Opinion Article: Closing the NHS Funding Gap - Dealing with Demand not Capacity

IMS MAXIMSBy Angela White, Medical Director, IMS MAXIMS.
Without a detailed understanding of the NHS, you could be forgiven for thinking that the global financial crisis and government's austerity measures were somehow responsible for the financial crisis and the capacity gap that the NHS faces. But nothing could be further from the truth, which is that there has ALWAYS been a gap between demand for healthcare and capacity to deliver AND the gap has increased year on year; and increasing financial input, unless directed very strategically, has historically not addressed the gap.

In addition, it could be argued that the increased healthcare expenditure by the last government avoided focusing on long-term solutions to reduce the capacity gap and may have even have adversely affected it through introducing inefficiencies which have resulted in getting less output for more expenditure.

What is the capacity gap?
Put simply, the capacity gap results from the difference between the demand on the healthcare system by the population and the available capacity to service that demand. Most commonly, as discussed in healthcare regulator Monitor's recent publication, many influencers and analysts seek to address the capacity gap by falling into the trap of focusing solely upon increasing productivity from existing resource.

Whilst this is in part valid, it is likely that many parts of the health economy are already implementing measures to optimise capacity in this way so ensuring that all resource is utilised wisely and appropriately.

Breaking away
The NHS has become increasingly perturbed through five significant reconfigurations during the last two decades. Critically, the implementation of each change has barely concluded before a different direction of travel is being plotted. Not only has insufficient time been allowed for changes to 'bed in' and deliver results but the structures in the reconfigurations have not fundamentally 're-tested' the system itself.

The NHS in England is in crisis and what is needed is not to suggest more of the same with ideas such as GPs seeing more patients in each surgery, but rather open our minds to a radically different set of approaches to thinking about the issues and the risks the system faces and how we might respond to them.

The presenting demand for healthcare should receive similar attention as the capacity to meet that demand. Measures to modify demand may revolve around population health education, primary prevention and education for self-care but other innovative ways should also be explored.

Learned helplessness
There are many who entered the NHS full of energy and enthusiasm, altruistically motivated but who found their dedication, initiative and often highly innovative 'projects' were refused a hearing, overruled by management or successfully commenced but then sacrificed to the latest cost improvement program. With the 'stuffing' knocked out of them, such colleagues started keeping their heads down and tried to get what satisfaction they could doing their job. Other experienced and valued colleagues took early retirement, some moved to the private sector, abroad or to other industries where they felt more valued. Many of their great ideas and projects are left sitting on shelves gathering dust.

It has often been said that staff in the NHS suffer from 'learned helplessness' with professionals across the disciplines believing they are unable to influence change in the service. Many of my colleagues engage in conversations with like-minded others who are deep thinking with well thought out ideas of what is needed. However, having been squashed too many times by the system they no longer choose to speak out, even when they know they are being led the wrong way. Self-preservation prevents them taking action as their experience has been that their efforts are not valued and lead nowhere.

Calling all sleepers
Now this might sound a little crazy but you are all still out there - and you know who you are - a bit like 'sleepers' in one of those 'sci-fi' movies just waiting for a signal to come along to re-awaken your earlier enthusiasm to contribute to making your chosen area of healthcare what you know it can be. It's time to liberate the content of those conversations with those 'nuggets of gold' ideas that can contribute to successful solutions.

Yes, many will agree there are inefficiencies in the way available capacity resources are utilised but these represent only part of the opportunity for positive change in closing the funding gap. Your projects may well have come of age.

I believe the Dalai Lama once said: "If you think you are too small to make a difference, you should try sleeping with a mosquito."

About IMS MAXIMS
IMS MAXIMS is an electronic patient record provider working towards better, safer patient care. Specialists in developing clinical and administrative software solutions for healthcare providers, IMS MAXIMS currently supports more than 150 organisations, 11 million patient records in the UK, and 1.9 million patient records in Ireland, approx 50% of the population, as well as 20,000 users of IMS MAXIMS products.

MAXIMS is at the heart of the clinical and administrative life of everything from large UK and Irish hospitals, to small specialist independent clinics. It gives patient data to clinicians in exactly the format they need, and allows it to be shared with colleagues and updated in real-time. MAXIMS suits any clinical specialism and is excellent for order communications and reporting. Medical and administrative records can be kept fully up to date, with the minimum of effort. MAXIMS is web-based so there is no need to install software on computers or invest in expensive extra hardware.

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