Being stuck in a young peoples' pub with football one evening last week, the discussion turned to what a large multinational company might have in common with the National Health Service. A company which we estimated to be 100,000 people compared with the 500,000 (a guess) of the NHS. So smaller, but the same order of magnitude.
Both were pushing hard on costs, so lots of pressure on the shop floor (as it were) to get quarts out of pint pots. Mistakes are punished in both places, so lots of stress.
Both had a mixture involving a small number of large units and a large number of small units.
Both suffered from management fads and fashions, with disruptive new wheezes being regularly pushed out from headquarters. I believe that some Tories believe that the way to stop this is to cut headquarters' staffs to the point where they don't have the time to dream up the new wheezes.
Both suffered from a lot of regulation. Regulators peering over their shoulders telling them how things should be done.
The company had something of a class divide between the front-of-house fee-earners and the back-office support people - with these last being more or less expendable. While the NHS had class divides between management, doctors, nurses and others. Rather like the army, with its officers' ladies, sergeants' wives and other ranks' women. But do these class divides do damage in quite the same way?
We thought that the similarities ended about there.
NHS customers are more likely to be in poor shape. More apt to be a bother.
NHS buildings are more likely to be in poor shape.
NHS management structures are being badly disrupted by various privatisation and contracting out initiatives. Perhaps by fragmentation into profit centres, into silos, at the expense of the whole person approach.
A much higher proportion of NHS staff will be on or near minimum wages. A much lower proportion of them will have had fancy educations. There will be higher turnover and a higher proportion of temporary and contract staff. In aggregate, far harder to manage.
NHS is full of odd computer systems doing this and that; rather like police forces in that way. Very hard to roll all these systems into a neat and tidy, integrated service. Full of odd systems generally doing this and that; ditto.
NHS business is growing fast in that the number of expensive old people is growing fast - while funding is being held down. Bed occupancy rates, for example, are far too high.
Medicine is changing all the time, with lots of new drugs, new procedures and new machines rushing onto the scene, some of them very expensive. Change which the organisation somehow has to accommodate.
The division of labour between NHS and local authorities has not yet been sorted out, leading to plenty of tensions and inefficiencies in that area.
Health is something of a bottomless pit and we have much to learn about how best to do rationing. To which the company might say that you simply provide as much health as the market will bear, as the market will pay for - to which we might say that the US example does not provide much support for that approach.
At which point we reached the end of our ration of alcohol. Noticeable after the event how easy it is to put the NHS to rights after a drop of the right stuff. We all have views about health, just as we all have views about education!
PS: taking a quick bite at Earlsfield Station on the way out, I noticed a train which had been rebranded from Southwest Trains to Southwestern Trains and which was also sporting some large yellow flowers. Perhaps this is the big idea of the new franchise holder - an idea which did nothing for me, not caring for this fashion for putting pictures on the sides of wheeled vehicles. Just so much more visual clutter in a world which is already very busy in that way. A new franchise holder who fell even further from favour later on in the evening with services badly disrupted by a train broken down somewhere between Earlsfield and Waterloo,
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