We look at changing demands within the UK NHS
I am going to start this all back-to-front. My suggestion is; simply giving the NHS “more money” – is cementing out of date working practices. The problem is – there are things called “patients”. There are more of them, and they are being quite unreasonable by living a lot longer than they should. This is redolent of my Data discussions about relational databases; they are just to clunky to handle the volume of patient data we have (so goes the argument). If Hospitals are going to continue to be relevant, then they need to start with a blank piece of paper, adopt radical new ways of doing things, and that includes how they pay for stuff. Putting in place new practices is inextricably linked to finding innovative ways of paying for them.
The problem is – people don’t like change. Nobody likes change. Our comfort zone is precisely that; why not keep things the same? The common unspoken argument goes something like – It’s all worked more or less, up to now.
Except that it doesn’t any longer. As indicated above – there are just too many people wanting healthcare. And if you believe the guys at CIFS in Denmark, “hospitals” are no longer in the driving seat anyway; it is the patient – or “consumer” – that is increasingly driving us to adopt new facilities and services for which we have no plan and no budget.
But maybe we don’t need a budget. Maybe we should just” do”. One way around this obstacle, is the following:
My colleague, who is a Head of Finance at a major UK Trust – sips his coffee and says; “you know , Richard, – apart from essential capital costs – we have stopped making big budget procurements. We now pay as we go. Suppliers enter into flexible monthly contracts, and we pay for what we use.”
Companies in the UK such as System C, are already looking at these sort of innovative practices; similarly in Scandinavia, the EVRY company now offers iPad based versions of its solutions for smaller clinics, based on a mobile SIM tariff. This is the tip of a very large iceberg
And it is seismic; it brings to an end the five-year contract, the large software acquisition. It means that suppliers can no longer promise to deliver but never deliver (we have seen this several times) – or supply goods and never train their hospitals (and we have seen this too). It also means that as hospital flexible demands change, – so can their supplier, and in real-time.
There are two win/wins here. The first is that hospitals can now engage in new technology Pilots, to prove clinical concepts and prove commercial viability, without fear of long term commitment. It means there need no longer be a “budget hiatus” every year, around now, that delay the introduction of new services that clinicians are desperately calling for.
A direct result of the mobile world we live in, is that increasingly, suppliers are linking their offer to commercial or clinical results in some way. This is important, because it allows much better monitoring; the introduction of new services can be far better and much more simply controlled – with the minimisation of implicit greater risk.
But it also means that hospital management needs to throw out the hostility that routinely surfaces towards the very organisations that are able to help. For this quiet revolution to happen, there needs to be what I will call a “Scandinavian Partnership” model, of engagement. It is an ironic description; Scandinavian procurements and “upphandlings” are some of the most heavily legally monitored in the world – but that in itself misses the point.
In a world where you and I are now able to tell our Doctor and Hospital what they need for us – who needs a procurement process anyway? Just go and do it.