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\u201cThere are five things about the NHS that are not sustainable,\u201d said Phil Morley, chief executive of Hull and East Yorkshire Trust, in the middle of a conference last week on sustainability and health. He spoke like Cicero, only with more humour and a strong Northern accent. The conference was about environmental sustainability, but Morley painted on a broader canvas. Although they might simultaneously be horrified, his troops must surely be inspired by his rhetoric.<\/p>\n
\u00a0The first thing that is not sustainable is the amount of resources the NHS consumes. How many pages of A4 paper do you think my trust uses a year, he asked the audience. People thought tens of thousands, but it\u2019s 16 million. What is the cost of a unit of blood? The answer is \u00a3450, and yet too often blood that is not transfused is left to warm up and wasted. Morley would like everything to be labelled with its cost.<\/p>\n
Money is the second thing that is not sustainable. Imagine, he told the audience, putting a pound into a slot every second. It would take just over 11 days to pay a million pounds, but to pay off the nation\u2019s debt would take 33 500 years. Hull has to save \u00a325m a year on a budget of around \u00a3500m. Seventy per cent of the cost is staff, and so there will have to be fewer staff\u2014and 90% of the staff are doctors and nurses. Yet the service can\u2019t be delivered with 2000 fewer staff, and productivity has gone down. There will have to be less estate, and each member of staff has to save \u00a33000. How can it be done?<\/p>\n
One way is changing patient expectations, and they are the third thing that is \u201ctotally unsustainable.\u201d The hospital in Hull has just done a third hip replacement on a woman of 90. A mother in her 20s brought her 7 year old into casualty crying because his hamster had died. A family of five came to casualty because they all had head lice.<\/p>\n
Morley works half a day a month somewhere in the NHS, and one day he worked as a secretary in orthopaedics. He rang a man to tell him that his shoulder replacement would be next Thursday. It\u2019s a complicated business to get everything coordinated for such an operation, but the man said \u201cOh I can\u2019t do Thursday. Can you make it Friday?\u201d You wouldn\u2019t,\u201d said Morley, \u201csay to an airline \u2018I can\u2019t make 9, can you get the plane to leave at 9.30?\u2019 We have to tell people what we can do, what we can\u2019t do, and what they have to do for themselves.\u201d That\u2019s hard for professionals, he added; they want to help.<\/p>\n
\u00a0Really beginning to get into his stride, Morley said that fourth thing that is not unsustainable is \u201cthe way we treat our patients.\u201d What\u2019s the biggest killer in the Britain, he asked the audience. People knew it was cardiovascular disease. What\u2019s the second? \u201cIt\u2019s not cancer, it\u2019s being in hospital. The NHS kills more people than cancer does.\u201d<\/p>\n
\u00a0Then he told the story of a 75 year old woman who\u2019d come to see him. She was tiny and very neat. She said how she\u2019d come to hospital one night with her husband who had had a heart attack. She and her husband had been married for 50 years and hadn\u2019t spent a night apart. She wanted to stay with her husband, but the nurse told her to go home. \u201cBe sure to ring me,\u201d the woman said, \u201cif anything happens.\u201d The nurse promised, and the woman went home and waited nervously by the phone all night. Unable to wait any longer she went back to the hospital in the morning. The nurses were busy, but the woman saw that her husband\u2019s bed was empty. \u201cHe died last night and was asking for you at the end,\u201d said the patient in the next bed.<\/p>\n
The woman asked to speak to the nurse who had told her to go home and hadn\u2019t rung, but the nurse had refused and been supported by her union. The woman simply wanted her to say sorry.<\/p>\n
Morley countered this story with one of exemplary behaviour, but his fifth thing that was unsustainable was \u201cthe way we treat our staff.\u201d NHS staff are the most valuable thing we have, he said, because staff who are well looked after look after patients well. But working in casualty he sees staff being cursed and hit and patients saying \u201cGimme, gimme, gimme.\u201d Morley asks other leaders in the NHS \u201cHow were you inspired today?\u201d Leaders need to be inspired by what they do. \u201cIf NHS leaders are not inspired by the NHS then they should go and work in Sainsbury\u2019s.\u201d<\/p>\n