The NHS

I am a medical doctor who has been practicing for 6 years in the British NHS.

The NHS is a great institution. It has brought help to anyone at their point of need for over 68 years. Founded by Aneurin Bevan on 5th July 1948. Built as an instutition by the people, for the people it has certainly been (historically anyway) far from the insurance based systems of the US or the more industrial-type approaches of some other nations towards health. Quite rightly it is something that British people remain proud of.

Acutely Diseased?

However, it was founded at a time when acute illness was more common than chronic disease. It was also founded on a flawed assumption that if you made everyone better then the population as a whole would be healthy. This is unfortunately only true in part; as we are now painfully aware — if you make people better from their acute illness then eventually they live long enough to develop chronic diseases which are not so easily ‘cured’.

You see hospitals are not (and never were) really built for managing chronic diseases. As soon as you take away the specialist hospital input on discharge that person is still left with the problem but has to deal with it largely alone. At this point a hospital building is of limited use.

What, so doctors aren’t special anymore?

Essentially in a word, no. (There you go I have done it). Back when there was no alternative people just accepted it. However, a second key change happened in 1989 which sowed the seed which would eventually change that. When Tim Berners-Lee (disagree with me if you want to) came up with the world wide web the possibilties this would lead to were unknown. Still 27 years on they are largely unrealised, but in 1998 Google made the web searchable (again feel free to disagree); only now are we starting to feel the full effects of this seizmic change.

What this primarily means is that information is now cheap and free (as evidenced by things like books which fortunately for Amazon they foresaw and now sell us everything else instead). It is not just bookshops and libraries who were affected by this seizmic change. Professionals and businesses of all kinds are continuing to see the value of their ‘knowledge’ diminish while their clients knowledge continues to increase and ‘unqualified’ competition stiffen.

The responses to this have been various but in many ways dysfunctional. By focussing even harder on what worked in the past many professionals of all shades have literally driven themselves out of business (look at some taxi firms and Uber for instance).

In Medicine the reaction has been very mixed. Whilst I welcome some recent intiatives to improve patient engagement and make services more patient focussed, these efforts have frequently yielded mediocre results as they are actually glorified customer-focussed data gathering exercises rather than change engines. Such a missed opportunity.

Regulations, Guidelines, Procedures, Repeat

In addition to this in my short 6 years of medicine I have witnessed a stifling increase in regulation to compensate for poor performance. This has largely consisted in the rise of a very rigid system of regulations and checks. This has had the effect of improving the very poor performers at the expense of the best (as in teaching and other public services).

No organisation can really excel if it is constantly trying to meet (sometimes arbitrary) targets. (At this point I must make clear that there are lot of hospitals doing a very good job despite the overwhelming bureaucracy – (I know because I have worked at some of them). However, this doesn’t change the fact that the good is the enemy of the best 1; and you will never get to the best if your efforts are just focussed on meeting targets (WHAT you do?) and improving processes (HOW you do it?). The key is WHY? 2

Why is Why so important?

And this is the problem as I see it: As a country we have lost our healthcare WHY?! The reasons are many but we have become defined by WHAT we do and HOW we do it rather than WHY we do it. If we really cared about WHY we do it then we would do it differently because our still largely acute-illness focussed, pre-internet model of care isn’t working that well anymore for the majority of patients with chronic diseases they have looked up on the internet.

It’s time to stop paying lip service to patient-centered (particularly outpatient) care and start practicing it. You see what we primarily don’t need in my country is a insurance driven model of healthcare, rationing, more doctors (although this would be a nice luxury), more nurses (again would be nice but is not the key) or more fads of management, structure, technology and applications. Instead we need to rediscover our WHY and with it our empathy, compassion, patient-centeredness, team-spiritedness and drive to continually make things better beyond the point where it is about money.

Theirin lies the future of healthcare for anyone who wants to catch the vision. I predict it will be 20 years from now before this really starts to catch on.

If you want to join me in pursuing this? Connect with me on LinkedIn or Follow me on Twitter (I’m a human I prefer connections). If it is not an automessage I will read it. (unless its abusive in which case I won’t.)

References:

1. Jim Collins: Good to Great.

2. Simon Sinek: Start with Why.