At what point can an organisation which has undergone many years of reorganisations and “efficiency savings” actually create any more efficiencies and still comply with the regulatory regime?
Leave aside the arguments about the £350 million lie of the Leave campaign, because it’s not actually relevant until Brexit is complete. Even if every penny we actually pay into the EU were diverted to the NHS, apart from the inability to fund agricultural subsidies and infrastructure funding, that is a long way short of £22 billion, and money that the Leave campaign posited would be free in 2019 is no use when the NHS needs it in 2016.
One might say that NHS Trusts would just say that they need the extra money to fund patient care or they may have to close units, cut staff and ration treatment – one could suggest they are exaggerating just to get extra money out of the Government.
But are they exaggerating?
Go back to my first point. As regulation has increased, additional bureaucracy has arisen to meet it to avoid affecting patient care. Privatisation of services (contracting out, clinical commissioning, whatever it is called in whichever area this week) requires considerable overhead in specification, tendering, monitoring, and variations to cover months when too many patients walk into A&E and need operations and other treatments which are not covered in the contract, artificially increasing costs. Existing cuts and growing waiting lists requiring contracting out of work by private firms staffed by NHS doctors and other clinicians in their spare time.
Throw in the effect of delayed action due to waiting lists, where more expensive treatment is required to lack of early intervention, and also the mental health impacts of delayed intervention – autism services always come to my mind, but waiting for an operation that would considerably improve quality of life is damaging, due to the extended restriction on enjoyment.
With this amount of overhead imposed by the Government, and with so many years of efficiency savings already carried out, the question is: are there any lawful true efficiencies that can be carried out while still delivering the same or better clinical care? Should we in fact be looking at undoing some of the efficiency savings due to what were already diminishing returns having long since turned negative?
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Andy tweets at @andyboal