The big-ticket cost over-runs with the multi-billion pound National Programme for IT (NPfIT), the departure of the Parliamentary Under-Secretary of State at the Department of Health, and almost half a billion pounds of expenditure on management consultant fees, would appear to leave little room in anyone’s diary for the humble Patient.

Yet, somewhat miraculously, NHS is an organisation that functions daily on the lifeblood of highly committed and qualified staff. They remain focused on serving the real customer – the patient (or more precisely, millions of patients per annum).

The Patient Service Conundrum

In recent formal and informal discussions with many of the NHS staff, community representatives and professional advisers, the message that comes across loud and clear is that the NHS is over-managed, under resourced, and insufficiently communicative and coordinated.

What’s more, it faces conflicting poles of strategy on a daily basis: Patient Service Excellence versus Operational Excellence.

In order to highlight this painful conundrum, one has to examine the experience from the private sector. In particular, we have to look at the advent and subsequent disillusionment with Customer Relationship Management (CRM) over the course of the last decade; as it may help us to shed more light on the key challenges faced by the present-day NHS.

One of the reasons why the true goal of CRM (and its various other guises such as CEM, CM, etc) often proved unattainable was because most organisations saw CRM primarily as a technology initiative; with some process reengineering, and a peppering of business change, workforce and customer training, and project management thrown in for good measure.

What most organisations simply overlooked was the fact that, whilst process automation and new technology can provide significant (and in some cases spectacular) efficiencies and cost savings, customer service excellence often requires that certain parts of an organisation's business processes must have a degree of in-built redundancy to accommodate service agility and responsiveness to customer demands.

Therein lays the conundrum for the 21st Century NHS.

A ship with two anchors

Given the current intense focus on performance improvement, cost cutting, revenue generation and achievement of government targets for patient service (e.g. reduction of waiting times, drug availability, etc), a constant tug of war in priorities is inevitable. And no amount of expenditure on management consultants or new technology will help to resolve it.

Instead what is needed is a clear strategy from the top management to reiterate the focus and true purpose of the NHS. And that must always be to serve the patient; not at any cost, but at a reasonable cost to the tax-payer. Correct?

So, if that means that certain parts of the NHS will require built-in redundancy (by way of extra beds, ambulances, staff, swabs, needles, or prescriptions) then that is what it would take to achieve patient service excellence. After all, that is what the patient (who is also often the tax-payer) expects.

Notwithstanding, there is still plenty of potential in the NHS for attaining the optimal balance between patient service excellence and operational excellence (and cost efficiencies) through:

• Smarter working practices and stronger financial management,
• Leaner and "greener" processes and reduction of wasted resources,
• Greater involvement and consultation with patients at the local level in key decisions,
• Attracting top talent and right calibre of people,
• Replacing the internal ‘old boys’ networks with open and collaborative people networks, which resonate with the true diversity of the NHS and the local community and businesses.

Finally, when one takes a holistic view of the wider NHS and its greater purpose, the picture that emerges is not that of an ailing organisation, but one that is wholly fit for purpose; albeit in urgent need of clear direction, positive change and political will-power for tapping into the greater potential and goodwill of the NHS foot-soldiers, who are so often taken for granted.

Read Part 2 of this series of articles »