Site Administrator Agile
Site Administrator Agile • 1 May 2009

Efficiency is dead, that’s official. The word has been hijacked by crunch-drunk politicians and now means cutting the public sector payroll. So we need a new word for real efficiency, especially in the NHS. Suggestions please!

Frances and the team at Campaign for Greener Healthcare have invited me to blog. This is probably because for the past year I’ve been bombarding her with brilliant thoughts, smashing ideas, and feedback from practical NHS ‘resource efficiency’ projects in Cornwall. As a virgin blogger I am nervous, but then at 62 it is nice to be a virgin something, and there’s the frisson of possible comment.

In these ‘resource efficiency’ projects I have taken the best of industry’s ideas, the sort of methods that have given Toyota a world lead in ‘lean’ engineering, and translated them for NHS use, adapting them to the very different culture and purpose of health care. This kind of efficiency has nothing to do with cutting jobs. It is focussed on improving the way we use every kind of resource, so that the process of providing good health care now does now wreck the health of future people. Urgently this means cutting carbon. And because carbon is entailed in just about everything we use and do it has significant potential to cut costs too: but friends tell me not to talk like that. Cutting costs and making savings in the NHS is dirty talk. Better to call it “cost avoidance” they advise.

This vignette illustrates just how strange our NHS has become. Indeed as someone who has worked on sustainability with all kinds of private and public sector managements over the past 15 years, it sounds like a symptom. Recently I reported our pilot programme to a trust director. The programme had involved delivering three workshops to each of four GP surgeries, two community hospitals, renal, path labs, a children’s ward, outpatients, and a mental health unit. The idea was for each unit to put together a small team, to size up the issues presented by climate change in their particular unit, to prioritise them down to a few doable actions for now, and some for later, and to write a plan of action. The idea was not to make savings. However in looking at processes to reduce carbon we identified some £250,000 possible savings in cash – and that was not counting the big-ticket carbon/cost items like energy use, pharmaceuticals, and transport. Guess the reaction? “I don’t think there are those sorts of savings to be made.” Which is a pity because I thought there were probably double; we just hadn’t had time to cost many of the possible opportunities for reducing carbon.

To meet the Climate Change Act target of 80% CO2 reduction by 2050, which is the same as the new NHS Carbon Reduction Strategy target, we need to find a way to reduce carbon right through the fabric of the NHS. We need to do this with the grain of an organisation in which cost savings are so problematic, greater efficiency so inconceivable, yet in which every group of staff you meet can spot carbon savings everywhere. So how? In industry what has worked best is to put together a multi-disciplinary team, sometimes called a kaizan team. They identify the issues and create the action plan. Then the trick is to tackle only one big resource efficiency issue at a time. The cash savings from that are put in a pot and used to lever out the benefits of the next challenge: and so on. This works. Clearly finding the right NHS words is part of the battle. So we need a new word for real efficiency in the NHS that does not allude to cost savings or, thanks to economic turmoil, to the kind of public sector ‘efficiency’ job cuts needed to pay back the stupendous debt involved in bailing out the bankers. All suggestions welcome.

For full report on the pilot see the attached download.

Toolkit ‘NHS Compass for Climate Change’ available in current CD draft format from

Mike Poole is an independent adviser working with NHS Trusts and other public and private sector organisations on projects pioneering practical ways to meet the challenges of climate change and sustainability. Eco-nomic Ltd. 01822 840612.

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