Healthy debate – cost and care !
In a recent speaking engagement with the NHS in London I presented some of the ideas from our book on the dual economy and the reasons why there is a split in buying habits and expectations from the market. It’s either lean or luxury, low cost and low care or high value and high expectations. My examples were from the airline business and from retailing, but meant to spark some interest and thought from the NHS executives.
The question I was asked in the masterclass that followed was about the need in the NHS to offer high care and meet high expectation whilst being low cost. My suggestion to them that this was neigh impossible got the response that I didn’t understand their industry. Well on reflection I think they are right, at least in terms of the politics of their situation. In no other area of endeavour, except maybe the military, do we ask so much from the people we employ as public servants. On the one hand we ask for real value for money and on the other we ask for exemplary patient care treating each person as an individual and with individual needs and expectations. If we look at the economics of this it does not add up…. individualisation takes time and to a lesser extent money. High performance in terms of treatments takes investment in skills and expertise that is not cheap. Low cost enterprises don’t hire expensive well trained staff, don’t invest in great infrastructure and don’t pay for good advice and services. The two situations are not compatible.
Take the US model where health is provided by private contractors and insurance based arrangements. It works to a degree , except for the very low income or no income. Germany and France are similar in some respects – you pay to get a great service and both the USA and our European neighbors have high standards. Care costs !
So what has this got to do with change and leadership? Well the question was asked by someone who seemed resigned to doing the impossible – being asked to do something that economically was not logical – being asked to split his focus. Well I think in the Uk at least the task is to deliver exemplary care at a reasonable price. Not to be lean and mean and low cost – just right cost. Not to cut the budget and cut the care but to spend well and not waste money that is better spent. Re framing his question would have been a better response from myself, to what could you do really well and do for less cost than now? We can all improve but we don’t have to be world class on service and price…. ask an economist.. the math don’t work.
