The overarching concern of NHS staff is how the NHS can improve care while simultaneously reducing cost. For 75% of staff that we surveyed, cost and quality are viewed as trade-offs or alternative priorities, with the belief that cost reductions will inevitably lead to a reduction in quality.The fear is that cost reduction will become the main goal of the decision makers, a goal that will supersede all others, including quality of care.
Our survey showed that there is a worry that those not involved with care will be the people pulling on the purse strings, leaving health care providers to be forced to make cut backs and make shortcuts where they ideally wouldn’t be made.
But isn’t the point of the reforms to give greater power to health care providers? To make them more involved with budgets to ensure that the reduced budget is spent as effectively as possible with minimal waste?
Why then is this not resonating in the minds of the NHS staff? Perhaps the discontent is down to this trade-off and a lack of healthcare specific evidence about the relationship between cost and quality. Or perhaps it is due to a lack of understanding over who will be doing what after the reform.
Our results show that the NHS staff feel that someone who does not have the right skills or experience is making financial decisions yet many commented that GP’s, the people most in the know, are reluctant to take on this responsibility because they will become overworked and unable to give patients the care that they deserve.
So how can we marry cost reduction and quality optimisation? One option is to make the person providing the care also in charge of budgets. But this is unpopular with NHS staff because it will put them under a lot of pressure, as a report released by the Nuffield Trust shows. Perhaps then budgets should be the responsibility of CCGs.
But CCG’s don’t know as well as GP’s where the budgets would have the greatest use. Perhaps then simply having greater staff engagement in decision making across the board both in councils and in healthcare will assist this marriage. From reading blogs and articles and comparing them to comments in our survey it seems to me that there is a lack of agreement in who should be doing what. The NHS staff surveyed have great sympathy for staff, and in particular GP’s, because of the greater pressures that they will be facing, whereas the blogs and articles that I have read seem to be pointing a finger at staff accusing them of not doing enough to support the changes.
Our survey showed that the top concern of those surveyed is the increased pressure that will be put on NHS staff after the job cuts. We can’t therefore expect them to be involved with finances and budgets as this will put even more strain on them. Those surveyed agree that GP’s are in the best position to be providing care and looking after budgets, they just don’t seem to think that GP’s can cope with the workload.
Our greatest hope is that NHS staff and specifically GP’s have a strong enough love for their job to help them drive through these changes and the increase in responsibility. This is now more important than ever before because coupled with this responsibility comes an increase in scrutiny as the healthcare system becomes more transparent and patients are encouraged to review their care.
For these changes to work we need decision makers who love their job and do it because they want to help people. My suggestion therefore is to invest in training and have more specific entry requirements into NHS employment. By training well, a select few, who display the capacity to care, we might go some way to achieving this seemingly impossible target of improving care and reducing cost without having to argue over who is working too hard or who is making too many decisions.