And this is one of the most common themes in much of the management literature on health. A great deal of talk about scale, processes, restructuring, return on investment but less obvious is the link back to people. The major problem is that this kind of thinking is resulting in very poor decisions being reached, is creating a huge and very real financial burden to the taxpayer and is affecting patients.
Part II of the piece concerns more of this kind of thinking. No, it's not NPfIT, although that surely fits the bill. The plaudits here go to PFI. Another Select Committee, this time the Treasury, has panned this government policy judging it to be poor value for money for the taxpayer. The Government had become "addicted" to PFI, the Committees Conservative Chair said. The reason? Because PFI is a means of getting something now and paying for it later. The situation is so bad that the Committee is calling for PFI debt to be added to the official national debt. A move that, if it were to happen, would increase that figure by £35bn.
How about then that contractors maintain finished buildings to a higher standard? Well, no, not that either.
Surely then there must be some wriggle room for, in this case, NHS Trusts to renegotiate terms given the tough economic circumstances we face? Dream on. These contracts are so watertight that in fact what you have is a situation where the profits from selling PFI equity on the secondary market are more lucrative than the actual commissioned projects themselves.
One study estimated that of 154 projects looked at, if the £500m profit made in selling on PFI equity was applied to all PFI schemes then the overall profit the private sector has made on this element of the scheme alone would be £2.2bn. What is even more remarkable is that the return on investment on those schemes for which information is available is over 50%. This compares to a construction industry average of 2.8% over the same period (the last 6 or 7 years). If you focus on health alone that profit margin reaches 66.7%.
So there you have it. Yet again, some bright sparks in the DH come up with the "go to" answer. In this case it is PFI. The legacy - lots of new buildings and a mountain of debt that is a significant contributor to the funding gap that the NHS is struggling to meet. A problem that will, undoubtedly result in patients and their carers being adversely affected.
The outrage is that there is one example after another of colossal wasted money in the system and yet the management paradigm that results in someone somewhere thinking that M&A, or PFI (or NPfIT) are good ideas continues.
Apparently Sir Alex Ferguson said that Danny Wellbeck went off on loan to Sunderland and came back a man, annoyingly in time to beat my team last night. Not quite sure what he meant but in his case that transformation only took one season. We've spent decades watching debacle after debacle in the NHS. Perhaps it's time for the senior leaders in the NHS to "man up" and start taking some responsibility for a way of thinking that has damaged public finances and peoples' lives. Stop frittering away your intellectual capital on thinking that drives the system further away from people and start putting it to good use. Start basing decisions on knowledge not the work of think (or guess) tanks. Change your thinking. And do it quickly.