Try to imagine how effective our public service delivery could be if every one of our public servants was allowed to care about what they did, and felt that their ideas would be listened to.
The Christie Commission has been asked to look for ideas on how to better deliver public services in Scotland. We submitted our thoughts to the commission to the general effect that if you want to deliver more effective public services, give the money to the people who deliver the services, they know what is needed and where to spend the money. The new English Parliament is reacting the same way. They are dismantling the money sucking administration of our public service to release the funds direct to the people who provide the services.
While researching this piece for the commission we came across this story that says it all. In most NHS hospitals staff is routinely frustrated in its efforts to provide care for sick people by having to provide beds for healthy people. That is not what people became nurses to do and they find it extremely annoying.
This problem is known as bed blocking and is caused by a number of different reasons all of which mean that a patient when declared healthy cannot for some reason be sent home. The hospital is therefore forced to look after them until arrangements can be made to get them out of the hospital, releasing the bed for another patient.
In the Vale of Leven Hospital in Scotland, one of the nursing staff was experiencing this same frustration at having to look after people who were not sick, she explained that when a patient was well enough to be transferred home from the hospital after midday on Friday, the transporting ambulance would not be available until Tuesday and the patient had to remain at the hospital at a cost of £2,000, or £500 per night. This was due to the fact that the ambulance station closed at midday on Friday and an ambulance could not therefore be requested until Monday. At this hospital all ambulance requests had to be made 24 hours in advance.
This was not a new cause of frustration, it was a situation that had existed since the nurse had qualified and it was not until she was the senior nurse on the ward, the ward sister was on holiday, that she felt able to ask why this ridiculous situation existed. She telephoned the ambulance station, a 10 minute drive from the hospital, and asked to speak to one of the ambulance drivers. The first question she asked was why there were no ambulances available after midday on Friday. The driver replied that in a cost cutting exercise some years ago the receptionist at the ambulance station, who was classed as non-essential, had been asked to reduce her working hours. As a result, her working week finished at midday on Friday, while the essential staff, the ambulance drivers, sat in the ready room playing cards until five o’clock when they went home because they were never called out on Friday afternoons.
The staff nurse, sensing that this was a situation the ambulance driver also realised was slightly ludicrous, asked whether it would be possible for the receptionist to transfer the telephone through to the ready room before she left at midday. This seemed not to have occurred to the ambulance driver who had always accepted the situation as “The way we do things around here.” He agreed that there did not appear to be any reason why this could not happen and the ambulance service on Friday afternoons was immediately restored, at no cost.
Having made such easy headway the staff nurse pressed on and asked her second question. Why, when the ambulance station was only ten minutes from the hospital, was it necessary to order an ambulance twenty four hours in advance. The driver explained that in the same set of negotiations that had resulted in the reduction of hours for non-essential staff, performance targets had been set for the ambulance crews. One of these targets was that all requests for ambulances that came from the hospital had to be met within 24 hours. In order to ensure that this target was met, the hospital had been told that in future they must give 24 hours notice when requesting an ambulance.
The staff nurse’s next question was, “If I asked for an ambulance now, how long would it take to get here?”
“Ten minutes”, the driver replied, “and even if we were really busy it would be unlikely to be more than an hour.”
In one phone call the staff nurse had got rid of the ridiculous problem that had been created by the administrators. If she had felt the freedom to improve services in the way she knew would best serve the hospital’s patients then that call could have been made years earlier, or perhaps the whole ridiculous situation would never have been allowed to occur in the first place.
The sad thing is that the people who currently control the spending in that hospital have no idea that this saving has been made, or what happened to make it. The administrators at that hospital still believe they are in control but they are still worried about the other estimated 4,000 beds every year (£2,000,000 per year wasted) in this one hospital that are being blocked by healthy patients who cannot go home.
They have yet to ask any of their staff how they think these savings could be made. They still do not understand that the solution to this and a host of other expensive problems already exists within their own workforce and that they only have to listen to them in order to find out what is frustrating their ability to give the quality of patient care that they have been trained to deliver.
The staff nurse who made the call did so not because she had any special skill or was a high priced consultant. She made the call because she cared about her patients but was prevented from giving them the care they needed by a system set up to suit the hospital administration, not the public.
Try to imagine how effective our public service delivery could be if every one of our public servants was allowed to care about what they did, and felt that their ideas would be listened to.
