On first reading, yesterday’s report in the Western Mail, that Wales’ health boards do not know how many patients are receiving radiotherapy treatment, nor what the cost of that treatment is, seemed quite ‘shocking’ or ‘staggering’ to use some favourite words from politicians’ press releases. It seems inherently obvious that they ought to know such things, doesn’t it? But then I remembered a dictum of one of my old science teachers – “that which is obvious isn’t necessarily true”.
Jumping from an inability to answer some very specific questions about the detail of expenditure on one particular type of treatment to an accusation of ‘financial ineptitude’ as the leader of the Lib Dems has done might make for good headlines, but doesn’t necessarily reflect reality. There are, as anyone managing a large budget will know, many different ways of analysing expenditure in order to manage and control it; an inability to respond to a newspaper’s request to analyse it in one particular way does not, in itself, mean that there is a lack of control.
One of the challenges for those managing a large and complex organisation like the NHS is to ensure that they concentrate their attention on key information, and don’t get drowned in mere data. Finding the right balance can be harder than it looks. I don’t know whether they’ve got the balance right or not – and yesterday’s story gave me no help at all to improve my understanding. The most that I can say is that there are some questions which the external auditors ought to look at to satisfy themselves that expenditure is being properly controlled.
What I do know is that ensuring that data is kept in a format which will enable any and every question to be answered on demand is not likely to be the most productive use of resources. And those criticising the inability to answer this particular question seem to have complained often enough in the past about the numbers of bureaucrats and managers in the NHS. Asking for more detailed record-keeping seems inconsistent to say the least.
Oscar Wilde described a cynic as “A man who knows the price of everything and the value of nothing”. I don’t want a health service which simply ignores price issues; but I do want one which understands value as well.