Editorial Wednesday 16 April 2014: Working smarter - National Hunt winter racing, and horses for courses

My Lords, Ladies and gentlemen, NHS comrades (and regulators),

I have received some comments about the relative infrequency of Health Policy Insight posts of late. Thank you for your concern. I am fine, and indeed still hold opinions and do analysis about the NHS. It's just a question of time available.

However, here is a little thought for you all, inspired by some overheard dialogue on the tube this morning as I was on my way to the latest meeting of the HSJ/Serco Commission On Hospital Care For Frail Older People (to which I am secretary; yet despite this handicap, the Commission is doing good and interesting work which should add value).

The overheard phrase was "yeah, of course he works hard: so does a donkey, but it's never gonna win the Grand National".

Not only do I think you'll agree that's a great phrase, but it encapsulates a truth for the health service.

Many NHS staff have worked their butts off for the past few years to ensure that patient care is as good as it can be in a time of flat funding (albeit when most of the rest of the public sector is dealing with major real-terms cuts).

The latest Kings Fund quarterly survey reveals finance directors' understandable gloom about the economic squeeze (because as we all know, technology and demography drive developed world health systems cost pressures to increase around 2-3% year on year).

I am not cheering you up here, I sense, and while that is one of the things I usually hope to do, I am neither a Pollyanna nor a Micawber. It's really a bit shit for a lot of people and organisations just presently.

But there is a serious point in the comment about the hard-working donkey. It's not only that we are not going to keep going with more very hard work: anyone who has tried to constantly just work harder will tell you that the fuel tank is inevitably finite.

The serious point is firstly that the service must find ways of working smarter. Constantly working harder and harder is probably at high risk of creating failure demand, as errors creep in even with the best-intentioned overworked professional.

It also doesn't allow front-line staff to have those essential 'staring-out-the-window' moments of creativity and different perspective, which tend to be the midwives of innovation in very much the way that going on courses branded ''innovation' don't.

Horses for courses
There is a point about horses for courses. A donkey is a crucial team member for certain kinds of jobs, but it is never going to win the Grand National.

And we need to be much clearer about when the task is dragging a load. That's for donkeys. (Never despise a donkey: some day, until the e-donkey is invented, you will surely need one.)

But some tasks need steeplechasers, and some hurdlers. Some need jockeys, and some are for flat racers.

And beware of winter National Hunt racing, since most of the field are geldings.