Matt Morgan: The NHS must be much less environment friendly

After I not too long ago returned to the NHS after working in Australia for a time, I used to be dreading the method of countless functions for usernames, parking passes, and identification badges that lay forward of me. Fortunately, because of the NHS’s bureaucratic inefficiency, my present usernames remained energetic, the automobile park barrier opened as earlier than, and my ID badge nonetheless labored. Inefficiency labored properly.

Now that healthcare budgets within the NHS are glowing vivid purple, I think about we’ll quickly be hit by predictable plans to attempt to be extra environment friendly by shaving decimal factors off stationery budgets, outpatient clinics, and the free teabag coverage. However we should always keep in mind the danger of suboptimisation—the place particular person course of enhancements find yourself being to the detriment of the general organisation.

A few of the most essential elements of my day when working within the intensive care unit are the “in-betweens.” These are the gaps between right here and there: the anticipate the raise to reach after seeing a affected person within the emergency division; the stroll with colleagues to purchase some lunch; the time ready for a scan report back to be finalised. Though reducing out such “inefficiencies” may seem to be a terrific concept, one thing much less simply quantifiable can be misplaced.

Ready for these raise doorways to open offers me a while to consider methods to handle the sufferers with extra complicated issues. The stroll to the espresso store with a colleague is when shifts are mentioned and swapped. And the time spent ready for a scan report offers me a minute to organize the warning shot I’ll be giving to members of the family earlier than the scan exhibits the information nobody wished.

In a system that the King’s Fund assume tank has discovered to be already very environment friendly in lots of areas,1 if we resort to salami slicing to make a spreadsheet flip inexperienced it could actually have unintended penalties. A systemwide strategy is required, and we should always recognise and be conscious that offering top quality healthcare must afford house to the human beings delivering it. Effectivity isn’t every part.


  • Competing pursuits: I’ve learn and understood BMJ coverage and declare that I’ve no competing pursuits.

  • Provenance and peer overview: Commissioned; not externally peer reviewed.

  • Matt Morgan is an adjunct scientific professor at Curtin College, Australia, an honorary senior analysis fellow at Cardiff College, UK, advisor in intensive care medication in Cardiff, and an editor of BMJ OnExamination.