Thursday, 20 January 2011

The NHS juggernaut rolls on

Few people can deny that the NHS needs to change in order to make it more responsive to the people it’s supposed to serve, rather than the people it’s currently serving: mainly management bigwigs and staff.

So, on the face of it, the government’s move to slash bureaucracy seems like a good idea. Around 30% (or 21,000) NHS pen pushers are due to be wheeled away in their office chairs, to the local Job Centre, stopping on the way to cash their redundancy cheques for £1 billion. A mere 40,000 will remain in post to provide vital management functions; after all, policy documents and gender monitoring reports don’t write themselves, do they?

However, before you get the Champagne out to celebrate this bonfire of the bureaucrats, temper your joy with the fact that much of the work these managers were doing is now being passed to GPs; and we all know how generous and public-spirited our doctors are. With the average GP scraping by on just £105,000 a year (not including evenings and weekends) these front-line angels of the health service will no doubt take on this extra work for a very reasonable sum and we shall all be better served.

Sounds good, doesn’t it? We’re going to swap one bunch of paper pushers for another grasping faction of the medical fraternity. This is all going to go swimmingly. Dare I suggest that the health secretary's plans are going to be as easy to implement as pushing manure back into a cow with the aid of a paperclip.

Why do we seem to have so many problems running healthcare in the UK? I know other countries have their problems, but there’s something seriously amiss here. Are we sure that mucking around with a crumbling structure is going to make any difference at all? If we were talking about something like a sports club or a large corporation then I’d say give it a shot but this is people’s lives and pain we are gambling with.

On one hand politicians are trying to save money and stretch budgets while, on the other, the unions and medical profession are trying to stop any erosion in their members’ interests. In the meantime the poor voiceless souls in the middle – the patients – appear to have been entirely overlooked. No one has asked us what we really want. Still, the NHS wasn't set up for the exclusive benefit of the sick and the frail. Perhaps it’s time for a far more fundamental reform.


  1. "After all, policy documents and gender monitoring reports don’t write themselves, do they?"

    But maybe if the CQC didn't insist on the availability of policy documents which cover every aspect of healthcare provision (and which are an auditable part of a hospital or clinic's governance), maybe the so-called pen pushers wouldn't spend so much time on them. But of course, if the CQC didn't insist on good governance, how much more quickly would the edifice of healthcare provision crumble, and to what cost in terms of quality of service to the patient?

    "In the meantime the poor voiceless souls in the middle – the patients – appear to have been entirely overlooked. No one has asked us what we really want."

    Okay, then: what do you want? You spend a lot of time on this blog slating the NHS but I don't see much in the way of suggestions, ideas or constructive comments.

    So, please, edify us? What do you want? How would you make it better?

  2. Neil, I think your response tells us a lot about NHS management. However, I'm happy to list here a few of the things I want from the NHS:

    1 I want to be able to eat food that's fit for human consumption and that will help me to heal so I can leave hospital sooner.

    2 I want to be given the correct drugs, on time and by a nurse who can speak and communicate with me in my own language.

    3 I want to be given help to wash when I am unable to wash myself

    4 I want a hospital that's clean and hygienic that doesn't need to be shut down for two weeks at a time because of outbreaks of MRSA, norovirus and c diff.

    5 I want staff to administer pain relief and not to withhold such relief as a punishment for elderly patients who are noisy or uncooperative.

    6 I want an NHS that treats its patients with dignity and respect.

    There are six things to be going on with, Neil. And how would I propose to do this? Good management and proper performance-related pay rather than fat cat CEOs being paid £200k a year. I'd like the payment for the NHS to be provided through general taxation but I'd like to see hospitals owned and run by not-for-profit private entities in a fashion similar to many European systems.

  3. "Neil, I think your response tells us a lot about NHS management."

    How exactly? Is that an implication that my comments are made from an NHS management standpoint? I don't even work for the NHS.

    Kudos to you, though, for delineating those six points, most of which I'm in complete agreement with (particularly number 1).

    Re: issues with closures for MRSA ... that's kind of a poisoned chalice, isn't it? Hospitals needs must have hygiene and cleaniness in mind at all times, however that doesn't change the fact that by their very nature they're full of ill people. A hospital itself doesn't cultivate MRSA - MRSA is brought in my an infected patient. Kind of a no-win situation there.

    The private model is a tricky proposition. It's all very well saying "not-for-profit private entities", but a private entity is inevitably profit-driven, corporate-modelled and beholden to its stakeholders, ie. the ideal breeding ground for that exact same genus of fat cat CEOs.

    I'm all for trimming back senior management salaries - in any sector - but I do think better packages for grass roots nursing and admin staff would reflect in a higher calibre of candidates for crucial positions. Performance related pay is, again, another good idea in theory but necessitates time-consuming review processes that distract from the actual job and require the utilisation of administrative functions that could be better employed in patient-benefiting roles.

    Having said all that, I think your six points could be the basis of a longer post that might serve as a rallying call towards the aspects of the NHS structure that can be addressed and improved.

  4. I meant that your knowledge about CQC and it's demands tells us a lot about how NHS management is chasing its tail. I didn't imagine you worked for the NHS as I don't know anything about you other than you appear to be quite knowledgeable about the workings of the NHS.

    As for hospital infections, I would start by stopping nurses walking or driving to work in their uniforms. I see it every day as I live almost next door to a hospital. I nearly died because my ward was closed to visitors for a ten day stretch due to a C DIff outbreak. My wife was denied access to the ward and during that time I deteriorated thanks for poor nursing and observation. If my wife had been allowed to see me should would have noted my deterioration and been able to alert the staff. I was within two hours of death thanks to a raging infection that the staff didn't notice despite a very high temperature and a CRP level that was off the scale. I would be walking today if the ward staff had paid closer attention. The ward I was on was filthy and very badly run. It makes me really angry so you'll forgive me if I get passionate and heated about the NHS shortcomings.

  5. Your passion is understandable given the appalling experience you had. I'm an avid reader of your blog and my recent comments really span from the fact that when I started reading Notes From A Hospital Bed about a year ago, the general tone of your writing was acerbic, witty and made its point very well. You were highly accomplished at pointing out a shortcoming and making me laugh at the same time. I've felt that the tone has changed recently to a more openly hostile critique. More of a polemic than the earlier satirical approach (God, I sound like critics of Woody Allen's late period, preferring "the earlier, funnier ones"!)

    But I do appreciate the reasons why you run the blog and your standard of writing remains high. If I've disagreed on the occasions I've commented, it's because my own experience has shown me a completely different side to the NHS.

  6. The dreadful food was a gift to funny writing, as was being tied to a bed for ten weeks. My experience affected me deeply and when I left hospital I vowed I would try to do something to alter the shortcomings I saw. Watch the programme I've made on hospital food.., Channel 4 on Feb 7 and things may become clearer. I am basically a polemicist because I am a journalist/columnist... It's what I do. I'm just trying to use words to make a difference.

  7. I'll certainly tune into the C4 documentary.

  8. Good discussion from you both: we need the voices of reason to be heard amongst the various political factions pedalling for their own agendas.
    I know the infections come in from outside but wards used to be scrubbed daily, every single inch, with hot soap and water and of course staff had to change into sterile uniform once in hospital. Less reliance on liquid handwashes etc and some basic hygiene rules would help.
    I have been in and out of hospitals since 1970 and have seen desperate changes for the worse despite increased medical knowledge.

    Good for you traction man, keep on being polemic.

  9. Thanks, Sweffling. I remember visiting hospitals as a boy and they smelt so clean and antiseptic. Hospitals don't smell that way anymore. Can anyone tell me what that smell was and why it's disappeared?

  10. there is an old episode of yes minister where Jim hacker states to a shop steward "a hospital is not a source of employment for your members I is a place for healing the sick". That was made over 25 years ago yet still rings true. The NHS is seen by the unions as a source of employment first and a place for the hurt and sick a distinct second and this attitude pervades much of the public services. Bare in mind that the NHS is the third largest employer on earth and I find it hard to believe that the health needs of this island require a workforce of that size and a budget so large.
    What's the solution? I have no idea but a good first step might be to put away the sentiment and emotive language that arises whenever the NHS is mentioned and ask yourselves "what do we really expect of a national health service and how much are we prepared to pay for it?".

  11. Very interesting post. Does anyone else wish to comment? Is it time we stopped being so dewy eyed about the health service. Could there be better ways of healing people? Is our sentimental attachment to the NHS actually making us sick? Discuss.

  12. Sorry but I just have to wade in here partly because I am passionate about health and partly because I have been working for a GP Commissioning consortia. Whilst I can well understand why the government want to make the changes I have grave reservations about whether the GP consortia can actually achieve a better service. On paper it is a great idea - in practice are GPs sufficiently skilled to manage the process? Don't for one minute think that the PCTs will actually help with the transition. They might be making all the right noises but deep down I rather think they are aiming to scupper it rather than facilitate it.

    Yes I do think we are too dewy eyed about the NHS. We tend to believe (probably because that it what our mother's told us) that doctors will 'make us better'. In general THEY DON'T.

    They help but for the most part it is mother nature who makes us better and not the doctors. If you break a leg it does actually heal on its own, yes it helps that the doctors set it straight to help the healing process but it does heal on its own. I recall years ago when I had a puppy with a broken leg which the vet didn't actually 'set' - he pointed out that as it wasn't displaced it would heal fine on its own as 'dogs aren't as stupid as people and if it hurts it won't use use it, it will stay off it until it heals' and that is exactly what happened. Now don't misunderstand me I am not advocating that we stop putting plaster on fractures I am just making the point that it is nature that heals not medicine.

    Look however at medical problems and you realise that in very many cases doctors don't actually heal they merely 'manage the symptoms' and use expensive drugs to do so. Diabetes is a prime example of this, as a nation we are eating ourselves into this disease which is expensive to manage within the NHS and which is never cured. Yes you can get lots of drugs to help you manage the symptoms and lead a relatively normal life but you will never be well again once you have got it. Therefore doesn't is make more sense to stop eating rubbish in the hope that you won't get it in the first place?

    Of course the drug companies don't want that to happen as it cuts their 'market' down in size. The food manufacturers don't want it as they can make a fortune out of selling us rubbish packaged as food. The population don't really want it either as they seem to enjoy eating rubbish (and lots of it) and they stick with the belief that if they do get sick the NHS will make them well again .................

  13. Pot on, Laramax. It's this sort of informed and intelligent observations we need in order to improve and preserve the NHS. At the moment there are so many competing and vested interests. Everyone is getting their say except the poor old patient.

  14. Two things - first of all, Mark, your programme next week has been "bumped" by Andy Coulson and the News of the World.

    Second, I don't see much value in training people as doctors so that they can become managers and administrators.

  15. The programme has been rescheduled for 21st Feb.