8 11 2010

The tragic story of unnecessary deaths at Stafford Hospital has again brought the issue of what kind of impact the cuts proposed by the Government might have not just generally but specifically, on the National Health Service’s ability to provide a functional service and not to put lives at risk.

Trade Union Unison have once again led the voices that state the cuts are wrong and cuts to funds will mean cuts to jobs which will inevitably mean cuts to front line services.

Unison, confusing cuts with reduction in services (along with everyone else)

Unison is undoubtedly driven by serving its members and attempting to preserve as many of their jobs as possible. However, as with many others, they appear to be confusing cuts (and job losses) with a reduction in services. This need not be the case.

Whether we cut or do not cut is asking the wrong question. The reality is that the country is in a financial pickle and large-scale savings must be made. However rather than saying, ‘where can we cut?’ we should be asking ‘where can we maintain quality service provision while reducing the cost of that provision?’

It’s a subtle but important distinction, one which demands a process which is led by strategy rather than structure. I have often repeated within this blog that structure should be the servant of strategy not vice versa (as so often in the UK) and this issue demonstrates this perfectly.

By looking at making cuts the main driver, structures in general are trimmed (or slashed) to save money. By looking to maintain services, the question subtly changes from ‘where can we save money?’ to ‘where can we maintain services for lower expenditure?’ This forces us to look at what the strategy is and re-examine the structure required for not simply delivery but efficient, effective delivery.

The NHS; better strategy would maintain services for lower costs

Further, in organisations like the NHS where there appears to be a strategy for every eventuality without consideration of how to vertically integrate some or all of those strategies, the savings could be colossal without front line services (patient care) being compromised at all. In fact, given that the NHS was recently reported to have at least (no one knew for certain) 353 different strategies in operation above PCT level and hundreds or thousands more below that level, it is entirely likely that service provision could and should be improved for a significantly lower spend.

In areas for which other Government departments are responsible the same case is true although generally the waste (for that is what it is) is at a lower level than in Health. For example, the Government has asked individual police forces across the UK to look at where they can save money where the strategy led approach would instead ask, ‘how can we maintain (or even improve) policing across the UK for less money?’ The first assumes a rigid structure thus limiting strategy, the second looks to establishing the right strategy to define the best structure.

Sadly for Unison and its members, as well as many others across the country, asking and addressing the right question will lead to job cuts but that should not inevitably also mean a reduction in services.

Anyone who suggests otherwise is not asking the right question!

© Jim Cowan, Cowan Global Limited, 2010

Twitter @cowanglobal



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