🦇 Jennie Rigg 🏳️‍🌈 (she/her)

If I hear one more person wittering on about "efficiency savings" in the #NHS I'm going to scream. The NHS has been pared to the bone in the name of efficiency savings and it does not work because you can't predict exactly when or how people are going to need the service.

I don't want the NHS to be efficient. I want it to have the capacity to deal with whatever gets thrown at it. I WANT there to be empty beds, because that means there's nobody waiting for a bed. I WANT Doctors to spend a certain amount of their day twiddling their thumbs, because that means people aren't stuck waiting in pain and desperation.

Am i weird?

Dec 22, 2022 at 8:50amWeb
Show threadCharlie StrossDec 22, 2022
@miss_s_b Additionally, Doctors (and nurses, pharmacists, cytologists, etc) NEED to have time to "twiddle their thumbs" every day b/c that time is available for ongoing education. The state of the medical sciences is advancing continuously and if you don't read A LOT you will fall behind. Which, ultimately, means losing patients who might have survived with better treatment.
Show thread(rainynight65) has movedDec 22, 2022
@miss_s_b @cstross I think doctors and nurses having time to twiddle their thumbs also means they aren't hopelessly overloaded and overworked. Exhaustion leads to burnout, not to mention a higher likelihood of mistakes and accidents.
Show thread🦇 Jennie Rigg 🏳️‍🌈 (she/her)Dec 22, 2022
@rainynight65 very much this @cstross
Show threadVerity AllanDec 22, 2022
@miss_s_b No. It's also well-known in optimisation theory that you don't want 100% utilisation because the tiniest problem and it goes to hell. Even on very predictable systems, like car manufacture, you leave slack so that dropping something can be recovered from without hindering others. This goes double for the NHS. Spending 10 minutes as a manager means you hear this; it's poor politics that's driving this.
Show threadBruce Felt.BuzzDec 22, 2022
@miss_s_b the NHS has always managed to do so much with so little. Almost 20 years ago I was tasked with setting up a mental health service the government costed at 16million. We were given 1.4 million. We managed (it was a functioning service, but not perfect). The NHS was the most efficient health service in the world. It's not now, it has been starved of funding.
Show threadJonathan BennettDec 22, 2022
@miss_s_b Imagine if a supermarket only had enough stock to supply one day's typical demand, and there's a rush on some items. You'd end up with no toilet roll on the shelves.
Show threadBⒶd-Dog Monkeyboy;¹🏴‍☠️💗💛💙Dec 22, 2022
@miss_s_b
Yes, you're totally weird.
You're also right.
Never stop being both.
Show threadPete / SyllopsiumDec 22, 2022

@miss_s_b You're not weird, but what 'Efficiency savings' actually means is 'I don't want to pay more tax, or I want someone else to pay it' if you're a punter, or 'I want more money for my corrupt friends' if you're an MP.

The NHS is still inefficient, but so are all other public services, partly because of humans and partly due to overpriced and corrupt tendering processes.

Show threadSchroedingerDec 22, 2022

@miss_s_b You are probably weird. I love weird people.

I work in IT. If our servers are running at 100% capacity, that is a major problem. They should run at more like 60%, so that there is resource for other tasks and problems and something to ramp up into.

The NHS is currently running at 100%, and it is suffering all of the same problems. It needs to run significantly less that this.

Show thread🦇 Jennie Rigg 🏳️‍🌈 (she/her)Dec 22, 2022
@SteveClough yep this was exactly my thinking
Show threadHugo MillsDec 22, 2022
@miss_s_b This is exactly what, for example, Google's much vaunted "20% time" is about -- it's capacity planning for peak load, and maaaybe getting something useful out of the "downtime".
Show threadRob LandleyDec 22, 2022
@miss_s_b Efficiency and resiliency trade off. Increasing efficiency usually decreases resilience by eliminating spare capacity.
Show threadAlexandra LanesDec 22, 2022
@miss_s_b You're weird in that you're right... Nobody actually cares that much about the NHS being efficient until there's a shortage of resources, at which point efficiency is a desperation measure in lieu of actual proper funding. In medical terms, efficiency is starvation.
Show threadRaj ACDec 22, 2022

@miss_s_b
So, yes and no. The difficulty isn't "efficiency". Having healthcare professionals who are healthy is more efficient than them burning out. Having spare capacity is more efficient than cancellations. That's about how efficiency is defined.

But...there are widespread cultural problems within the NHS that percolate through the way in which we train *all* professionals within it and that isn't per se a failing of government.

Show thread🦇 Jennie Rigg 🏳️‍🌈 (she/her)Dec 22, 2022
@rajacexplains yeah but you're talking about /actual/ efficiency, not the tory definition of efficiency, which is "starve it of cash till it falls over, then say it's broken and flog it to your mates"
Show threadnoahDec 22, 2022
@miss_s_b no weirdness detected
Show thread🦇 Jennie Rigg 🏳️‍🌈 (she/her)Dec 22, 2022
@text bugger. I'll have to try harder ;)
Show threadnoahDec 22, 2022
@miss_s_b fair point!
Show threadBruno NicolettiDec 22, 2022
@miss_s_b @cstross resilience and efficiency don’t always go hand in hand.
Show threaduninvitedCatDec 22, 2022
@miss_s_b If you are, I’m right there with you!
Show threadNemoDec 22, 2022

@miss_s_b
Efficiency is the minimum of resource used for a given level of service.

And it's always desirable.

But some systems are critical, and we like them to be efficient, but we *need* them to be robust.

(Resilience is the ability to recover from exceptional strain, also nice. What is *needed* is good performance across a range of demands, robustness)

Show threadCadbury MooseDec 22, 2022
@miss_s_b
No: sensible. All systems need a little slack in them, to cover unforeseen circumstances. Health and emergency services need a lot more spare capacity because you never know what's coming at you next. (Also it allows time for training, development, and not having to rush things that need more time.) The shower in power care nothing for this, or the public they are supposed to serve, only their own power and wealth. It's a kleptocracy.
Show threadRichard MischookDec 23, 2022
@miss_s_b so well said!!
Show threadDrewDec 23, 2022
@miss_s_b
"We need to synergistically engineer client focused solutions, that's a given, but what about the fungibility factor in our in-house through - put? Leveraged margins require.." Oh, sod it, I can't keep it up. Let's just look after each other instead😏
Show threadJudi SutherlandDec 23, 2022
@miss_s_b There are empty beds, because there are wards that have been closed and mothballed. There are inefficiencies - check out the money spent on PFI, check out the ‘internal market’. Ask what ‘NHS Property Services’ does, or how it controls what happens in hospitals in terms of money rather than clinical need.
Show thread🦇 Jennie Rigg 🏳️‍🌈 (she/her)Dec 23, 2022
@judisutherland yeah I live in Calderdale, you don't need to tell me about PFI, but that's not what tory ministers mean when they say "efficiency", is it?