Nurses should spend less time helping patients and more time ordering bandages

I was speaking to the absolute epitome of a pub bore. Flapping his jaws about how the problem with the NHS was too many admin staff doing absolutely nothing.

"Quite right!" I said, feverishly agreeing with his red-faced ranting, "Nurses should spend less time helping patients and more time ordering bandages!"

He paused, slightly, as the gears in his brain started grinding. "Well, no, not like that. Obviously."

I agreed again, "Too true. Doctors shouldn't be installing computers either. They should be co-ordinating those who install computers."

He spluttered, "You're twisting my words!"

But was I? Really?

I'm sure there is some waste in the NHS. There's waste in all organisations. But most of what people think of as bloated middle-management is the boring work of keeping an organisation running.

Once an organisation gets beyond a certain size, it needs people to help manage the organisation itself. I've worked at a startup where the engineers had to take time out of their day to build desks because the CEO didn't have enough cash to pay for delivery and assembly. I've been at corporates where managers spent about a day a week approving timesheets and running payroll - because a professional payroll department was too much of an overhead. Memorably, one company announced that they were getting rid of the tea-ladies who carted around an urn and selection of cakes - rather than having a cuppa at their desks, people left the building for half an hour on a group beverage run.

In all those cases, relentlessly focussing on the "core" mission had a moderate to severe impact on delivery.

Should we try to reduce the unnecessary administrative burden and overhead of our processes? Yes! That's an undoubted good idea. But what is "unnecessary"?

Here's the part where you tell me that the NHS shouldn't be providing... oh... I don't know... racial sensitivity training or coloured lanyards or pagers. Fine. Whatever. You have your bugbears and I have mine.

But the inescapable facts are that non-frontline services need to be performed to support the frontline. Without a payroll team to ensure people get paid, even the most dedicate nurse won't stick around for long. Without someone to tell the cleaners which toilets need cleaning, and researching the most cost effective way to buy bleach, and dealing with the fallout when there's interpersonal conflict - the dirt piles up and people get sicker. Without someone forecasting bandage use, the optimal number to have in storage, the rotation of stock, monitoring the quality of goods delivered - you end up with insufficient bandages or paying too much to store bandages.

Just because you don't understand how the world works, doesn't mean the world doesn't work properly. And just because the world is broken, doesn't mean it is broken in the way you think it is.