It’s a moment of nervousness I don’t really like. Strangers on a train, asking about our likely arrival time. Is that the extent of the chat, or are the two chaps sharing our Virgin East Coast table thinking it’s just the start?
I do realise that friendly people being friendly is not really the basis for anxiety. As a London commuter however - I’m trying to work out if I’ve been smiled at more than sworn at - maybe less an overblown reaction. Oh great. We’re chatting. Nerves continue. I leave my laptop open as a physical manifestation of my discomfort.
They’re lovely. I’m an idiot. They’re interested in the NHS, and we exchange fairly expected chat. GPs: Them: “Overpaid!” Us: “Well, not really”. Managers: “Far too many!” “Do you not have managers in your business?” Finance: “So much waste!” “Yes, but NHS not alone”. MPs: “Wouldn’t employ them in my business!” “Ok, might agree.”
They’re in energy. Well, sort of. They help finance deals which result in power plants being built. This is interesting. My laptop now shut.
Power, and the more-closely-linked-than-I’d-realised topic of waste, are issues which exist at the corner of your eye, occasionally coming into focus but never for long enough to warrant serious examination. Renewables are cheaper than they were now aren’t they? We’re doing Hinkley Point with the Chinese, so that will surely help.
There are issues to think about. 54% of our gas is imported. Costs have risen sharply over recent months, largely because of the devaluation of the pound. There’s appetite for new power plants in the UK, but invariably projects are risky and timescales long.
"I don’t know whether this is genius or silly. Spoiler alert: this blog isn’t going to tell you. But it made me try to think through, if it was a good idea, what it would require to happen across the NHS? "
The gentlemen – we never did exchange names, and have no idea what their business was called – want to build power plants next to hospitals. This would mean cheaper disposal of clinical waste (up to £600 a tonne apparently), and cheap production of energy to fuel all those scanners and strip-lights, bleepers and beds.
I don’t know whether this is genius or silly. Spoiler alert: this blog isn’t going to tell you. But it made me try to think through, if it was a good idea, what it would require to happen across the NHS? It would be innovative, without much precedence (although something similar has happened in Cambridge). It would result in benefits in the long-term, probably not reaching full potential for a decade or more. It would mean hand-in-glove working with the private sector, probably in some form of, wait for it, private finance initiative.
But let’s stick with it, taking it as read for these purposes that it is going to result in great value in the long-term. Would anyone go for it?
I’d be amazed if they did. You would need to be creative enough to see the opportunity, and brave enough to think you could weather all of the political flak associated with risky innovation (let alone the private sector). But you would also need a level of managerial-bandwidth to be able to accommodate thinking through an issue which may cause significant short-term pain, regardless of the long-term reward.
In a different conversation earlier in the day, I’d heard the term ‘time-austerity’ for the first time. I like it. The reduction in people’s time to think, their head-space to ponder, is often one of the first casualties of any financial squeeze. It’s a hard case to prioritise the strategy team at the expense of the frontline.
If our train companions managed to speak to a hospital chief executive – another unexpected conversation requiring a write-up – I would put good money on the outcome being one of: interesting idea, have other priorities today, come back in a year perhaps and we’ll see. And in a year? Will our leaders have had a sack of time delivered in the post? Will they even still be there? The idea fades away, a decade passes, the lost benefit goes unnoticed. Unnoticed everywhere that is other than the savings that would have been realised, the extra staff employed, the patients’ care improved, the lives happier and healthier.
This blog is not an ad for building power plants next to hospitals (insert jokes about a lot of hot-air here). But it is a bright neon sign for having a time-span longer than Jeremy Hunt’s next performance meeting. Is there any £100bn industry anywhere in the world which is as fixated on short term performance as we currently are?
In the NHS in 2016 we’re not losing sleep over the opportunity cost of missed innovations. Instead, we’re already wide awake worrying about financial costs, regulatory costs, personal costs of failing to keep a firm grip. The rub is that without spending time now to lay the foundations for a more efficient future we’re going to be awake for a very long time.