Could Do Better - Room for Improvement in the NHS
2020health Director Julia Manning has written for Centreright
.com with 10 problems still hampering the NHS:
1.
Wasted Investment - a Naive assumption that
money alone will raise standards
. Cumulatively hundreds of billions extra have been spent on the
NHS since 1997 but we still can't access the latest medicine or innovative technology; most
hospitals are understaffed; delays in diagnosis means poorer prognosis; community nurses are
becoming a rare breed; transaction costs are ludicrously high and simple business paradigms are not
applied. Labour have been appalling stewards of the public purse.
2.
NHS IT fiasco - Labour thought it was about IT
when it should have been about improving care.
Mind boggling belief that the Centre should control supply of IT
through firms with no products to hospitals with existing systems while ignoring the workforce. At
a predicted total cost that rivals the Olympics, the NHS IT Programme has so far cost us at least
£2Bn [there is dispute over actual spend to date] and delivered precious little other than
increased costs and decreased efficiency, now being counted in million pound deficits by hospitals
such as the Royal Free.
3.
Consultation Shams - insulting charades that
purport to draw on frontline expertise.
What is the point of spending millions on round Britain
'consultations' with hand picked audiences who simply endorse and consolidate the proposals? Result
- the most disillusioned workforce [clinicians and managers] in the history of the NHS.
4.
Healthcare Acquired Infections [HAIs] - death
by neglect.
The knowledge of HAIs has been growing particularly since the
1990s when the incidence of MRSA exploded. Hospital responses have varied but there is no doubt
that the ability to deal with HAIs has beens significantly hampered by the huge burden of
innumerable, centrally imposed mandatory targets...
5.
Targets - Centrally imposed goals that
completely miss the point.
Never before has so much data been collected by so many for no
discernible gain! The 18 week target for treatment may sound good until you realise the
average wait was less than that in the 1990s; 4 hours maximum wait in A&E has been a magnet for
rising numbers of people guaranteed a quick fix; fast tracking cataract patients [reversible sight
loss] left those with glaucoma [irreversible sight loss] untreated; the obesity register is purely
that - a list of patients who have been weighed by their GP, no other action required; GP moves
straight To Go and collects some more Monopoly money.
6.
Choice - recognition that competition drives
up standards has disappeared.
We were promised 15% of NHS provision was to be by the private
sector [you know, the ones with lower HAI rates, highest patient satisfaction, best facilities,
pleasant surroundings and motivated workforce] yet this remains at 5%. Choice can't work without
decent patient information, some of which is available on the Net if you know where to look,
but most NHS users are over 65years and not Net savvy. If there is no competition, little
information and no real consequences for poor performance, standards will not improve.
7.
Medical training - vocational courses with no
promise of vocation.
At £250k per person one would have thought that the Government
would have created enough hospital training slots for newly graduated doctors [the MMC/MTAS debacle
goes on]; or was enabling female surgeons back into post after extended maternity leave; or had
funded enough jobs for newly qualified nurses and physios. You would be wrong.
8.
Crisis in comprehension - dependency on
foreign staff is still a barrier to understanding.
An international NHS is an asset, but working with the elderly
myself, I repeatedly hear reports of not having a clue what the doctor/nurse/carer said. It's still
a taboo, but the NHS has become so dependent on foreign staff that the language requirements have
been sidelined and many patients are left with little understanding of their condition.
9.
Elderly isolation and neglect - care at home
is not always best.
Care Home closures seemed to stop making the headlines after
about 2003, but it is estimated that about 74,000 places were lost between 1996 and 2003 as funding
was reduced and regulations and red tape proliferated. Added to this, support and care for
those at home by social services and community healthcare is decreasing year on year leaving the
elderly isolated and neglected. There is no choice for some of society's most vulnerable. Care
closer to or at home was thought to be cheaper to provide - well it definitely is if you are no
longer providing it.
10.
Change has usurped Improvement - there is no
inherent value in change
. Endless changes and reorganisations ['change is what we do' say
NHS managers!]; continuous imposition of centrally imposed directives and targets, and
death-by-audit has squeezed the passion out of vocation and the value out of experience.
Professional pride in service is now a rare condition.
I don't write the above lightly - I've given 18 years of my
working life to the NHS. But where is the stewardship, the improvement, the ownership? These are
the core values of 2020health so if you agree, contact me, Julia@2020health.org and help us develop
new bottom-up policy ideas to restore our pride and rejuvenate our NHS!
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