Thursday, 24 February 2011

Do you REALLY want to Save the NHS?

It's nearly too late. NHS "efficiency savings" are being finalised - 20 Billion pounds worth of them and yesterday, False Economy revealed that over 50,000 jobs will be lost and they will include doctors, nurses, dentists, paramedics and all other front-line staff.

So could the NHS ever have saved this eye-watering amount without patient care suffering?

Not only do I believe they could have, but I believe they might have improved both patient care and the working lives of staff. I want to tell you why and it really matters to me. It won't be short and snappy - you can't save the NHS in a few paragraphs - but I do believe it's vital.

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Before we can suggest solutions, we need to understand a little of the history of the NHS. We need to remember how it came to be what it is today.

We couldn't do much back in the 50s when the NHS was founded. A few operations, antibiotics, x-rays and basic treatment. Over the years, wonders like MRI and CT scanners have launched diagnostics into a new millennium, miraculous surgeons have developed organ transplants and left almost no cell of the human body unreachable. Brilliant professors made leaps in treatment and medicines that mean we live many years longer and survive thousands of illnesses and accidents that previously would have killed us. Premature babies can now be viable from as little as 23 weeks and a dazzling array of specialisms and medications now come together to ensure they survive.

As each of these miracles unfolded, a new department got "tagged on" to the system. New departments had to communicate with one another. If a whole new branch of medicine emerged, existing staff had to learn about it and understand how to use it. Hardly a week has gone by since its inception, when the NHS hasn't discovered something new or "tagged" something else onto the system. The many branches and tentacles and support networks and community arms swamped the modest original model decades ago.

Then came computers. A deathly slow, inefficient system from the 80s limped on for years too long and that too was added to and modified every time something new came along. Over the years, this programme or that database emerged, but soon one programme couldn't communicate with another and wards could't talk to dieticians or radiologists couldn't talk to consultants. Tests got ordered but lost or appointment systems crashed and the NHS waded on, like Gulliver, with hundreds of thousands of Lilliputians inadvertently holding him back.

Add to this politics. Short termism. Any government elected for four or five years will aim to make the most impact for the least cost in that time. Never mind what happens after the next election, as long as it holds together long enough to look effective. Never mind the patients that suffer or the nurses and doctors who want to scream all day long at the farcical systems and routines of their daily working lives. Each new government "tags on" another few modifications and make the whole thing even more complicated and inefficient.

This will NEVER take the NHS forward. It will always be run on the egos of politicians and never on the needs of those that use it and work within it.

It doesn't help that the NHS started its life in conflict. The public, the Labour Party and most nurses were fiercely in favour. Consultants, the Conservative Party and initially, GPs were fiercely against. The two were dragged together by the sheer force of nature that was Nye Bevan, but for literally decades they were uncomfortable bedfellows. Nurses were often undervalued or their skills dismissed and patients were often ignored as individuals. There was an elitist hierarchy built into the system that has often been too slowly broken down. The BMA was almost entirely self-governing and a culture of silence ensured that mistakes were usually hushed up, whistle-blowers frowned upon and the more highly qualified the staff, the harder they were to dismiss. None of this served the patient and has only worsened since "compensation culture" took a hold. Hospitals are now terrified of being sued as well.

You might think I'm scoring a cheap political point by pointing out that Labour supported the NHS while many Tories opposed it. I'm not. Combative politicians, by definition, disagree over the future of the NHS, and this conflict has ensured a total lack of stability and forward planning over the years.

This will NEVER take the NHS forward. It will always be run on the egos of politicians and never on the needs of those that use it and work within it.

The problems need enormous solutions. They need a cross party commitment to remove the NHS from politics altogether. To set up a modernisation fund that runs into 10s of billions - all of which would pay for itself many times over - over time.

Firstly,we need to design a bespoke computer system, designed from scratch, that could cope with the unparalleled complexities of providing good patient care. Systems that made life easier, that meant anyone could communicate with anyone else, that was intuitive enough to pre order regular appointments or order discharge medications so that they are ready in minutes rather than hours. Labour looked at doing this, but found that it was far too expensive and long term, Why spend all that money on the success of some future government? In the end, this would permanently save billions a year in missed appointments, double bookings, lost bookings, wasted orders, bed blocking and pointless delays. In the end

But if you really want to save big sums of money in the NHS there is only one way of doing it. Ask the people who work in it. And the people treated by it. What on earth is the point of asking MPs or focus groups or costly management consultancy firms to save the money? That's just more tinkering. The only way NHS staff will feel inspired to save that money for you is to ask them how. To really ask them and to listen to and act upon the answers. What happened to all those public "consultations" and "surveys" the coalition published online? The thousands of people who commented with suggestions on how to save money?

I imagine they suddenly realised that a genuine consultation of staff and patients would take years. Every job in the NHS, from porter to professor, is packed with farcical wastes of time and money every day. One will never improve without the other, because the system relies on each separate department to work together in order to function. The porter waits hours a day because of bad communication, a professor has research grants pulled by new governments or because of cuts. Nurses end up spending more of their time trying to sort out the messes created by it all than they do caring for patients. If every last person in the NHS was asked "What is wrong and how do we fix it?" we would get the answers we need. We wouldn't get them immediately, but in the end we could create an NHS fit for the 21st century that really was the envy of the world again. In the end.


Finally there must be a mass standardisation of care across every trust, in every GP's surgery up and down the country. At the moment, a brilliant surgeon can develop a procedure, use it successfully for decades, but it might never filter out to the regions or be used by his or her colleagues. Care on one specialist ward can differ wildly from another. The NHS must decide best practise in every discipline and roll it out everywhere. Regulation should be in the hands of an independent body, not thousands of independent boards all doing their own things. The "postcode lottery" is not all about money, it's also a symptom of disparate groups - who will always vary in expertise and vision - behaving like independent states.

As an excuse for demolishing the NHS altogether and replacing it with a private system, we are often told that enormous, institutional public services like the NHS will never provide good customer service. We are told it gets bloated and lazy. What an enormous heap of claptrap that is.

Let me give you another reason why the NHS can't always provide excellent service. This is a vast workforce with no say over the direction of their company. Every 4 or 5 years they get a new set of bosses, who muck everything about without asking if it's a good idea. They hire people you don't need or fire people you do. They decide your wages or demand that you work harder with fewer staff. None of the managers or CEOs of the company get a say, none of the staff, just a new "board of directors" from the remote bubble of Westminster that never visit any of the branches. When you put it like that, it's ridiculous isn't it?

Here's an idea - why not suggest that the NHS runs itself? No more politicians, just a cross party agreement on future policy and then a Co-Operative of the staff? For every efficiency found or system improvement taken on, the department responsible could earn a percentage of the saving to use to make their own improvements, or to offer as pay incentives or bonuses. Finally, once and for all, why don't we empower the people who know the system best to get on with running it? Why don't we give them a stake in their own futures, allow them to plan for the future, give them back a pride in what they do and show that we value and trust them rather than constantly undermining them?

No-one else can do it, only the staff, but on the whole they are way beyond trusting any new scheme or consultation. They've been let down so often they've learnt to be a pretty cynical bunch.

How about patients? How often do you watch Newsnight or SKY News or the Daily Politics and see a debate over healthcare taking place between two or three patients? Politicians never ask us either. Some hospitals however, make great attempts to involve patients on their boards, or in planning staff training. Many have done endless studies into mental health care or chronic care or elderly care and their expertise and best practises can - and must - be rolled out across every hospital. Imagine asking hundreds of thousands of long term patients where the system wastes money? We know! We see the £1000 bags of liquid feed get lost or wasted, we see the £2000 ampoules of drugs thrown away because doses are prescribed wrong or they're not stored properly.

The NHS is our largest expenditure and will only cost more and more as people live even longer, even more miraculous discoveries are made and even more efficient treatments are developed. The answer is to get it fit for purpose now. If we carry on using it as a political football, it will just become less and less able to cope with the ever increasing pressures it will certainly face in the future.

People will read this and say "Oh, that will never happen. Politicians working together? Co-operative of the staff? Spending Billions of pounds up front?

Well, it could happen. We could make it happen. If Nye Bevan could set up the entire NHS in less than a year, in the face of violent opposition at a time when we had the largest deficit of all time then we could decide to end the short term mentality that so weakens the NHS today. We could invest the money to make it happen and know that all those IT contracts and all that private sector involvement would boost the economy and create jobs.

We could take the NHS away from politicians. We could make them agree. We were promised a "new politics" after all, so lets demand it. Of all the issues we vote on, the public (if not the politicians) agree overwhelmingly that we love the NHS, we're proud of it and we don't want to lose it. We could stand up and say that enough is enough, that we don't want politicians and their quests for glory holding our NHS back any more.

Will we? I hope with all my heart that we do.


**Please help me suggest this to the rest of the country. Once again, please link, tweet, share or write to your MP. If our politicians are too timid or blinkered to propose radical solutions to enormous problems, then I believe, it's time we showed them how. Thanks

31 comments:

  1. Sue,

    I will pass this on to who I can.

    √Čoin

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  2. Thanks Eoin and Syzygy Sue!! I can always rely on you two.

    A Co-Operative NHS eh? Bet that'll ruffle a few feathers :))

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  3. Am spreading the word, Sue. Good Luck.

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  4. "Here's an idea - why not suggest that the NHS runs itself? No more politicians, just a cross party agreement on future policy and then a Co-Operative of the staff? "

    LOL! So it's bad for Co-Operatives of staff to run libraries, but it's OK for them to run the NHS?

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  5. twitted by a southerner in the US.

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  6. Happy to pass this on by whatever means. Systems have failings everywhere, including here in France where bureaucracy is mind-boggling at times. But one thing that I have long thought the NHS could learn from the French is patient responsibility. In the UK we were spoonfed and yet given very little REAL information about our own health. Here we have to take more responsibility. For example when we go for an X-Ray we are GIVEN the thing and it's up to us to take it to the appropriate specialist. If we need a blood test we go to the local laboratory and make our own appointment before getting the results which we take back to our GP or specialist. This must save a huge amount in cross-communication at the same time as minimising error. What a pity that EU partners don't talk to each other and share ideas about things as basic as healthcare.

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  7. But does the criticism of the GPs commissioning services not apply to this too? That GPs are best at being GPs, and nurses are best at being nurses, and we are better employed using their talents and skills in those ways, than in commissioning and management?

    And do the criticisms of the Big Society not apply to? That those who shout the loudest will get the most? And those most *able* to shout the loudest? And that it's a way to get people to do things for free that the government should be providing?

    How to stop privatisation if it is no longer nationalised?

    Not being difficult here, genuinely trying to understand!

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  8. Well exactly. I really like this. But in a cack-handed kind of way this is exactly what the government is trying to do? The Co-op part at least, not the investment or mass consultation part.

    They are removing politicians from the NHS and allowing GP's, Hospitals etc to set themselves up as self-run trusts. And removing political control from the NHS by handing it over to the trusts and comissioning groups and setting up quangos to act as regulators for the whole thing.

    This is precisely what the left has been criticising though. Turning the NHS from a centralised, monolithic, politically controlled state organisation. Apparently this is 'destroying the NHS'.

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  9. Sue being a child of the 50's, I remember my siblings and myself being taken to the clinic to be immunised against Diphtheria, whooping cough, tetanus and polio. Polio was a killer back then, so even from its conception the NHS was making a real difference to the lives of ordinary children from ordinary and under-privileged backgrounds.

    I have worked in the NHS as a senior nurse for a great many years, if you asked any person at any one time the main thing they would like to see happen, it would be to take the NHS away from political interference. However, this government in particular would say that this is what they are doing, do not be fooled "THEY ARE NOT"!
    What this government is doing is reckless beyond extreme, what they did to the NHS during their their 19 years was criminally reckless, I know I was one that had to try and work with all the "Ken and Barbie" NON medically trained managers they foisted upon us who told us what to do and when to do it, and what supplies we could and could not have for our patients, wards and departments. Let them tell the relatives of the patient I lost because I had did not have an intubation tube small enough for her on an adult ward, I was told it was not necessary in my crash trolley, by the time we got one from the paediatric wards across the other side of the hospital it was too late! I shudder at the memories of the Tory run NHS and if you think this is a cheap shot, that is up to you, I find nothing cheap about the loss of a human life in those circumstances. It obviously bothers me because many years later it still plays out in my mind as if it were yesterday and I still feel like it was my fault "somehow".
    Before people rush to criticise the last Labour governments they should remember that we had to stabilise the NHS before we could even think of the treatment to save it and that alone took billions of pounds.

    We could stop these insane reforms now that are not only costly but will result in premature deaths of some people. we should have the debate about where to take the NHS for the future, we should save the £3 billion that the Tories are spending on these totally certifiably insane reforms and we should start the fund that will see the NHS run efficiently with that money instead of wasting it. The reforms are said to be costing £3 billion, I believe they will cost far in excess of that and people should ask why it is the government can suddenly find this amount of money at a time they are busy telling us we are broke!

    Could it just possibly be that these NHS reforms and the GP consortia are being used as fig leaves to conceal the d full-scale privatisation of the NHS?

    By and large I support what Sue has suggested, however, in order to take the NHS out of politics first we need the debate and these insane reforms halted immediately.

    Sue have tweeted, posted, linked and recommended and also done a few other things to help spread this around. x

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  10. The German NHS has a computer system which seems to work. Can't they just buy that? Why does everything the NHS orders have to be so expensive? Do they not live in the real world and pay real prices? I think people who try to change the NHS should do a world tour of other health systems and then take the best from each one. Why do we need massive hospitals with long waiting lists? There is so much that could be improved, but it would need a complete re-think of the bodies that run the NHS, and I can't see that ever happen.

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  11. Just a few points from someone who has worked in the NHS since the early 80s, as well as in other countries in the EU and the US.
    1) I agree that certain EU systems promote a sense of responsibility in patients (France and Germany coming to mind). Both systems provide better care than the UK for the majority of patients. Cost is shared between the state and the individual- currently an average person would pay less than our NI contributions (although top-ups are allowed which increases an individuals cost). Every patient gets a bill so cost is known and depending on your provider you may sometimes have to pay up front.
    2) Recent comments about hospital food- in most EU hospitals you are charged hotel fees of around £6 a day for the first 2 weeks- again you can decide to pay yourself or claim through insurance.
    3) Our IT systems....hmmm...having worked in Germany, I have never understood why the UK didn't just buy this system, rather than trying to piggyback onto a lamentable DOS based system. I have yet to have a competent IT person explain this to me....
    4) Most of the good EU systems pay more %GDP into healthcare than we do. Same goes for the US. More money does not necessarily mean better care (having worked in the US county system I can vouch for this).
    5) Countries like Germany, Switzerland and France all have different schemes but the general underlying trends are the same. The role of the state is to ensure that patients are treated fairly...they do not run the hospitals, instead they control how much a certain procedure can be charged at as well as deciding what should be available to all. I left the UK under the previous tory government (I was an A&E sister at the time) to work in Germany and then the US. I left a system where patients were lying on trolleys for hours because there were no beds to put them in. Not the case under the German system. Unfortunately the case under the US County system. To be fair to the US, I also worked at a state of the art trauma centre in Bethesda where this was not the case.
    Not sure whether a co-operative is the way to go however. I do think the state needs to stop interfering with the day to day running and that maybe its time to rethink how the system is financed. In the last 15 years or so, many, many papers have been written comparing the best and worst of most worldwide healthcare systems. I feel that the biggest problem in the UK is our obsession with being seen to be "fair" to all. Please don't shoot the messenger- what I mean is that you will never be able to stop those who earn more money from spending it. What is wrong with using your extra cash to pay for window dressing (most NHS hospitals offer privare rooms etc) as long as this is not hurting anyone else? We already have top up schemes such as PPI and the like and those with lots of money will always be able to circumvent the system...so maybe we should stop concentrating on trying to stop them and look at how other countries have managed to provide a decent level of care for the poor without alienating others. One final thought- no other country has gone down this route- most realised early on that this level of state control would lead to excessive paperwork and ultimately cost more. What we need to be thinking about is how to introduce a fair, insurance based system with appropriate controls to ensure those who cannot pay for whatever reason are not excluded.

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  12. Dino-nurse I understand and agree with much of what you have written, however what is your understanding of the French system? I know a while back the French government were complaining their system was far too costly and were looking at our NHS.

    My fears for a system where people buy in healthcare from private companies is that for many this is simply not feasible. I am extremely reticent (to put it mildly) about the "any willing provider" system, because here is where the rot will seem to set in.

    With regard to your point about people with funds circumventing the system, yes it happens and I have no problem with that, if those people are treated in private hospitals. I do object to the introduction of more private patients into the NHS and I object to this for many reasons.

    The Tories have recently removed the cap which prevents NHS Trusts limiting the number of private patients it treats, I am horrified at this. We all know that a removal of that cap will result in private patients taking precedence over NHS patients for scanner times, scanner appointments, surgical procedures etc etc etc. Also what will define the the staff caring for private patients in hospitals? Are they to have their consultant and team private, yet be nursed by NHS nurses and nursing assistants and portered by NHS porters etc? So we will have a system where the consultant is being paid plus plus, for doctoring private patients, while the rest of the staff are on a wage freeze? Who pays for the use of NHS technology, supplies, equipment and operating theatres etc? Again a private surgeon assisted by NHS theatre staff?

    I know the government have made it look good by excusing their private patient cap removal by saying that all profits will be ploughed back into the hospital, but at what cost to NHS patients and the NHS?

    If the ratio of private patient to NHS patient grows rapidly (and I see this happening in cash strapped hospitals) then NHS waiting times for consultant appointments will grow and NHS waiting lists for surgery will grow. Indeed hospital waiting lists are already increasing rapidly.

    Even if private patients are treated in private hospitals, we all know that most private hospitals are simply unable to cope with some of the many emergencies that can arise and often the NHS ends up picking the tab up for failings in private medicine.

    I think this one issue alone clearly demonstrates how complex the NHS actually is and how crazy this Tory government's reforms actually are.

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  13. I have worked in France as an ICU nurse, albeit over a decade ago. I have friends who still work there and as far as I am aware, no EU country wants to adopt the system we have here. Most have concerns about an aging population and the longterm implications that this brings. Also that the costs of new innovations is constantly rising.
    Whilst I share you fears about the lowest common denominator, this has not happened in other countries within the original EU, due mainly to the constraints placed on them by government bodies. For example, in France and Switzerland, insurance companies are charged a set fee for a given procedure and are not allowed to pass any extra costs onto the client, unless they are "topping up", so you pay extra for a private room, not for a CT scan. Around 10% of hospitals in these countries are truely private as the costs of running such facilities are astronomical. 50% are so-called state hospitals (not the same as NHS, it means they will take all patients, so get the bulk of money from the state through compulsory insurance) and the remainder are a mix of not-for-profit organisations. The insurers also have to be seen to provide a good standard of care for those who cannot top-up or only have state funding.
    Most of the non profit hospitals stay afloat by attracting middle income patients who cannot afford totally private treatment, but can, say opt for a private room or cable tv for example. This does not seem to mean that treatments for poorer people are put on hold. The only problems I remember were in Germany and this was more to do with the paperwork around so-called free treatment...you had to be pre-approved by the state provider beforehand and this did seem to cause some delays, although I believe it has improved. Lets face it, a large percentage of the population will be paying a premium and never really using the healthcare system. As long as the insurers are made to spread the more costly patients between them fairly then the system stays afloat.
    My real issue is that all the scaremongouring will mean that things are left as they are and ultimately even more money will be wasted on more pointless rebranding. If we acted now and followed France and Germany, we could still retain the ideals of the NHS. If its left too late, those who are young/healthy and can pay for the odd elective procedure will already have left for the private sector and the NHS will be left with the more complex, costly patients and lets face it, we will be left with either having to vastly increase support which will not be popular or carry on rationing care. The worst example of this is the county system in the US- mainly in the poorer southern states (I would never go back). The best examples of not-for-profits are found in the northern US, or so I am told.
    Finally, whilst most private hospitals do not have proper ICUs due to the cost, when a private patient is transferred to an NHS ICU their insurance provider is charged (albeit reluntantly on their part due to the cost). It would not be ethical to deny ICU treatment to any patient, so from my point of view their point of origin is not the question. The same goes for non-nationals...their government/holiday insurance etc are chased by billing. As for fears around the influx of private patients swamping the NHS- at present less than 10% of the poulation have private healthcover and those that do are mainly using it for elective surgery. The bulk of NHS patients are medical and many of these would not be able to get private cover in the first place, as things stand. No private provider is voluntarily going to take on potentially costly patients and this is where the government needs to bring in controls, just like the other EU states I have mentioned. This way the cost of chronic care would be spread more equally. This is where the county system got it very, very wrong.

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  14. This is a great post Sue, I'll spread it everywhere I can.

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  15. I am not convinced that going down the same route as other EU countries is the answer. I know you are not saying this and I am not implying that you are, but such is any healthcare, no one size suits all. I realise that the majority of NHS patients are medical, but treating medical patients is often more costly than a say a day case procedure, especially now we have a vast amount of surgery being taken over by short hospital stays due to the advent of keyhole surgery. Surgery in the majority of cases is elected to cure the actual problem, eg appendicitis, cholecystectomies, tonsillectomies etc. You get the gist.
    The way things are at the moment we do not treat that many private patients in Trusts, but now the cap has been removed, I think we will see a sharp incline, also, if these reforms do go ahead the number of people opting for private care I believe will increase, I think this is born out by private healthcare providers because they are all gearing up for a boom! They would not be doing this if they had not done their market research. Although this has not yet been mentioned, I’m sure it will somewhere in the very near future, people will be allowed to opt out of paying a full NI in favour of taking their own health cover out, this will see a very sharp increase in the number of private patients, which is why I believe the cap to treating them has been removed in NHS Trusts, in readiness for the influx of private patients. This will under any event cause strain and pressure within the system and the introduction of the private market coupled with the any willing provider system could actually see NHS Trust shutting their doors and closing down. Now you say something needs to be written into the system to stop this and other anomalies that GP commissioning may cause, but this is the whole crux of the situation, this white paper has not allowed for anything like this and it is going to leave GPs, NHST trusts and their patients vulnerable. This government are just forcing this through parliament without proper consultation, without proper scrutiny and they have already started to implement it with the 140 pathfinder pilots up and down this country, and yet it has not been approved by parliament yet!
    The point I am making is that the NHS is always reforming, progressing and evolving it has to, but allowing nurses and doctors to control and run the NHS, I believe it does not have to change that drastically, certainly not like these insane reforms. This government admit that their own reforms are going to cause major disruption to the NHS, that is OK for them to say, they probably have the money for their families to be seen privately when things go wrong, but for the majority of ordinary people this will not be the case and they will start paying with their lives, it is almost inevitable.
    I do not think it is scaremongering to point out these problems, it is the debate we all should have been having before this white paper even went anywhere near parliament and now with the majority of GPs, physicians etc. voicing their grave doubts about these reforms, if the government are serious about listening to doctors, nurses and other healthcare professionals, then they should heed what they are being told.

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  16. Another fear I have is about GP consortia. Presumably they will be getting the same £80 billion budget that PCTs currently get and £20 billion enforced efficiency cuts will not be deducted from it? Even so, GPs budgets will be finite and apparently we are told that once GPs budgets are gone they are gone, they will not be able to apply anywhere for a top up funding grant which is currently the case for NHS Trusts. So what happens if one consortium happens to have more than their fair share of aging population? Or more than their share of treating disabled people. Or people with so-called self-afflicted chronic conditions, from drug or alcohol abuse? How is that going to work? Will the number of any such patients have to be limited by any one GP consortium? If so what happens when such patients cannot find permanent GP care? I can see this being a real problem and the creation of some kind of health vagrants drifting from emergency care to emergency care because that may be the only care they can receive. I see no provisions to stop this happening in fact I see the polar opposite.
    The way these reforms stand now, all I can see is an three tier healthcare being created, those that can get cover while they are young and relatively fit, which can change in an instant and general changes as people age, then people who can afford private healthcare and then people who cannot and they have absolutely no chance in the future of changing this, so what we will be left with? Probably the advent of hospitals specially designated to treat such patients. Also there is the problem of the cost of the premiums for private healthcare and companies categorically will not take on people with disabilities or chronic conditions and I doubt very much of they will take on anyone past a certain age. It doesn’t really matter that many people will not require that much healthcare now, at some point in their lives they may and we cannot really reform the system on a gamble like that.
    Why is the government rushing into these reforms? It is not as if the NHS is “broken”, in fact it enjoys the highest satisfaction rates. Yes there are pockets that need improvement, there is a problem with post code lottery medication, but I fail to see how rushing headlong in to these radical reforms is the treatment that is needed, why don’t we just fix those particular problems? They are hardly insurmountable.

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  17. whilst initially enthused by these proposals for the re-organization of the NHS,and removing it from political gameplay, I find myself sharing similar reservations to those expressed by incurable hippie

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  18. You don't make nurses and doctors take over the admin work!! It's not BS, lol

    You simply take the politicians out of it, that's all. They don't get to make arbitrary decisions based on ideology any more. Doctors decide about their patients, nurses decide about their wards etc.

    I'm NOT someone who believes the NHS is failing due to layers of inefficient management. My hospital employs 6000 people!! Just IMAGINE how many middle and higher level managers that would employ if it were a private company? And imagine how much the CEO would earn!!

    Managers didn't swallow up all the money, that's rubbish too - they made up just under 3% of total NHS staff. They made sure there were beds when needed, they scheduled departments and they made sure wards and services ran efficiently.

    Of course, if we sorted out the computer systems and politicians didn't keep making staff implement their ridiculous "improvements" every five minutes, we wouldn't NEED so many managers....

    There should be national standards, a national computer system and national budget, but staff should just be left to get on with their jobs and incentivised to make the system as caring and efficient as possible.

    What the coalition are doing (in the words of my consultant)n is simply transferring the budgetary hot potato from one group to another) Without the real long term will and MONEY to see change through, it'll only ever be more tinkering around the edges, except this time, they're threatening the whole thing.

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  19. Can I be you for a day please Sue?

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  20. Why on earth would you want to be me Julian?
    I'd probably say yes unless you have leprosy or something though :)

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  21. No, I don't have leprosy (eep, jinxed!), I'd just like to have some of your awesomeness. My local hospital was the first in the NHS and they're rightly proud of that fact. I intend to write to Kate Green about this when I've had time to muse on it myself (which may be Saturday, as I've a funeral type thing tomorrow).

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  22. Awesomeness, lol

    The rest of the country would only see my uselessness, nice to be awesome :))))

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  23. Just dropped in to say best of luck with at least the computer bits. As a user I found the systems non-existent rather than disintegrated and as a professional computer man I cannot understand why a systems analyst had not sorted it out long ago. I believe enough computer firms and management consultants have earned a pretty penny from this morass.

    Other than that i cannot comment on what sounds like 'make the NHS like the BBC' proposal. The Beeb is a commodity is it not and not subject to much political interference.

    Back to my political dotage.

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  24. Passion, Practice and Teamwork are what makes an organisation great.

    Being passionate about the work you do. You can see it in the performance. You really want to get it right.

    You practice hard. How much? The answer, 7 days a week. You really dedicate yourself to being the best at what you do.

    Teamwork is essential. Eat together, work together and support each other. There is no doubt that any of us could be great individual performers; but we work best as a team, selflessly, all the time, every time.

    So can government and the NHS ever achieve this?

    No organisation can thrive with constant politically led change, short term targets, inadequate IT and inefficient back office support systems.

    I think I am agreeing with Sue if I say that what is probably needed is more front line authority and responsibility; alongside more long term strategy from the top.

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  25. Wow, thanks for that comment Adam - You have excellent credentials for knowing if my suggestions are viable and it's always nice when experts agree with patients.

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  26. The German NHS has a computer system which seems to work. Can't they just buy that? - BECAUSE THEY KEEP PROCURING FROM FUJITSU/BT & MICROSOFT

    Why does everything the NHS orders have to be so expensive? Do they not live in the real world and pay real prices? BECAUSE LABOUR PRIVATISED NHS LOGISTICS TO DHL & WE WARNED IT WOULD COST MORE
    I think people who try to change the NHS should do a world tour of other health systems and then take the best from each one. AGREE
    Why do we need massive hospitals with long waiting lists? WE DON'T HAVE
    There is so much that could be improved, but it would need a complete re-think of the bodies that run the NHS, and I can't see that ever happen. ME NEITHER, THE OBSESSIVE COMPULSIVE POLITICAL MEDDLING DISORDER NEEDS TO STOP & PRIMARY CARE NEEDS A MASSIVE OVERHAUL....LIKE AT GP LEVEL...NEW CONTRACT PLUS NO DRUG BONUSES AND A BETTER/CHEAPER LINK TO SECONDARY CARE (HOSPITALS) TO GET EARLY INTERVENTION WITH SPECIALISTS TO SORT OUT YOUR ILLNESS BEFORE IT GETS TOO BAD AND SO SAVING HUGE AMOUNTS OF CASH

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  27. Good blog post! I'm just hoping someone listens to you and saves our NHS before its to late! politicians need to stay as far away as possible from our NHS!

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  28. Yes, Sue, a lot of sense I think. Quite a lot of overlap with ideas in my piece for Left Foot Forward. You can read this on my site at http://www.futureeconomics.org/2010/10/nhs-reform-for-worse-or-for-better

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