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Truth, dare, kiss or promise.
Remember? It was a kid’s game.
Choose truth and answer an embarrassing question.
Choose dare and do something foolish.
Choose kiss and hope for the best.
Choose promise and give your word.
Politics has its own version.
The truth is usually uncomfortable. The dare becomes a bold announcement. The kiss is the favourable headline and the promise is made by someone else, for other people to deliver.
Labour promised to reduce NHS waiting lists and restore the 18-week treatment standard by the time of the next election.
On present trends, it ain’t gonna happen.
The list may be a bit smaller. The longest waits may be substantially reduced. The proportion treated within 18 weeks will probably improve, but…
… millions are still likely to be waiting, and more than a million could remain beyond 18 weeks when Labour next asks for our votes.
The Biscuit Boy has inherited more than the NHS from Silly Boy.
He’s inherited the promise.
Streeting’s cunning-plan was to create a fog of activity.
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More appointments.
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More surgical hubs.
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More scans.
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More weekend working.
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More use of the private sector.
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More list validation.
Each announcement sounded impressive. Together they created the impression of movement, but…
… spinning yer wheels wont drive you out of the ditch..
The number that matters is whether more patients are being ‘completed’ than ‘started’. At the moment, they’re not.
In May, nearly 1.73 million new pathways were added and around 1.43 million were recorded as completed.
The waiting list rose by only about 60,000 because another large group disappeared through corrections, validation and other removals... legerdemain?
Well... some of that is entirely legitimate.
People recover, decline treatment, move away, go private or appear twice on the list. Poor records should be corrected, but…
… a duplicate can only be removed once.
A patient who no longer needs treatment can only leave the list once. When the historic database has been cleaned, the easier reductions disappear and the NHS is left with the real problem:
More people are joining the queue than are leaving as satisfied 'customers'.
You can only clean a waiting list once. After that, you have to treat it.
Queueing theory is brutally simple; when arrivals exceed departures, you're in the doo-doo, or...
... for the purists;
John Little’s famous law; L = λW
The number in a system equals the arrival rate multiplied by the average time spent there.
NHS people know this, and...
They know an operating list cannot run without anaesthetists, theatre nurses, beds and recovery staff.
They know extra outpatient appointments can create more demand for diagnostics and surgery.
They know patients cannot be discharged without community services and social care.
They know that validation can tidy the numbers but only once.
There’s a management lesson here.
A difficult target; can focus minds, release energy and bring an organisation together.
An impossible target; staff know they cannot achieve does the opposite… creates cynicism, encourages gaming and teaches people not to believe their leaders.
Deming warned against imposing numerical targets on people who had no power to change the system producing the numbers.
Nothing demotivates people faster than holding them responsible for a promise they did not make, using resources they do not control.
Murray should have started again. Not by abandoning the ambition, but by replacing the slogan with an operating plan. It’s not too late…
He should do five things.
First, publish an honest trajectory.
Show where the list and 18-week performance must be every quarter between now and the election.
Second, concentrate on flows, not announcements.
Publish new pathways, treated pathways and administrative removals separately.
Third, match the promise with capacity.
Identify the workforce, diagnostics, theatres, beds and community services needed to deliver it.
Fourth, give regions responsibility.
Set agreed trajectories, allow resources to move around and make regions accountable for correcting slippage.
Fifth, tell the truth when the plan is off course.
Missing a milestone is not the scandal. Hiding it beneath another announcement is.
Ambition describes where you want to go. A promise says you know how to get there.
The NHS has had the dare, the public the headlines and the promise.
What it needs now is the truth.
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