The Changing NHS

The Healthcare Commission recently released the results of its’ annual survey of 128,000 NHS staff across England.  According to the Guardian Society,only 42% would be happy with standards at their own establishment. A quarter said they would be definitely unhappy and 34% did not have a view. Just under half the staff in hospitals said care of patients was their trust's top priority, but 25% said it was not.
 
However, job satisfaction levels, although slightly lower than last year, remain relatively high. 68% of acute trust staff and 75% of staff in primary care trusts reporting that they were generally satisfied with their jobs.

On a related note, I recently attended a seminar where the CEO of a USA based not for profit healthcare system explained that his organisation’s mission was to ‘delight’ patients.  He claimed that a key reason why his organisation was successful in this regard was because his pay, to quite a large extent, was dependant on the Board judging that the organisation had achieved a key metric concerning patient satisfaction.  Basically every in-patient is surveyed, after discharge, and asked whether they would recommend the hospital to a friend.

That got me thinking. Currently, according to the Department of Health’s Pay Framework, (download from here) it seems English PCT Chief Executives earn a basic salary between £100k - £142k pa and have the possibility of an annual  performance bonus payment if the organisation is deemed to have met its’ financial control target and the CEO is judged to have performed above satisfactory in a four point scale. I couldn’t find the corresponding figures for Acute Trust Chief Executives – have you ever tried to search the DH website! -  though in 2005 the BBC reported on an IDS survey that claimed the average English Acute Trust Chief Executive was earning a basic salary 18% higher than a PCT Chief Executive.

Given the general direction of NHS policy, more market power in the hands of patients and more non-price related competition amongst providers, perhaps we ought to see the focus of these incentive schemes shift, away from financial control and general CEO performance, towards something more tightly focused on ‘delighting’ patients?

1. Would NHS Trusts really focus more attention and energy on ‘delighting’ patients if their CEOs had this kind of arrangement in their contracts?
2. Are CEOs sufficiently influential internally and capable of resisting other, potentially competing priorities that are externally proposed?
3. Are Chairs of Foundation Trusts likely to have more of an appetite to introduce such incentives as part of their duty to manage the performance of their CEOs?
4. If, yes, would a scheme be more effective if it meant a CEO might lose a percentage of their basic salary rather than gain a additional amount over and above a guaranteed minimal and if yes, what % of salary would need to be ‘at risk’ in-order for CEOs to make delighting all patients their number one priority? 2%, 5%? 10%?
5. Could a simple, measurable and meaningful patient-focused metric be identified, stuck with and used?
6. Should we consider introducing a similar scheme for Medical Directors?  Alan Maynard, Professor of Health Economics at York University has recently floated this idea for all GPs and Consultants.
   

You manage what you measure – hmm - you manage what you get paid for might be more accurate?

Steve
www.stevepashley.co.uk

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