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  • Writer's pictureNick Hague and Paul Hague

Customer experience in the NHS and private sector

There can't be a better example of an organisation delivering poor customer experience than the NHS. This much loved organisation promises to look after us in times of need but it is failing badly. If you have the misfortune to visit NHS accident and emergency you should be prepared to wait hours before you receive treatment. If you are waiting for a knee or hip replacement, you will be waiting months. It is so bad that, despite the huge cost of the NHS, people are turning to private health care in droves - even though they have already paid for NHS treatment through their taxes.


The fact that people are turning to private healthcare exacerbates the problem. Consultants who used to work mainly within the NHS are taking on private patients and have less time to help those who are state funded. There is a shortage of trained medics at almost every level. GPs are a mixed bag with many suffering overwork. This is partly because most are part-timers (9 in 10 salaried GPs now work part time, according to a Pulse workload survey). Whatever, it is horrendously difficult to obtain a quick appointment.


We recently visited the Spires private hospital in Manchester in an attempt to see how they were coping. We were astonished at the contrast with the NHS. Nearly everybody who worked there has worked in the NHS. Disillusioned with the chaos and the low morale in the NHS they have migrated into private practice. Without exception the nurses, doctors and auxiliaries we interviewed were cheerful. Timelines and appointments are kept and the care patients receive is second to none. The hospital is rated as "outstanding".


What is this private hospital doing that empowers it to deliver great customer experience? The first thing to note is that every hospital, private or state run, has an element of chaos. Heart attacks don’t happen to order and when they occur, they must be dealt with straightaway. Medical emergencies are the norm in hospitals. This means that hospitals must be organised to deal with chaos. In the Spire it is organised chaos whereas in the NHS it is disorganised chaos.


In a any hospital there is a huge amount of bureaucracy. Almost everybody treating a patient will ask their name and date of birth. Depending on the treatment they will also repeatedly ask boring questions such as "which knee is it that is going to be replaced?". Boring though this may be, it is to eliminate chaos. Mistakes happen when checks aren’t made on patients and their problems.


OECD data estimates that the UK spends 1.2% of its current health expenditure on NHS administration versus an OECD average of 3%. It also appears that this relatively low spending on administration within the NHS is fragmented with outdated IT systems and superfluous paper filling processes in every part of the system. Although we would intuitively like to see more investment in staff and equipment in the NHS, the problem could be that the resources that currently exist are not used efficiently. Better administration could be part of the answer.


The biggest step-up however would be improved morale. When you work in a chaotic environment and receive constant criticisms from patients, journalists, and your bosses, it is difficult to feel good about your job. You know that patients matter and you want to do your best for them but you are held back by the madness.


Everyone working in the Spire hospital smiled and was happy. When we asked if they were trained to portray this affability it seems not. The ambience of the place is because outcomes are successful and there is a pride in working in a place that is classed as outstanding. Video screens around the hospital display vision and mission statements. Everyone knows the purpose of why they are there.

Search online for the mission, vision and values of the NHS and you find a variety of statements, all aspiring to high standards of excellence and putting patients at the heart of everything it does. The lack of consistency is probably because they are so far from being achieved and constantly being tweaked.


We are sure that sorting out the NHS isn’t easy. The answer must be to reduce the chaos and to reduce the chaos means better planning and systems.


"Good order is the foundation of all things" Edward Burke

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