steve the skeptic
@policyskeptic.bsky.social
government policy, health policy, evidence, statistics and sometimes other topics
That doesn't mean it is easy
November 27, 2025 at 1:54 PM
That doesn't mean it is easy
So, stop focussing on claiming productivity is about more work or harder work. Understood properly it is about less work and more fulfilling work creating more value for patients.
November 27, 2025 at 1:54 PM
So, stop focussing on claiming productivity is about more work or harder work. Understood properly it is about less work and more fulfilling work creating more value for patients.
But it is possible and does have a big impact on productivity. When it works less activity leads to more output and better outcomes. And the work feels less futile, improving staff motivation...
November 27, 2025 at 1:54 PM
But it is possible and does have a big impact on productivity. When it works less activity leads to more output and better outcomes. And the work feels less futile, improving staff motivation...
Not least because it doesn't have enough operational managers, nor does it train medics or nurses in the management skills needed to understand how processes work...
November 27, 2025 at 1:54 PM
Not least because it doesn't have enough operational managers, nor does it train medics or nurses in the management skills needed to understand how processes work...
This isn't easy. It needs people to think about whole pathways for patients not just individual silos of activity. Pathways and processes often need major redesign to eliminate the causes of waste and the NHS has a very low capacity to do redesign...
November 27, 2025 at 1:54 PM
This isn't easy. It needs people to think about whole pathways for patients not just individual silos of activity. Pathways and processes often need major redesign to eliminate the causes of waste and the NHS has a very low capacity to do redesign...
Increasing value rather than increasing activity should be the goal. But, obviously, doing less wasted work frees up space, time and resources to do more useful work and to deliver more value...
November 27, 2025 at 1:54 PM
Increasing value rather than increasing activity should be the goal. But, obviously, doing less wasted work frees up space, time and resources to do more useful work and to deliver more value...
The better perspective on productivity focusses on value not activity. Value is about focussing on the results and outcomes, not on the amount of activity required to get those outcomes...
November 27, 2025 at 1:54 PM
The better perspective on productivity focusses on value not activity. Value is about focussing on the results and outcomes, not on the amount of activity required to get those outcomes...
In emergency care useless work (some call this failure demand or failure activity) may be the majority of the work done. Eliminating that work would greatly increase productivity...
November 27, 2025 at 1:54 PM
In emergency care useless work (some call this failure demand or failure activity) may be the majority of the work done. Eliminating that work would greatly increase productivity...
A disturbing proportion of activity in the NHS only happens because of failures in other parts of the treatment process (eg long waits in A&E happen because there are no free beds or diagnostic tests are redone because of failures to share previous results)...
November 27, 2025 at 1:54 PM
A disturbing proportion of activity in the NHS only happens because of failures in other parts of the treatment process (eg long waits in A&E happen because there are no free beds or diagnostic tests are redone because of failures to share previous results)...
A better perspective is to see productivity being improved by doing less work.
This is important because a great deal of actual NHS activity is "waste" that fails to add value to the patient or fails to improve outcomes...
This is important because a great deal of actual NHS activity is "waste" that fails to add value to the patient or fails to improve outcomes...
November 27, 2025 at 1:54 PM
A better perspective is to see productivity being improved by doing less work.
This is important because a great deal of actual NHS activity is "waste" that fails to add value to the patient or fails to improve outcomes...
This is important because a great deal of actual NHS activity is "waste" that fails to add value to the patient or fails to improve outcomes...
We need to reset the hierarchy of how policy is chosen. What matters is what works, not what is popular today. Forgetting that is the core problem.
November 24, 2025 at 12:36 PM
We need to reset the hierarchy of how policy is chosen. What matters is what works, not what is popular today. Forgetting that is the core problem.
But if governments keep steering policy by what IS popular today, they will sail in circles and never navigate to a better destination...
November 24, 2025 at 12:36 PM
But if governments keep steering policy by what IS popular today, they will sail in circles and never navigate to a better destination...
An effective government can't do without comms and short term poetical strategy, but their goal should be to sell difficult policy ideas not to generate policy. Some good ideas are unpopular and take time to deliver obvious gains...
November 24, 2025 at 12:36 PM
An effective government can't do without comms and short term poetical strategy, but their goal should be to sell difficult policy ideas not to generate policy. Some good ideas are unpopular and take time to deliver obvious gains...
Comms and short term political strategy are in charge of policy...
November 24, 2025 at 12:36 PM
Comms and short term political strategy are in charge of policy...
This means that the goal has become better headlines in tomorrow's media or short term opinion poll boosts, not actual achievement and improvement over time...
November 24, 2025 at 12:36 PM
This means that the goal has become better headlines in tomorrow's media or short term opinion poll boosts, not actual achievement and improvement over time...
So policies that might well lead to big improvements by the end of a government term but are unpopular in the short term or hard to explain to voters get dropped in favour of voter-pleasing policies now (even ones that might not work at all)...
November 24, 2025 at 12:36 PM
So policies that might well lead to big improvements by the end of a government term but are unpopular in the short term or hard to explain to voters get dropped in favour of voter-pleasing policies now (even ones that might not work at all)...
In short the decisions about which policies to pursue is driven by short term political popularity not by the long term effects of the policies...
November 24, 2025 at 12:36 PM
In short the decisions about which policies to pursue is driven by short term political popularity not by the long term effects of the policies...
So major decisions about what to do are determined by the popularity of policies with focus groups and opinion polls not by whether the ideas are likely to succeed in the long term...
November 24, 2025 at 12:36 PM
So major decisions about what to do are determined by the popularity of policies with focus groups and opinion polls not by whether the ideas are likely to succeed in the long term...