High Peak Liberal Democrats

First and most importantly, hospitals are large, high tech and high skill businesses. They are continually investing in equipment, and the best hospitals will have motivated doctors, nurses and managers who take ownership of their jobs and are part of the process to continually improve the clinical excellence and effectiveness of the hospital. Hospitals share many of the challenges of excellence with manufacturing businesses.

What are the barriers to excellence? I will give just one: capacity.

I know of no business that can be excellent while running at maximum capacity most of the time. A business running continually at 100% capacity is fire fighting, lurching from one crisis to the next, lacking strategic direction and usually having a stressed and irritable staff.

A business that runs at, say a capacity between 70 and 100% will be under pressure for short intense periods, but will normally be under control and will be able to follow the right clinical path for every patient nearly all the time. A hospital can provide excellent care on this basis.

For most of my time on the ward, every bed was full. I don't know what happened when new patients were admitted through A & E. They couldn't come on to my ward. Some inefficient compromise will have had to take place, wasting staff time and reducing clinical effectiveness. In contrast, when a bed or two became free, they were sometimes taken by patients like me in for a while. On other occasions, patients with fractures were given a bed overnight so the fracture could be monitored and subsequently x-rayed. The free capacity allowed for clinical excellence.

I identified two structural reasons for the lack of bed availability. The first reason was that the patient, having finished their clinical care, had nowhere to go. It is a compelling argument for joined up interlinked NHS services like a business supply chain. Norman Lamb wrote on this subject on LDV on 14th May.

The second reason was the attitude of some patients. I was, frankly, appalled by the way a minority of patients treat the NHS. For them it is a 5* hotel, where they can walk in and out of the ward as they please and expect instant attention. The result of this attitude was that the clinical care that the hospital wanted to give was undermined and drawn out by the failure of the patient to cooperate. A patient who should be in for a couple of days would be in for a week. When I asked the nurses about this, they made it clear they were pretty powerless. And a reading of the NHS Constitution (and particularly page 11) gives about as clear a message of entitlement without responsibility as it is possible to give. The Labour Party has indeed hijacked the NHS. A Lib Dem NHS will always be about the rights of a completely universal service AND the patient responsibilities that go with it.

One last thing: competition. In my recent experience, competition was largely irrelevant. It was clinical excellence that was critical. Excellence exists in both the public and private sector. The NHS isn't a monopoly in the way the water companies are, and there is clearly a role for innovative excellent private companies within the NHS supply chain as part of a dynamic culture of an excellent health service.

* William Hobhouse is co-founder of the Liberal Democrat Campaign for Manufacturing and runs an industrial textile business in Rochdale