I have spent several hours discussing the NHS this weekend with someone who has known it quite well for more than a quarter of a century - my wife. She is a GP but spent rather longer than most in that part of the medical profession working as a hospital doctor before shifting direction. Hardly surprisingly she has an opinion on what is going in in the NHS as a result, as do I. Our conclusion was that everything is changing in the NHS, for a number of reasons, although we each reached that conclusion for differing reasons.
Her conclusion is that of greatest significance is the change in mood of the one of Colleges of which she is a member, the Royal College of General Practitioners. Until very recently that College appeared to accept that whatever happened with regard to resources GPs could and should supply an ideal service to all in the UK. But that now seems to have changed: the RCGP no longer seems to think that is the case. They now seem to have shrugged their shoulders in resignation and have accepted that the ideal GP service, let alone the ideal GP consultation is not possible for three reasons.
The first is that government pressure has made it impossible. A decade or so ago they changed the way that GPs were rewarded and introduced the Quality and Outcomes Framework (QOF) scheme to reward GPs. This required vast amounts of form filling, but also dramatically increased the focus on some aspects of preventative medicine for which the evidence bases were not always very strong e.g. (I'm told) chronic kidney disease. The result was that if GPs would be paid then they had to undertake considerable numbers of tests, invite patients back for repeat monitoring, and use very large numbers of appointments in the process. Given that money was attached to these outcomes, hardly surprisingly that's what GPs did. All of this was predicated upon resources being available, and whilst they were it worked. And now those resources aren't available. But GPs still have to do the repeat preventative appointments or they lose income - which means they lose staff now, because their budgets are already cut, and so the resources available for those who are really ill are being cut dramatically. The basis on which the system was designed does not work, and it's now a serious impediment to progress in itself.
Second, the ideal GP consultation takes 12 minutes, at least. Once it was possible to aspire to that. Now it is not. There are too many appointments to make that possible. So GPs have given up hope of doing things well. The best they can now do is as well as possible, which is not the same thing at all. It's not their fault: it's a recognition of what is possible now.
Third, GPs have under the Health and Social Care framework been set in opposition to hospitals. The crisis at Hinchingbrooke reveals that: when Circle thought it was going to run a surplus by dragging resources from primary care GP on the Clinical Commissioning Group dragged those resources back. It does not really matter who is right or wrong: the system is wrong, and that's the point. GPs without management skills are being asked to run a service as well as their own practices and conflicts are built into the system which is designed to be competitive and not co-operative and the outcome is inevitable: all competition is predicated on the idea that failure is not just possible but desirable and failure is what we get as a result. But the cost of failure in this case is real human suffering.
I'd look at this a bit differently although none the less reaching the same conclusion. First, I'd suggest all systems require the maintenance of a necessary minimum number of systems including back ups and alternatives to ensure that failure can always be accommodated, and failure is inevitable in any human system. After a number of years of pressure for cuts those alternatives have been deemed wasteful and have been eliminated. The result is that the capacity to manage crisis no longer exists. A crisis is not now about making decisions on which alternative resources to use: it is about saying there are not alternatives. All of which proves the absurdity of the drive for productivity in the NHS and many other public services. In many markets inability to supply results in either price change or substitution of products. In essential services inability to supply results in real hardship. Cutting the resources to the minimum needed to maintain regular supply is not wise in that case. In fact it's the exact opposite: it's about guaranteeing failure to meet peek demand, and that is what is happening now in the NHS because a market language where failure can occur has, again, been applied to a public service where failure to supply is unacceptable.
Second, there's been an extraordinary change in the public. The logic of health markets was that the public could make choices and exercise informed judgement. In fact we have seen them do nothing of the sort. Over recent years the public has changed dramatically, which is the other major reason for increased appointment demand. Far from exercising judgement, the public now demands that it has a right to be 'put right now'. They do not respect the fact that not all medical issues are soluble. Nor do they realise, as they once did, that many more issues are solved in a few days simply with the passage of time. So we get the increasing demand, frequently heard at doctor's reception desks, that an appointment is needed today and not three days time because "I'll be better by then". Precisely. The health market has not encouraged choice or judgement. It seems to have created total dependence where people wish to accept no responsibility for themselves. Deeply unpopular triage systems are the consequence - where those who have no need to see a doctor whether in A&E or at a GPs have to be weeded from the system to allow room for those with real need have to be introduced. That's not fun for anyone, but social change requires it.
And third, there is a failure to recognise that if this is what people want then they have to be supplied with it - and be charged the tax that pays for it. People are making choices: politicians would be wise to follow their demand, increase spending, increase tax and keep people happy.
But in the meantime it is inevitable that health systems need re-design, again. A focus on putting most of the world on a statin looks like an unaffordable luxury now. And GPs need to be paid to meet need, not want. Whilst hospitals have to learn how to send the worried well way in the shortest possible time. And all of that has to happen in a system where co-ordination has to be come the vital management watchword, which means the whole disintegration of regional health authorities and primary and secondary care into competing units has to be reversed.
The idea of re-organising the NHS seems deeply unpalatable but Lansley's disastrous legacy, for which he has already been consigned to the wilderness, cannot survive. The NHS has to become national, again. And it has to ensure all current health needs are met as a priority. And service has to be at its core - and that does not leave room for profit.
Hinchingbrooke's failure is not chance: it was inevitable. Preventing more failure is now what is needed. But it will take a big new vision, not tinkering at the edges. And that will mean that a great deal of change has to happen, soon. It's that or the NHS falls over. That's the choice we have.
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The analogy I use is the ‘tight ship’ one-not strict rule enforcement-but one where sailing ships would tighten the ropes on the sails to catch the maximum amount of wind-there was no ‘give’. This might give some extra speed but a sudden squall would put pressure on the ropes and possibly break them or even carry away the masts.
I am not sure the term ‘tight ship’ was ever used in this way but I think it shows what you are saying: where there is a crisis we can’t cope because all systems need a reserve or ‘give’ to meet those emergencies.
You haven’t mentioned in my view the biggest issue with medical appointments. People miss them, they don’t turn up, they don’t tell anyone. At my surgery they missed a whole Saturday when no one turned up. Also the appointments for that day still get missed. If you are so ill and need an appointment then turn up. They usually miss 300 a month.
Now this is a city so it might be different to the country, I know things are different there.
However I was also shocked to be sent to see a specialist at a very well known hospital. To see a sign telling the missed appointments as well.
Something needs to happen.
I do not believe you re the Saturday story
And let me assure you – if some people did not turn up to every surgery medics could never get through the booked work
Believe it or not they do not sit twiddling their thumbs for the missing ten minutes
Doctors have at least as much time spent not seeing patients as they do patient facing
Few understood that
My point missed by yourself was that these lost appointments mean people are missing out of available appointments. This means people cant get to see their GP or Doctor, because they cant get an appointment.
I know that Doctors have other time away from seeing patients. I also know that Doctors do things like check repeat prescription or doing insurance requests etc.
If they cant see their GP, with 300 appointments missed a month then they go to A&E.
If everyone turned up fewer appointments would be offered
GPs are finite
They know people DNA and allow for that in booking a 4 hour surgery
My dentist phones me up when an appointment is due.
http://www.hilltopsmedicalcentre.org/website/K82067/files/Meeting_of_the_Patient_Participation_Group.docx_28052012.docx
As per Saturday
Which does not support your claim – as I suspected
I am shocked at your reply. I really am.
I have been following Doctors through their patient scheme for a number of years and have never heard them say it was a good thing.
Is this a policy for the whole of the NHS or just Norfolk?? Or is this a medical organisation like the Royal College of General Practitioners who have this policy???
I am really genuinely shocked. I presume this is why everyone goes straight to A&E.
No doctor says it is a good thing
I know a great many doctors
All know of they had 100% attendance they’d have to curt the number of appointments
Which has the same net effect – there are only so many they can see and doctors are finite
DNAs are a pain…but thinking everyone will tell you the whole truth on this is a little ridiculous
This is my Doctors DNA policy. http://www.hilltopsmedicalcentre.org/website/K82067/files/DNA_Leaflet.doc
Is my Doctors surgery not telling me the truth???
I am actually really upset by this. I believed them, I thought I could trust them.
TO Carol, on the new computer system most GP surgeries use is called System one. This can text you the patient the day before.
It can text the day before
I have no heard of anyone doing it
When oh when will people stop assuming that the whole world a) has a mobile phone b) that the mobile phone works everywhere.
I have an 89 yr old mother who does not keep a mobile phone at her side or cope with texting. I live in a village where there is no mobile phone coverage.
My 88 year old dad refuses to engage with IT
Lansley has hardly been ‘consigned to the wilderness’. Cameron is forcing him on the UN, which is an absolute disgrace.
Anyway, this is a great blog which needs to be shared far and wide.
Carol
Yes indeed it is – some deep searching questions here.
Over the years all public sector organisations have been taught to see their service users as ‘customers’, and the service users themselves have been encouraged to see themselves as customers too.
I have a retailing background and the customer is someone who will give their money to someone else if you do not meet their needs and theirs alone.
All this ‘customer-isation’ has done is raise expectations. When you see the amount of money taken out of many of these services, you then have to question why raise expectations?
Well – yes – you might sweat the asset a lot more (get more for less) but also you are really setting up the service to fail. This will mean it is easier to get it changed by promising better from privatisation or farming NHS work out to private providers.
Throw in a bit of Government re-organisation (costly and time consuming) and you have a toxic case for more of the wrong kind of change.
Richard seems to be saying that as a result of former questionable change, we need to change again.
He’s probably right but it really angers me because this is all the result of politicians using tax and national insurance cuts as vote winners as well as the fact that they like to portray themselves as managers of public sector services when they are nothing of the sort. Miliband is already making promises about the NHS under a new Labour government as a politician – not as a clinician!!!
We need to get back to basics – stop seeing the NHS as a political football and just enable it to do what it says on the tin.
This would involve it having some say about sugar and alcohol consumption and other matters that result in more demand.
As for how this could be done, I haven’t got the faintest idea. At the moment I just want politicians to leave the NHS alone, but there has to be some form of accountability as Richard argues.
I share your anger
But we can’t leave it as it is
Yes – absolutely correct – we can’t leave it as it is because the state it is in can only lead to privatisation.
I’m a bit old fashioned – I like to trust the experts. I’d therefore favour the doctors and clinicians reforming the service but with a emphasis on listening to patients about the quality of care – any service needs a feedback loop and I’d rather this be from service users than politicians. I’d try to lead it that way and get rid of the petty managerialism that seems to dominate now.
I’d also like to see some of minimum agreed standards that would mean the same uniform standards across the country.
I’d also favour some sort of contract with the taxpayer or service user – a ‘something for something’ deal.
But to be honest – as I’ve said before – it’s a huge job and I would not say that I knew enough about how it works to suggest anything more concrete.
I’d be fascinated to hear of your wife’s experiences concerning the internal workings and what they might tell us about what is going on.
An excellent analysis and evaluation, Richard. I don’t disagree with any of it. But as well as a big new vision one of the elephants that has long been in the room has to be tackled – specifically the corrosive and corrupting influence that management consultants (of a certain consultancy company in particular) have on NHS thinking and policy. This has been an issue for years (see Colin Leys and Stewart Player’s excellent ‘The Plot Against the NHS’, published in 2011 but still well worth a read), but when I read in a recent Private Eye about the incestuous (and I think many people would argue, highly improper) relationship between senior staff in Monitor and McKinsey one gets an insight into one of the key reasons why developments within the NHS continue in one direction (i.e. commercialisation and privatisation) even though public pressure and the weight of evidence (e.g. the Hinchingbrooke fiasco) clearly indicate the need for an approach that goes in the complete opposite direction.
Of course, it’s not simply NHS policy making, strategy and oversight that’s been captured in this way, the same is true to varying (and frequently under the present government very large) extents across the whole of government and public service. But given the current crisis within the NHS confronting and removing the ideological “sickness” that lies at the heart of the system has to be a priority. Until it is all attempts to undo the awful damage that the governments reforms, and those of the previous government too, it has to be said, will be obstructed and/or twisted to different (neoliberal) ends.
Thank you for spending the time (both of you) chewing this over and putting this post out.
My view is that we need a practitioner-lead national debate about the future of the NHS followed by…yes…a referendum. This needs to take place outside the current electoral cycle. A referendum is needed to make a national debate effective and reach the people.
The NHS is too woven into our national fabric to leave to politicians. Seriously. A referendum will engage everyone.
There will be those who say it wouldn’t work. What question would you ask? Well I’d have three alternatives on the paper.
1. A full blown service as you describe with full costings, impact on taxation etc
2. The other extreme, full privatisation, with financial outcomes explained.
3. A middle ground. For example, a paired back service, less elective procedures, less management structure etc again fully costed, impact on taxation etc.
But that’s just my ideas. The point is the medical profession would be asked to propose the alternatives.
Let’s take the politics as far out of it as possible and let the people decide. We’ll then know what they value, and as a consequence be prepared to pay for.
Of course, we may be sad!
The boys went to a film and we chewed the cud…..
Which post are you replying to here Richard! (smiley emoticon).
Not sure
I can’t tell when I edit comments – a WordPress weakness
That’s exactly what the tories want: to “take the politics as far out of it as possible”.
After 13 years of Labour the NHS reached a pinnacle and it’s been on the way down ever since they left office. How political is that?
Yes but my ‘taking the politics out’ perhaps should have better been said ‘take the politicians out’.
And in any case, my reason for doing so is to let the people decide on the future of the NHS. That’s the last thing the Tories want.
I have problems with taking politicians out
We then have unelected politicians….and I don’t like them
I need to explain myself better.
First comes a political decision. The decision is ‘We need a national debate outside of the normal electoral process and we want those working in the NHS to frame the debate and put forward alternative ways forward. We ask them to come up with a range of options, I’m suggesting three, which cover the ideological spectrum’
Secondly the professionals come up with the alternatives.
Then a referendum campaign is held where politicians and others can campaign on the alternatives.
Then the public decide.
So what we seem to have is a hybrid of the worst aspects of a top-down politically-led centralized structure, with the worst aspects supposed ‘market forces’ (i.e. politicians handing out big contracts to their mates, with no upsides to choice, patient care, or efficiency).
One almost has to admire all concerned.
But what is shows us is that simply reversing the ‘marketistion’ implemented by the Tories (and Labour beforehand) isn’t the panacea that some suggest. If you want a comprehensive health service delivered solely or predominantly by people on the public payroll, and free of many of the problems you describe, then you need to find a solution to the problems that centralisation and political oversight cause themselves.
What are those problems, precisely?
Your entire third paragraph?
It seems a perfect example of decisions being made too far away from the people delivering services, imposed on everyone, and left in place long after the professionals have seen that they do more harm than good (e.g. because they’ve not been adapted to take into account changes in funding).
This is what happens in large organisations, and the NHS is one of the largest in the world. If people want to keep it large (i.e. not break it up) then that’s fine, I’m just saying that ideas to fix/mitigate those problems would be nice. It’s not as if people only started talking about the ‘NHS in crisis’ in 2010.. it’s been going on my entire life. It can’t always have been Andrew Lansleys fault.
No: the problem when market logic was brought in
From then on things went wrong
And yes, I am criticising Labour
And anything the NHS could do centrally would remain 1000 times more accountable than the average plc
“and be charged the tax that pays for it”
Tax doesn’t pay for it Richard. Please stop perpetuating that myth.
People and resources pay for the NHS. You can tax as much as you like, but if there is no manpower there who wishes to undertake the roles then there will be no system improvements. You can’t magic doctors out of thin air simply by invoking the Holy Power of Taxation.
We need to look at what resources are out there and what the current alternative uses they are being put to. If they are sat idle – on the dole for example – then we can put them to use in the NHS tomorrow. Just pay them the living wage to do so.
If they are used alternatively then we need to look at how to free those resources up. Taxation may be able to do that, but it might be more appropriate to use stronger powers to crowd out the alternative use – banning or nationalising private health care for example.
It’s time to get beyond the numbers and look at things in real terms. It’s the only way we can recover the situation in the NHS before we lose it completely.
Tax – or rather the spending that may be out of tax – does direct those resources
In that sense I am entirely right
Conventional economics ignores money and tax and look where that has got us
On the question of getting a text to remind you of an appointment at the GP, my practice does this even for appointments for blood tests,etc. (located in Hampton, Middlesex). I don’t know the system they use though. Also, my dentist (who I have seen far to regularly over the last 4 months as he replaced two front crowns) sends a text 3 days in advance of an appointment to remind you.
Before I forget, even my hospital sends a text a week in advance of an appointment that gives you a chance to reply – “ATTEND”, “REBOOK” or “CANCEL”
Our local hospital calls
I’m told it’s rare amongst GPs
Well it happens in my GP practice as well.
I’m told it happens everywhere there are enlightened practices.
I know of none where it is done
It is done by my GP, it is done by my local hospital and by Papworth and Addenbrookes (soon to be co-sited) and my dentist.
So?
Do you really think that changes my argument?
No!
I must admit though, watching the money-go-round of medical practice is [faintly] amusing.
As I asked my [past] GP: “why should I go to a private physio, when I can go to the hospital physio dept”
I could see no reason, until I was informed that the practice received a referral fee.
So, I self-referred to the hospital dept.
God knows what the arrangement is between the local hospital, the hospital at Papworth (great unit) and the hospital at Addenbrookes. My medical merry-go-round as the family call it!
No referral fees to hospitals – yet, that I know of
Likewise here in Slough. Calls and messages galore, quite handy in helping to remember appointments made.
So?
How does that deal with on the day appointments DNAing?
And people without mobiles – the elderly, that is who have most appointments?
I really think these comments are an exercise in massively missing the point?
“then we can put them to use in the NHS tomorrow”
After the 3-week wait for DBS clearance……..
I would love to hear what your wife thinks of NHS England. I was on a skipe feed to thheir AGM via a link from 38 Degrees. I was appalled how the board of that meeting seemed to be unable to answer any questions from the public, especially when asked about the affects if the TTIP gets passed. They fobbed it off even when 3 different members of the public who happened to be american (but not chosen for that reason) all said that the best thing about the UK was the NHS system and the last thing on earth that should happen is for us to allow the complete privitisation like the US model which brings misery and death to the country. I believe that any politician who has private health care for their family should not be allowed to vote on issues regarding the NHS. The NHS should be run by experts in health not accountance and investors. The NHS is about people not profit. Who can we trust to start rebuilding it?
“that’s the last thing the Tories want”
And labour, and libdems, and ukip.
Referendums are nice, especially when you know there is a good chance you’ll get the result you want.
Not so [politically] nice when the result is likely to be one that is unwanted.
And con and lab want small gov, not a 3-million plus workforce.
A referendum tomorrow, or in a year, where the question is: “NHS should be privatised completely YES/NO, would return a NO result (in an ageing population that knows that health insurance would exclude them, and their existing ailments).
Np politician wants to run in an election like that, and a vote to keep and improve a national health service free at point of treatment would, forever, be a foul taste in a politicians mouth.
Never forgetting that an appreciable amount of conservative and labour politicians (and lords) have their snouts in the healthcare trough.
JohnM I agree entirely.
Re your last point. ‘In The Plot Against the NHS’, Leys and Player have a very insightful diagram of the ‘Marketizers Network’ in and around the Department of Health and NHS which illustrates the extent to which the whole policy domain is crawling with people whose primary interest is privatisation and marketisation. It was put together by Spinwatch.org and I keep meaning to check if it was ever updated.
I think the general public, and indeed many health workers (as I know from my own experience), would be shocked and appalled if information like this was freely available and the full extent of the conflict of interest and/or ideological bias to market based healthcare “solutions” of many of those who manage, control and have oversight of the NHS was made clear. It would make transparent the fact that for many of those in senior managerial/policy/oversight positions in the DoH and NHS their primary aim is not a public, not for profit healthcare system but a private, for profit, system.
When the aims and objectives of those people are combined with politicians of a similar bent, as started to happen under Blair, but has exploded under the coalition, it was always obvious to many of us that the NHS as we once knew it would not survive. Unfortunately what caught me out was that the Lib Dems would so easily go along with the Lansley wrecking “reforms”. But then again, there’s actually very little they’ve had the balls to stand up to the Tories over.
Well, Shirley Williams for one will never ever be forgiven for her betrayal.
Politicians who have any private medical involvement should see it as a conflict of interest and should be excluded from any vote on private companies engaging in the NHS. There has been too little economic debate over this issue.
My own MP Sir Gerald Howarth, a tory told me that he had a previous engagement and could not attend the vote on the private members bill to repeal the “care act”, that it didn’t warrant his time as it was unlikely to go through. The truth of course was that they had all been told to abstain because to vote down would politically indefensible.
Current business and economic models favoured by the free market trade brigade are fundamentally flawed and have proven to have failed the vast majority of people yet politicians are still scared of the alternatives.
If we trully have world leading management expertise why is the NHS still in such a mess. The truth is as you say Mr Murphy that service has been overlooked whilst performance tests and competition have been foolishily favoured by vain ideoligists with misguided philosophies.
More power to your elbow.
Thanks
One of the saddest things is that GPS could have scuppered Lansley’s reforms, instead a combination of inertia / apathy on the part of the majority, arrogance on behalf of the ones who felt they could mange so much better than all those useless NHS managers could meant the reforms went through. The lie that it put the doctors in charge is still repeated. The reforms have managed to waste an enormous amount of GP time as they supposedly manage the new system- something you don’t mention in your discussion about why GPs are struggling so much.
Worryingly I see that a significant number of CCGs now say they want to take on commissioning primary care- they seem to have learnt nothing. Apart from anything else this is a HUGE conflict of interest. As the GPs most interested in management are often those most interested in making large amounts of money for themselves this is really concerning. It will of course, also allow the government to put even more blame for any inadequacies on the “doctors who are making decisions best for the local area” now that you hear parroted by Hunt etc.
CCGs are built on the greed of a few GPs who do not want to be in surgery
I would trust politicians more
That says something
NHS Sell-Off – The Full Movie
A documentory about the abolition of the NHS
https://www.youtube.com/watch?v=ultKvnw2h3Q
Something that seems overlooked in the ongoing debate over the NHS was the creation of local trusts. It was, in my opinion, one of the single biggest mistakes made in the history of the organisation.
At a time when every commercial operation in the world seeks to increase efficiency through economies of scale (usually via mergers and acquisitions) to say the least counter-intuitive. The breaking up of the NHS into more than 220 local trusts has led to the endless and unnecessary repetition of so many administrative and management operations that our NHS (after the Chinese Red Army and the Indian Railways the biggest single employer in the world, I believe) now has as many non-clinical as clinical staff. In addition the purchasing power of those trusts (for goods and services at local level) has been wholly diluted.
Perhaps the most damning and dangerous effect though has been the post code lottery that has been created in care nationally. Nowhere has been more remarked on in this respect than Mid-Staffs where what was actually a failure in management has been largely portrayed as a failure in care.
A future Government would do well to address this situation, perhaps moving to a handful of regional health trusts replacing the local ones, each one administered by one Board with overall responsibility (and accountability) for all aspects of primary and secondary secondary health and social care in their region (including oversight of tertiary facilities such as care homes), and the power and flexibility to direct resources across their region as necessary.
Excesses in administrative staff could be managed through natural wastage and by encouraging non-clinical staff to retrain in clinical roles.
A renewed emphasis on early detection and prevention (such as community screening initiatives and school health visitors) would not only save the NHS billions in the long term but would also have ramifications in society as a whole (think of poor Daniel Pelka).
Throw in a 12:1 remuneration rule and a regulation that favours Fair Tax Mark companies in bidding procedures, and you have an NHS blueprint worth considering.
And, as an aside, I wonder what the implications for the binding 30 year PFI contracts would be if those local trusts were simply dissolved…
We need n more than 10 regional health authorities across the whole of the UK covering primary and secondary care, ambulance services, social care and mental health services
The saving in cost would be phenomenal
https://flipchartfairytales.wordpress.com/2014/01/15/is-the-nhs-really-over-managed/
http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs
@JohnM
As a campaigner for our NHS I am very aware of the statistics you have supplied (and indeed quote them on a regular basis) but a direct comparison of this sort is meaningless when the commonwealth fund itself describes the US model as ‘an outlier’.
Moreover the changes made by the Thatcher/Major/Blair Governments brought our health service closer to the American model, and therefore, to its inefficiencies.
A more meaningful (and honest) comparison would include historical comparative data drawn from the periods pre 1979, 1979-1997, and 1997-2014.
The King’s Fund, for instance, records that between the period 1999-2009 numbers of qualified nursing staff fell as a percentage of the total by 1% (almost 12,000). Similarly qualified ambulance staff fell from 2% to 1%, while GP practice staff fell from 6-5% of total NHS employees. In the same period managers increased from 3-4%, while ‘Central function’ (HR, Finance, Payroll etc.) increased from 7-9% (or 24,000)of total.
The ‘Flipchart Fairy-tales’ statistics you provide highlight the fact that we now have twice as many NHS managers for instance, as we do ambulance crew. Ask yourself the question , if you fell off a ladder and damaged your back, who do you hope would turn up?
(It is worth remembering that the average NHS CEO earns approximately 5 times what the average nurse does so cutting the number of trusts from 220 to 10 would, just on CEO pay alone, fund another 1000 nurses. My local hospital trust alone has about 15 such senior managers).
Statistics released in the NHS Information Centre 2010 census revealed that, during the previous decade, management numbers in the service had seen a 66% increase to 41,000 whilst Qualified nursing staff had only increased by 20% in the same period and GP’s by 25%. This, of course, came on top of the large-scale increases of the previous decade in management roles, following the Griffiths Report of 1983 which introduced the first cohort of NHS management.
As these figures do not include the legions of management that invaded the NHS between 1979 and 1999, nor do they include all the unquantified numbers of ‘off-payroll’ private facilities managers and management consultants employed from the private sector, but funded from the NHS.
The statistics you have provided only contradict my original point if you take 1983 as a ‘year zero’ before which nothing else existed. The increased (and increasing) segmentation of our NHS pushes us closer to the diabolically flawed model of US healthcare which you quote. Making the comparison, without pausing to examine the historical context and trajectory is simply flawed. Without historical comparators that examine the angle of travel, such statistics are simply a meaningless snapshot on reality.
Yes, we have the most efficient health service in the world, but local stand alone trusts are part of a model deliberately designed to undermine the efficiency of that service with the aim of its ultimate destruction.
I have had the privilege of working in that service, as has my wife (a psychologist), my sister (a radiographer), my mother, her two sisters and her cousin (all life-long nurses), two of my cousins (physiotherapist and HCA) and two lifelong friends (also radiographers). In recent years both my wife and I, sadly, have come to rely on our health service for all the wrong reasons. Without it, we would both have been dead several years ago, so forgive me if I am a little passionate about the subject.
But please don’t conflate my arguments with a vacuous idiot like Nuttall.
I didn’t.
As usual, I start by trying to find something on the ‘net and end up getting totally side-tracked by Richard Murphy’s blog!
Thank you Richard for this.
Regarding the formation of trusts, they were simply a step on the road to privatisation, a means to bring in payments across parts of the NHS; fragmentation and the reduced ability to cross-subsidise was necessary in order to introduce a buy and sell system. Only then could they reduce care to ‘episodes’ to be bought and sold on the internal (faux) market. Without this being put in place, there would have been no place for private companies to operate.
The worker in this article explains it quite nicely –
https://www.opendemocracy.net/ournhs/anonymous/nhs-my-part-in-its-downfall
Please read it.
Incidentally, I have been employed by 5 different trusts in 18 years without ever changing jobs!
By the way, I love DNAs. That’s when we do our (ever-increasing) admin.
Thanks for your candour!
http://www.pulsetoday.co.uk/commissioning/hospitals-ready-themselves-for-primary-care-takeover/20008821.article#.VLflukbfWc0
Thanks for this posting John M. Anything that has PWC involved has got to be for pure profit. I have seen their actions destroy numerous smaller charties who were put into receivership by the Charity Commission. Their fees alone for any services would put the nail in the coffin for the NHS. This is what is wrong with it now… totally top heavy with “consultants” on finance not health.