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Image shows the acronym NHS in white on a mid-blue background
Sir James Mackey, the head of NHS England, has said something that is true, but unpopular: The NHS doesn't need more money.
Almost no established business needs more money.
Very few new businesses need a lot of money.
When you throw money at a problem, or even a series of problems, you don't actually solve anything. Instead, you add a new problem - decision paralysis. The more money you have to solve your problems, the more things you could do, and therefore the more choices you need to make.
Humans typically aren't that good at making choices - just think about how common the complaint of "But how am I supposed to decide what to have for dinner every day for the rest of my life?!" is. When, especially if it's just you, that should be effortless - you know whether you enjoy a lot of cooking or not. You know what food you like. You know how many stove burners and pans you have. You know how big your oven is. You know how much time you have. A lot of options are already ruled out for you.
Multiply that by the complexities of a very diverse, geographically disparate population, with extreme income disparity, and all the ways human bodies can go wrong, and you very quickly see how easily "analysis paralysis" comes into play when you can basically just hold out your hand to central government, and have any amount of money you name rain down on you.
Almost no established business needs more money.
Very few new businesses need a lot of money.
When you throw money at a problem, or even a series of problems, you don't actually solve anything. Instead, you add a new problem - decision paralysis. The more money you have to solve your problems, the more things you could do, and therefore the more choices you need to make.
Humans typically aren't that good at making choices - just think about how common the complaint of "But how am I supposed to decide what to have for dinner every day for the rest of my life?!" is. When, especially if it's just you, that should be effortless - you know whether you enjoy a lot of cooking or not. You know what food you like. You know how many stove burners and pans you have. You know how big your oven is. You know how much time you have. A lot of options are already ruled out for you.
Multiply that by the complexities of a very diverse, geographically disparate population, with extreme income disparity, and all the ways human bodies can go wrong, and you very quickly see how easily "analysis paralysis" comes into play when you can basically just hold out your hand to central government, and have any amount of money you name rain down on you.
The NHS is exactly the kind of business The Productive Pessimist was designed to work with.
The problems of the NHS seem complicated. They actually seem impossible to ever resolve.
The problems of the NHS almost certainly are complex - but they're not complicated.
The difference between complicated and complex?
Complex - there's a lot going on, and it's all interconnected.
Complicated -no one actually knows what's going on, and certainly not how, or even if, any of it is connected.
At The Productive Pessimist, I like to limit the work to no more than three core problems per business. Not per session: per business. Whether I'm contracted to work with that business for a week or a year, or any period of time between those two, we're going to refine the complexity down to no more than three problems, and, ideally, to a single area of focus, which would not just cohesively solve every problem, but also form the basis of a SOP (Standard Operating Procedure) which can be referred to every time it seems as though a completely new problem has emerged.
If the NHS were The Productive Pessimist's client, we would begin by asking three questions:
1. Should the NHS be primarily proactive or reactive?
2. How much control is the NHS able to give to patients?
3. What issues are part of "health", but are actually outside the NHS' remit?
On a cursory overview, without any NHS input, but with several years' experience working within NHS project management, my off-the-cuff responses are:
1. The NHS should be primarily reactive, providing emergency response and critical care in unplanned, unavoidable scenarios.
2. With the level of technology available today, and the number of charities working in the fields of digital literacy, the NHS can give a significant amount of control to most patient groups.
Considering the answer provided to Q1 is that the NHS should be working in reactive care, acting on this ability to hand over control to patients would shed a significant amount of current occupied capacity and cost within the NHS.
The problems of the NHS seem complicated. They actually seem impossible to ever resolve.
The problems of the NHS almost certainly are complex - but they're not complicated.
The difference between complicated and complex?
Complex - there's a lot going on, and it's all interconnected.
Complicated -no one actually knows what's going on, and certainly not how, or even if, any of it is connected.
At The Productive Pessimist, I like to limit the work to no more than three core problems per business. Not per session: per business. Whether I'm contracted to work with that business for a week or a year, or any period of time between those two, we're going to refine the complexity down to no more than three problems, and, ideally, to a single area of focus, which would not just cohesively solve every problem, but also form the basis of a SOP (Standard Operating Procedure) which can be referred to every time it seems as though a completely new problem has emerged.
If the NHS were The Productive Pessimist's client, we would begin by asking three questions:
1. Should the NHS be primarily proactive or reactive?
2. How much control is the NHS able to give to patients?
3. What issues are part of "health", but are actually outside the NHS' remit?
On a cursory overview, without any NHS input, but with several years' experience working within NHS project management, my off-the-cuff responses are:
1. The NHS should be primarily reactive, providing emergency response and critical care in unplanned, unavoidable scenarios.
2. With the level of technology available today, and the number of charities working in the fields of digital literacy, the NHS can give a significant amount of control to most patient groups.
Considering the answer provided to Q1 is that the NHS should be working in reactive care, acting on this ability to hand over control to patients would shed a significant amount of current occupied capacity and cost within the NHS.
3. Mental health, low-moderate support neurodiversity are very definitively outside the NHS' remit, although they are part of health.
Age-related frailty is outside of the NHS' remit, although it is part of health.
Maternity and pregnancy care is outside of the NHS' remit, although it is part of health.
Stable chronic condition management is outside the NHS' remit, although it is part of health.
IVF is outside the NHS' remit, although it may be part of health in that it can affect mental health.
Gender-affirming care - including gender-affirming care for cisgender people - is outside the NHS' remit, although it can be part of health.
End of life care is outside the NHS' remit, although it can be part of health.
Age-related frailty is outside of the NHS' remit, although it is part of health.
Maternity and pregnancy care is outside of the NHS' remit, although it is part of health.
Stable chronic condition management is outside the NHS' remit, although it is part of health.
IVF is outside the NHS' remit, although it may be part of health in that it can affect mental health.
Gender-affirming care - including gender-affirming care for cisgender people - is outside the NHS' remit, although it can be part of health.
End of life care is outside the NHS' remit, although it can be part of health.
The NHS' remit, by the answer to Question 1 here, is:
. To respond to critical incident and emergency healthcare
. To prevent transmissable-condition pandemics and epidemics wherever possible
. To enable as many people as possible to remain in active employment, both when those people become sick or injured on a temporary basis, and when they are chronically ill or long-term disabled
. To reduce the likelihood of individuals experiencing emergency healthcare needs
These responses give laser-guided clarity on the NHS' single problem: communication.
Internal communication around what the NHS will no longer be taking responsibility for.
Stakeholder communication with other organisations, government departments, and employers about how those stakeholders are going to pick up responsibilities as the NHS sheds those outside its remit.
External communication with patients and patient advocate groups about what responsibilities and remits the NHS will no longer be handling, and where and how people can find support for those challenges.
This shedding of responsibilities allows for the NHS to establish a genuine, professional, revenue-generating business; the "outside remit, but part of health" aspects become things which can be charged for, including the provision of zero-barrier payment schedules for those on low incomes, where a price is given for treatment, and it is paid down over a period of time, in affordable installments decided in collaboration between the NHS business arm and individual clients, with the treatment only taking place once the payment has been made in full.
Professional profit margins can, and should, be built in to those costs.
End of life care is not really part of health for the individual at the end of life; it is part of mental health for those around them.
. To respond to critical incident and emergency healthcare
. To prevent transmissable-condition pandemics and epidemics wherever possible
. To enable as many people as possible to remain in active employment, both when those people become sick or injured on a temporary basis, and when they are chronically ill or long-term disabled
. To reduce the likelihood of individuals experiencing emergency healthcare needs
These responses give laser-guided clarity on the NHS' single problem: communication.
Internal communication around what the NHS will no longer be taking responsibility for.
Stakeholder communication with other organisations, government departments, and employers about how those stakeholders are going to pick up responsibilities as the NHS sheds those outside its remit.
External communication with patients and patient advocate groups about what responsibilities and remits the NHS will no longer be handling, and where and how people can find support for those challenges.
This shedding of responsibilities allows for the NHS to establish a genuine, professional, revenue-generating business; the "outside remit, but part of health" aspects become things which can be charged for, including the provision of zero-barrier payment schedules for those on low incomes, where a price is given for treatment, and it is paid down over a period of time, in affordable installments decided in collaboration between the NHS business arm and individual clients, with the treatment only taking place once the payment has been made in full.
Professional profit margins can, and should, be built in to those costs.
End of life care is not really part of health for the individual at the end of life; it is part of mental health for those around them.
The NHS is never going to prevent people reaching a natural end of their life, whether that "nature" is old age, cancer, or the inevitable end point of a degenerative condition.
The NHS needs to hand over to counsellors, death doulas, faith leaders, spiritual leaders, and shamanic workers to help people make peace with the inevitability of their death, and to lead them through that death. How those groups and people work, whether they charge for their services or not, is not the concern of the NHS.
The government can support the NHS by making it a mandatory requirement that those participating in sports which frequently incur injuries requiring hospital treatment carry insurance, and are required to use private medicine, rather than the NHS. This requirement could also be mandated for those who persist in known harmful lifestyle choices such as smoking, vaping, drug abuse, and alcohol consumption.
Gender affirming care needs to be completely depoliticised - and will be, once it is removed from the NHS. It then becomes just another aspect of high street aesthetics - there is no reason, once the NHS is no longer expected to deal with it, that gender affirming care can't be something competent private surgeons carry out in high street clinics. If, as the Supreme Court and EHRC insist, "biology is immutable and unchangeable" - then what does it matter if a person a doctor once wrote "female" about on a birth certificate takes testosterone under supervision, or has a full mastectomy? What does it matter if a person a doctor once wrote "male" about on a birth certificate has their genitals removed by a qualified medical professional working in a licensed, sanitary, private setting.
Pregnancy is a privilege, and a choice. You want a child? You pay a non-NHS provider for the costs of having a biological child. Don't want to do that? There are children in social service care who need long-term families. In the context of how many children are in the care system, IVF is not just not an NHS remit, it is morally bankrupt as a proposition.
Mental health has real, and high impact effects on individuals, but it is a personal responsibility. And I'm saying that as someone who lives with moderate-low severe depression, extreme anxiety, and schizophrenia; I have gained more control of all of those conditions outside of NHS engagement. For the most part, "basic" mental health conditions - depression and anxiety - are just weather; they're a pain, they can derail plans - but you can get on with quite a lot in spite of the weather.
The six-twelve weeks of CBT the NHS mostly funds for mental health does no more than you'd manage to achieve yourself by engaging with resources, including peer support.
Like mental health, age-related frailty is a personal responsibility. Gyms exist. Level access walking paths are being laid down every other month. There are endless social exercise classes. You can proactively prevent and address frailty without ever going near the NHS.
Similarly, chronic condition management. I'm legally blind, and have fibromyalgia; my blindness is not going to improve; currently, none of my four sight loss conditions are able to be addressed through surgery. I just have to learn to manage around it.
Full-spectrum naturopathy (qualified naturopath speaking, although I'm not currently taking on clients) is far more effective for managing fibro than anything the NHS suggests, and I don't have to either find the energy to get out of bed, or, if I'm having a good day, lose a day's work, to attend a clinic.
If you're in the field of healthcare, NHS or private, orthodox or alternative, and you'd like to work with The Productive Pessimist to identify and solve your problem - email us: theproductivepessimist@yahoo.com
The government can support the NHS by making it a mandatory requirement that those participating in sports which frequently incur injuries requiring hospital treatment carry insurance, and are required to use private medicine, rather than the NHS. This requirement could also be mandated for those who persist in known harmful lifestyle choices such as smoking, vaping, drug abuse, and alcohol consumption.
Gender affirming care needs to be completely depoliticised - and will be, once it is removed from the NHS. It then becomes just another aspect of high street aesthetics - there is no reason, once the NHS is no longer expected to deal with it, that gender affirming care can't be something competent private surgeons carry out in high street clinics. If, as the Supreme Court and EHRC insist, "biology is immutable and unchangeable" - then what does it matter if a person a doctor once wrote "female" about on a birth certificate takes testosterone under supervision, or has a full mastectomy? What does it matter if a person a doctor once wrote "male" about on a birth certificate has their genitals removed by a qualified medical professional working in a licensed, sanitary, private setting.
Pregnancy is a privilege, and a choice. You want a child? You pay a non-NHS provider for the costs of having a biological child. Don't want to do that? There are children in social service care who need long-term families. In the context of how many children are in the care system, IVF is not just not an NHS remit, it is morally bankrupt as a proposition.
Mental health has real, and high impact effects on individuals, but it is a personal responsibility. And I'm saying that as someone who lives with moderate-low severe depression, extreme anxiety, and schizophrenia; I have gained more control of all of those conditions outside of NHS engagement. For the most part, "basic" mental health conditions - depression and anxiety - are just weather; they're a pain, they can derail plans - but you can get on with quite a lot in spite of the weather.
The six-twelve weeks of CBT the NHS mostly funds for mental health does no more than you'd manage to achieve yourself by engaging with resources, including peer support.
Like mental health, age-related frailty is a personal responsibility. Gyms exist. Level access walking paths are being laid down every other month. There are endless social exercise classes. You can proactively prevent and address frailty without ever going near the NHS.
Similarly, chronic condition management. I'm legally blind, and have fibromyalgia; my blindness is not going to improve; currently, none of my four sight loss conditions are able to be addressed through surgery. I just have to learn to manage around it.
Full-spectrum naturopathy (qualified naturopath speaking, although I'm not currently taking on clients) is far more effective for managing fibro than anything the NHS suggests, and I don't have to either find the energy to get out of bed, or, if I'm having a good day, lose a day's work, to attend a clinic.
If you're in the field of healthcare, NHS or private, orthodox or alternative, and you'd like to work with The Productive Pessimist to identify and solve your problem - email us: theproductivepessimist@yahoo.com
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