Monthly Archives: January 2014


The Case for Decentralising Healthcare to reduce hospital waiting lists.

Keynote address to The Kings Fund by Clayton Christensen, Professor of Business Adminisatration, HarvardBusinessSchool.

                        Clayton Christensen is no stranger to change. It’s been his life’s work. Analysing various industries and predicting how change has and can improve them.

In his presentation to the King’s Fund he began by saying that although technologies come and go, jobs rarely change. To explain this he used the example of sending a package, explaining that Julius Ceaser would have used a horse & chariot, Queen Victoria a train or telegraph, Churchill an airplain and David Cameron would use Fedex.

In healthcare the job remains to cure patients but the technology has changed massively. Healthcare has been one of the slowest industries to adapt to technology. It has not adapted at the pace of technology, leading to bottlenecks and increasing waiting lists.

Dr. Christensen does suggest a way forward:

1. Bring the problem to the solution (i.e. the patient to a specialist diagnostic centre)
2. Then bring the solution to the problem (i.e. treat the patient locally or at home)

He advocates the use of hospitals as highly efficient and effective diagnostic centres, to get to the right diagnosis quickly and efficiently. This should be provided by specialist clinicians with the best diagnostic equipment. Diagnosis by specialists with the best, often expensive, equipment gets the best results. It’s worth travelling for.

Once diagnosis, and in some cases surgery or other complex interventions (cures), are complete the patient should be handed off to more local and less specialist (intensive & expensive) service sproviders. In short, transfer the patient back into the community as soon as the specialist work is complete, be that Community care, local clinics affiliated to the hospital, GP surgeries or the patient’s home.

The case for specialist centres:

Where hospitals try to do everything Dr Christensen has found that up to 85% of costs go on overheads. Each doubling of a patient pathway causes overhead costs to increase by 30%. He suggests 3 viable models:

1. Specialist diagnostic and solution centres

2. Specialist centres for standard repair work e.g. hernia repairs

3. Facilitated networks for chronic diseases. E.g. Crohns

If you would like to see the talk in full, check out the Kings Fund web site:

Waiting Lists and NHS Planning Guidance

 Those who have read NHS England’s newly released guidance on planning from 14/15 to 18/19 could be forgiven for fixating on the £30 Billion spending gap. And it’s not just a CCG concern. The document makes it clear that provider involvement is mandatory. The view being that a challenge on this scale can only be solved by working together.

Projected resource vs Projected spending

A big change in the planning process is its time horizon. Traditionally 1 year, this has been extended to a 2 year detailed plan and a 5 year strategic plan. NHS England believes that there is lots of room for transformational changes in service provision so this is encouraged and expected. A 20% productivity improvement is expected over the 5 year horizon.

The largest new initiative is the better care fund, which aims to move £1.9 Billion of NHS funds into social care and in return move patients out of the NHS faster.

Although waiting time targets get little mention in the core text the full set of waiting time targets and associated penalties are still in place. NHS England have made the 14/15 contract tougher in relation to penalties and also made it clear that they must be enforced. Side deals between CCGs and providers will be frowned upon.

First plans must be submitted by 14th February.

For further information see:


Seismic changes in NHS management

Ask any CEO which is more valuable to them. What happened 3 months ago, or what’s going to happen in 3 months time?

Much has improved over the past 5 years. Many Trusts have business intelligent (BI) solutions that tell them what has been happening. They can use this information to improve, but only after the event. So what would happen if managers knew with reasonable certainty what was going to happen next week or next month.

In the commercial world this is not unusual. Supermarkets know how much of each product to put on the shelves for the coming weeks or months. Similarly airlines know where their planes need to be next week or month. The same techniques are available to Hospitals.

But what if the news is bad? Until recently it was not unusual for Trust culture to be that bad next does not travel up. But times are changing. Now managers want to know if there is trouble ahead.

In the past these managers were rewarded for being good firefighters. Stepping in to douse the flames after the fire has taken hold, or even tidying up after the flames have burnt out. The more gifted were able to spot the flames early through intuition, but such successes were rarely consistent.

But times are changing. The new penalty regime introduced in the 2013/14 contract  punishes Trusts quickly for breaches of targets. And the DoH have taken away commissioner’s abilities to let hospitals off lightly, through local negotiations. The penalties are now nationally enforced.

So as the pressure builds between financial saving (Nicholson challenge, CIP, QIPP, etc.), safety concerns, quality of care and patient satisfaction, managers need to look elsewhere for solutions. Before the problems occur.