As the NHS comes under increasing strain, Simon Moralee, senior lecturer in healthcare management at Alliance Manchester Business School, says that leaders must consider how work behind the scenes supports more efficient work on the ground when looking at reforms.
This winter the pressure facing the NHS has been evident like never before. Services have been stretched, waiting times continue to increase, and hospitals have had to cope with strikes as staff become disgruntled about pay and working conditions. None of these are new issues, but they have been crystalised by the impact of austerity over the past 12 years, ongoing increases in demand caused by the success of modern medicine in keeping people alive longer but with more co-morbidities and the lingering effects of the Covid-19 pandemic.
With budgets squeezed across the board, the Chancellor has made it clear that further funding for the NHS is unlikely; instead, reforms will be driven through efficiencies. It is a comment that has been made before and leads many to fear what it might mean for an already-stretched workforce.
While the NHS is a unique health systems model, when it comes to creating a more effective and efficient system, many of the principles are the same as in any other organisation. It is essential to have the right leadership in place to identify those areas where efficiencies can be made and ensure services that are essential to the day-to-day functioning of our NHS remain effective and unaffected. Ultimately, to improve delivery of care on the ground, the right decisions need to be made at the top, as this sets the culture for decisions in the middle and on the frontline.
Identifying key areas for support
All NHS staff deserve a huge amount of recognition for the work they do. Their impact on society cannot be overstated. Doctors and nurses are the first that come to mind; their roles, of course, are absolutely vital to a successful NHS. But it is important for us to think beyond these headline workers when considering how to create a more productive workforce by acknowledging the role done by allied health professionals and non-clinical staff who keep things going in the background, from porters and cleaners to facilities and operational management colleagues.
For their work to have the greatest impact, there needs to be a well-designed system in place that enables them to be as productive as possible. As in any business, there are workers behind the scenes that may not always be visible but make a valuable contribution, by offering support and alleviating pressure on those at the frontline. It is a delicate ecosystem and diverting resources away from some of these areas in favour of investment in frontline jobs can actually have a detrimental effect.
I have recently collaborated on a book chapter with Prof. Berne Ferry, head of the National School of Healthcare Science, which highlighted just why healthcare scientists are so important, and makes the case for why they are essential to keeping our NHS running.
Healthcare scientists account for 5% of all NHS staff, and their role stretches across every medical establishment, and every department. When many people think of healthcare scientists, they may think of incremental research in finding cures to long-known-about but hard-to-treat illnesses. But their role is also to respond to urgent clinical needs and immediately address new challenges.
Eight out of ten diagnoses delivered by healthcare staff are made by, or critically involve, a healthcare scientist. For example, when blood samples are sent off for testing, it is healthcare scientists that have been trained to interpret the results. They are in constant dialogue with those providing treatment to ensure that the right treatment can be provided.
Impact during Covid-19
During Covid-19, the NHS faced challenges never seen before and it required a monumental collective effort to respond to this. It is these kinds of challenges that can help to demonstrate the importance of having a sound structure that enables everyone to work as efficiently as possible.
Doctors, nurses, therapists and technicians showed unbelievable effort and resolve to offer the care required, but it also shone a spotlight on healthcare scientists in a way that hasn’t been done before. The general public got a glimpse into why their work is so vital to improving the overall healthcare services in the face of immediate challenges.
They played a key role in the development of life-saving and life-changing vaccines and were instrumental in creating and implementing PCR testing. Their findings were also critical in quickly identifying the symptoms of Covid-19 and devising the appropriate response, particularly in respiratory, cardiac and critical care treatment.
And their work hasn’t stopped. They continue to monitor for variants of concern, quickly identifying the Omicron variant, for example. Such work can support pre-emptive measures to ultimately reduce the strain that hospitals and GP surgeries come under, allowing other healthcare staff to focus on providing treatment.
Taking a holistic view
Healthcare scientists are a prime example of why we need to look at the system as a whole when aiming to drive efficiencies. If we cut back on the resources given to healthcare scientists, other more visible frontline staff will have to wait longer for diagnoses or take on more work themselves. It makes no sense to increase the number of doctors and nurses only to take away the vital support healthcare scientists offer.
Leaders need to recognise that no element of an organisation works in isolation. Creating a more efficient system means understanding how different services complement each other, and how they can work together to deliver better results.