A Prescription for the NHS: The Emperor has no clothes!

The NHS has just announced that an astonishing £11.8 billion has been wasted on the National Project for IT – otherwise known as the failed attempt to computerise medical records.  In addition, it has suddenly been ‘realised’ by NHS Trusts all over the country that their fantastic PFI deals are actually crap and unaffordable.  How can this happen?  Well, until the culture within the NHS changes, nothing else will change.  Here are seven issues and seven solutions:

Problems

1. ‘That’s true but you can’t say that’ – I’ve lost count of the number of times I’ve heard this said of PFI projects, NPfIT, underperforming or useless staff and stupid initiatives;
2. Recruitment from within – You can have an Oxbridge degree, a top school MBA, years of first-rate commercial experience and excellent references but you won’t get the job over some mentally retarded former nursing assistant who has worked in the bureacracy for 20 years;
3. Colleagues don’t hold colleagues to account. Staff tolerate colleagues who go off sick for six months minus one day, return and then go off sick again, and do this for years and years. In fact, and quite incredibly, national agreements guarantee the workshy their jobs if there are reorganisations whilst off sick. Job under threat? Go off sick!
4. No accountability. People don’t resign or get fired, even when hundreds of people die, nevermind waste billions of pounds. Look at Stafford. The head of the local NHS in the West Midlands shortly beforehand was former communist party member, David Nicholson, now rewarded with a knighthood and CEO of the NHS. The head of the body responsible for overseeing Stafford at the time was Cynthia Bower. She has now been made CEO of the CQC, the quango responsible for quality of care nationally. Both have neither commercial nor business experience;
5. Bureaucrats rule. Despite generally having far lower IQs and inferior qualifications, the bureaucrats see nursing and medical staff as ‘the problem’;
6. Endless reorganisation is allowing bureaucrats to justify their positions for ‘change management’ and ‘business’ whilst slashing doctors and nurses jobs, across specialities and the country. Services are being ‘redesigned’ by bureaucrats with no knowledge or experience. Most disgracefully, while clinical salaries are capped and budgets are cut, bureaucrats are giving themselves new job titles with the words ‘commercial’, ‘marketing’. ‘change’ or ‘business’ added and awarding themselves massive pay rises. I know of many who have seen their salaries increase by more than 30%;
7. The NHS is a political football, with constant top-down national initiatives and reorganisations which are both futile and expensive.

Solutions

1. Allow staff to tell the truth without fear of reprimand or grievance;
2. Force trusts to open vacancies to all applicants on a modern competencies rather than experience basis. Oh, and ban the crazy practice of not reading references until after an appointment is made. Instead, insist that that references are read prior to interview and make it compulsory for the nursing, medical and management personnel who will be responsible for the person being recruited to be on the interview panel;
3. Dock the pay of teams for underperformance and sickness, so that peer pressure is brought to bear on the workshy. And give reorganisational priority to those working rather than off sick;
4. Fire those who fail, starting with David Nicholson and Cynthia Bower;
5. Insist that nurses and doctors are involved in all major decisions – empower consultants and matrons again, as well as GPs;
6. Insist that cuts are made to bureaucracy before services and cap all individual bureaucrat salaries so that they cannot be awarded inflation-busting salary increases under the cover of ‘promotion’ or ‘reorganisation’ whilst slashing services;
7. Devolve powers locally, with local fundraising too. Scrap the Department of Health with central government delivery of only what cannot be delivered locally. Local papers, councillors and MPs do a much better job of holding NHS Trusts to account than clipboard-hugging quangocrats. Local people raised the money to build most of the great hospitals and would do so again, given the chance.

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