomes', etc. My point was simply theoretical: there's no reason, apart from the political, that productivity in a meaningful and human sense can't be measured in a healthcare system. It depends on nothing other than a humanly meaningful definition of productivity. But, again, and sadly, I agree that that's not the sort of definition that is to be expected.

Well I've posted my gloomy message on facebook so I may as well share it here. Today I attended a meeting for carers of people with mental health problems. The man who leads the session ended it by telling us, with not a little regret, that he was actually now redundant, and had been replaced. He was there in his free time, of his free will, to hand over to his replacement. As his replacement had not turned up, he has (bless him) undertaken to turn up again next month. In the mean time, all those carers who had learned to trust and rely on his experience, discression and wisdom will have to start from scratch with someone that they don't know, or will have nobody to turn to in times of crisis. Incidentally, I asked whether or not the replacement has seen his work load doubled. He hasn't. He's been moved from Crawley. And what have Crawley got? Nothing. Thanks Dave.