The proposals in the leaked McKinsey report on the NHS, suggesting that one in ten health service workers should lose their jobs, are not the answer. Change must come from within the NHS, with frontline staff providing care that is more effective and offers better value for money.
We all know that the economic downturn means that the NHS is going to have less money. Staff in the NHS know that, and they know that some tough decisions will need to be made about priorities and about the way services are provided. But the answer is not to launch an assault on hard-working clinicians and managers. Arbitrary job cuts will simply lead to poor morale and a decline in the quality of services and in productivity.
Instead, the government should bring together people within the NHS in each health 'economy' (ie, commissioners and providers of services in each locality) and work with them to hammer out the changes that are required. This 'hothousing' approach is about achieving organic change more quickly than would otherwise happen. The NHS is not a single organisation: it is divided into a series of organisational 'silos' that find it difficult to work together, because rivalries get in the way and because there is often no financial incentive to act in the interest of the system as a whole.
Hothousing would enable all the players in a health economy to get together and to work out the best solution for the system as a whole. Rather than criticising or undermining frontline staff, we could give them the opportunity to take the lead, to fix the things that are broken and to put into practice the solutions that will work in practice.
One of the key objectives of hothousing is to deliver better value for money by moving care 'upstream' – ie, to place more emphasis on prevention, early diagnosis, patient-directed care and care in the community, with less emphasis on expensive treatment in acute hospitals. This change can come about only if NHS staff work more effectively across the boundaries between the silos.
For example, a hospital consultant might spend part of his or her time in a local health centre rather than exclusively in hospital. It will be less about cutting jobs and more about ensuring that people in the NHS are working in the places and in the ways that deliver the best quality care at an affordable price.
Alan Downey is head of KPMG’s public sector business in the UK
