Making Difficult Choices In The NHS

Leading or managing in the NHS is always going to be a challenge.  The fact that you are operating in an environment which never stops and is subject to very close scrutiny makes it that way.


One of the toughest parts of leading and managing in the NHS is making difficult choices.  A lot has been written recently about the numbers of NHS organisations facing financial challenges.


In many ways this is not a surprise.  The overall level of investment in the NHS has dropped in real terms.  At the same demand for services has increased.


If in a private sector organisation decisions would be made to stop offering certain services or products.  Costs would be cut to the bone to protect the bottom line.


In the NHS this is a whole lot more difficult.  You can stop offering certain services.  This might help an individual organisation if the costs saved are greater than the income lost.  However unless the demand disappears it is merely a case of passing the problem around the system.


Costs might also be reduced.  There will always be scope to make some savings on non salary related costs.  Yet the biggest areas of spend are on salaries.  You might be able to reduce dependency on temporary staff by proactive recruitment.


At the same time you can’t just cut out staffing randomly as it has a direct impact on patient safety and achieving access targets.


So is it all gloom and doom?


I don’t believe so.  The first step is to acknowledge that there is an issue.  It might be tempting to bury your head in the sand in the hope that it will go away.  In reality this never works.


It is also vital to create some quality time to discuss the issues, the options, the benefits and drawbacks.  This needs input from many different groups to get a rounded perspective.  It definitely should never be something that is done in isolation.


Next you need a plan or at least the first few steps.  Within the plan there needs to be small steps where things can be tested and properly evaluated before moving on.  Big leaps or big jumps very rarely deliver.

And finally, there has to be patience.  There will be setbacks.  Things may well go two steps backwards before moving forward.  Having the courage and resilience to keep working at it will count in the long term.


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