Wednesday, 22 August 2007

Being bad

When I was a junior doctor a sage Consultant Psychiatrist said to me that he reckoned the difference between a great service and a dismal service was about 2%.

If referral rates got a little bit more then you were seeing more people than you had capacity to see, which is disastrous . . . you'll develop waiting lists and never catch up.

If funding is reduced and you lose 2% of your ward staff's time, 2% your annual bed base, 2% of your hours of community nursing input, 2% less medication for patients . . . whatever.

It wasn't a scientific or validated number, although it did hold true locally (where a dismal service had 2% less than a fantastic service). 2% is irrelevant, his point remains sound . . . it's just a small difference in resources between stunning success and catastrophic failure.

As an SHO (when they existed and training was thankfully exhaustive) another Consultant Psychiatrist told me that there shouldn't be a waiting time in NHS services.
- maybe you've enough capacity to see you patients (you can see 50 patients a week, you have up to 50 booked in every week).
- maybe you've not enough capacity to see you patients (you can see 50 patients a week, you have 60 booked in every week).
If you've not enough capacity you'll grow a waiting list and never catch up, having a extra 10 patients a week growing and growing until, ultimately, they've no realistic chance of being seen within a helpful amount of time.

Simple maths.

If you've got a service that's got greater demands on it than it can cope with you need to fix things or it'll implode and fail. If you've a service that's matching capacity and demand then (other than natural peaks and troughs) you'll have a responsive service that doesn't need to have a waiting list since everyone who should get seen can get seen.

More simple maths.

It's disheartening to see Dr Rant's appraisal of the state of the NHS. Disheartening because most of it is true. Outside the NHS 'cross the pond some folk remain cheerily positive about their work.

Do most people in failing services go to work thinking, "Right then, who or what can I really screw up today?" Surely most folk don't pitch up to work wanting to do a bad job. The systems around them and the edicts imposed upon them force a way of working, which is why it happens that way. Evolution. Services evolve because of the pressures on them pushing them in certain ways. It's not hard for systems of management to push a service 'til it breaks.

Equally, one sage voice felt that it wasn't hard to make it better, needing just a small amount. 2%.

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