Is this the future of the NHS?

Depending on who you ask the NHS is in trouble. I say depending on who you talk to because there is the root cause of almost all the problems the NHS has to deal with. The NHS is run by politicians and the state of any given situation depends on the hue of your party's rosette.

That in a nutshell is the long and the short of it. Every 5 years we have an election and the country selects some other Tom, Dick or Harriett to try and run the country. Often in that election manifesto there is a piece entitled "How to cure the NHS" or some such and we get another chinless wonder in place who sets about solving ALL the ills of a huge behemoth of a nationalised industry. For the most part they are change for the sake of change and as much money is wasted re organising the NHS as was apparently wasted under the previous system. 

Now I have worked in the NHS for 27 years. I believe in the fundamental principle of treatment free at the point of use, paid for out of general taxation etc. 

In a recent radio show on the BBC a Comedian called Rufus Hound made this unusual demand. He stated that the ownership of money should be a daily lottery. Some days you'll be a billionaire but the next day you could be a pauper. The reason for this is that this may well be the only way that everyone sits down and decides what services are out there for them because although you might not need them today, tomorrow may be another matter. 

This basically sums up my attitude to public services and the whole welfare state thing. What if I become needy tomorrow what will become of me? Who will care? There are people out there right now asking these questions of themselves right now. So we all contribute NOW so that when or if we ever have to ask those questions for ourselves we know someone will be there for us, carer or tax payer. It is how a civilised society works. 

I would like to be able to give an opinion on how to solve the current crises in our health care system. But I fear the answer is in fact a might complex. 

In short it is going to cost. Care is given by people and these people need to make a living. Drugs and equipment costs. It all costs. So we have to get over it. Health provision costs money, real money and lots of it.

We have to be prepared to pay for it.

The problem with the human body is that it is a complex machine. To successfully service it requires a lot of very specialised technical experts in each system. To this end Hospitals should not be run as businesses with the concept of profit and loss.

The reason is that no company in the world would ever have it's fingers in so many pies. The sheer number of specialities within medicine make any hospital over encumbered and exposed in a way no limited trading company would be prepared to accept. Any self respecting company would specialise in a particular speciality or procedure.

This is what we see with the current system of care giving where small limited companies are cherry picking the parts they can make a profit on and leaving the NHS to pick up the bits no one else wants.  

So let me tell you about the things that have changed in my time in the NHS. Change and it's management is the biggest topic for conversation.

When I were a lad most of the decisions concerning health provision were consultant led. Some would like a return to this. In theory it sounds fine and dandy but my experience is that it doesn't matter what change you want to implement, if you don't have the consultant on board it won't happen. In my early years consultants did have a tendency to get stuck in their ways. Change only really came about when an incumbent left or retired.

Currently Hospital management is able to wield a hefty baton to affect change on any part of the organisation that is not playing ball. This, of course is a double edged sword. But I have witnessed intransigent medics being forced into measures that made perfect sense and their only gripe is that they didn't think of it. The downside is that I have some concerns as to the aptitude of NHS managers.

They are an easy target in the NHS as they don't have any direct public contact so it easy to point a waggly finger at them and call them a waste of money. I wouldn't want to do their job i have to say. For many, many reasons and i could probably do a complete blog of 2000 words entitled "Why I wouldn't run the NHS!". However there are several old jokes around that do have a ring of truth about them. The rowing  story was very apt in the eighties as managerial positions were being created out of thin air at the time. As proof i found an article in the daily Telegraph in the 1990's that reported that the amount of money the government was paying for traditional NHS employees (doctors and nurses to put it simply) had risen in line with inflation over the previous 10 years but the money for managers had risen 1000 %. This was not due to managers awarding large pay rises but just the sheer number of managerial posts within the NHS. I will leave it for you dear reader to check on the provenance of this tale!

It does startle me just how big the "back office" has become. And then there is the joke about horses and committees. My experience of committee work is limited to the running of my own cricket club many years ago and may not seem to be of much value. It is true that we were definitely not the sharpest knives in the draw, but we were earnest. We had decisions to make and we often made them. But I found that, come Saturday and explaining these decisions to the rank and file club members I often found myself wondering how I signed up to it. On the night it seemed a sound and sensible idea and yet others instantly recognised the unintended consequences of said decision. The answer here was  quite frankly the wrong people were on the committee but that is volunteer organisations for you.

However there is a parallel. The wrong people might be on the committee.

The other thing I have noticed about the NHS is the incorrect use of information. Or rather how the NHS cant see the wood for the trees.

I want to cut a long story short because This blog is starting to develop a life of it's own. The story is though that after investing a hefty sum of money in a well known management consultancy coming and showing the staff effectively how to tell each other what is going on and who is going to deal with it (Essentially stuff we should be doing but somehow it gets lost under the banner of "some  one else's responsibility") a pattern was emerging. It appeared that patients were left hanging around awaiting some non invasive investigations rather than being sent home. The management response was to get all the "guilty" parties together and thrash out how to respond and not let it happen again. My point is that once again the NHS had the wrong people around the table. At no time did anyone ask did these investigations HAVE to be done as an inpatient. Why were perfectly fit and healthy people being detained in hospital at £500 a night?

I must sum up here because I will never cease if I keep dragging up examples

1.  Keep politicians out of health care
2. Cough up (pardon the pun)! It needs money and lots of it. There is no way of hiding this. We can argue about how to spend it but the how much is basically A LOT!
3. Reduce bureaucracy PLEASE
4. make it the nations business that health care progresses. Don't let anyone stand in the way of sound progress

Even as I write I can hear the arguments in my head. This is too important an issue to be left to politicians. The nation must have a debate with itself to decide these issues but please don't let a politician take charge!