The State of the NHS, and unflattering international comparison across Europe rear their heads again today. For us the key problem in the NHS is that bureaucrats are running it to their agenda,and getting in the way of doctors and patients working together on sensible solutions to medical problems.
In the NHS you can regularly see meetings called where combined salaries of over £1,000,000 sit around a table for hours debating expenditure of £15,000. The game will repeated again and again, week in week out and no decisions will be reached but hours will be reduced to minutes. The whole edifice is top heavy, and hinders the primary service deliverers (Doctors, nurses, physios etc) from getting on with their job. And the £1,000,000 worth of salaries committee just demands ever more information so that “fully informed decisions” can be made by “due processes, fair and transparent”. If any of the £,1,000,000 of salary ever got out and saw what was happening they might learn something…but of course no management ever wants that kind of real information do they? Didn’t the founders of M+S at one stage visit one or other of their stores each Saturday and listen to the sound of tills going, to check their sales and cash flow for themselves? And to make sure that the figures subordinates presented them with matched what was actually happening.
One of the men who helped get us into this mess rears his head again today in the Observer. It makes us SICKO with rage to think that the man who advised Phoney Blair has actually gone and joined one of the NHS’s natural enemies. If the captain of the ship is planning to join the opposition what hope has the ship? This is basically treason to the ideals of the NHS.
(Even the Chinese this week thought Blair was an expensive fake who spoke only “platitudes and empty generalities”)
On Dr Rant we hold no respect for current NHS policies which we think are expensive, valueless, misdirected and ineffective. We would start our NHS policy by stopping all of them entirely and sacking all those involved in creating them, and all those who willingly collaborate with them. We would scrap all the crap about the internal market which has created the worst problems the NHS has seen. This view will see a lot of people out of work, and would save the taxpayer a fortune.
I think Simon Stevens, Blair, Julian Le Grand-Prat, Alan Maynard, Kenneth Clarke, Alun Milburn, Patricia Hewitt, Liam Bryne, Liam Donaldson, Andy Burnham, Lord Warner, Alain Enthoven would be the amongst first to named, shamed and sacked. However their name is legion, and all their departures are long overdue.
Lord Darzi, David Colin-Thome, Dame Carol Black, and many others would go as medical collaborators. The keenness with which many senior medics have become spokespeople representing the government to their members, rather than their members to government is sad to see.
The whole lot of PCTs could be closed down and never missed.
Most of the managers in NHS acute trusts could be sacked and never missed.
All the management consultant parasites could be sacked and never missed.
The big American healthcare corporations should never be allowed anywhere near these shores. Seeing people like Richard Smith join one of these is just revolting. Another twateratus to enjoy booting out.
What would we put in place of current management?
Well firstly we would want local democratic accountability. So maybe local councils to run the hospitals and GP surgeries? And with locally elected officials as they have in USA so how about local elections for hospital chief execs, and fixed terms of office?
And the government’s role would become one of service specification, standard setting and regulation, rather than that of centrally directed provision. Bevan’s biggest mistake was ever to allow the clattering bedpan in Little Middlecombe to be heard anywhere other than Little Muddlecombe. On the other hand when nurses tell patients “just to go in their beds” you know that there has to be something very wrong in the current setup.
Above all the new service would have just enough management to support the front line personnel, and no more. The managerialist agendas of the last too many years are what cause most of the current NHS problems.
A Slimmed down NHS is entirely possible and indeed desirable. The bureaucratic fat is ripe for total destruction. Is Andrew Lansley brave enough to go for this?
There are some encouraging signs. The taxpayer’s alliance is getting more vocal. Nigel Hawkes in the Times has picked up well, “The NHS used to be underfunded and ineffective. Now it is only one of these”
People are going to start asking what value they have got from the massive squandering of public resources by new Labour over the last ten years. The answer is clearly far less than they have paid for. The answer is not more taxes and try again. The answer is local services, local discretion and far, far less bureaucracy.
As GPs the government may find us revolting. We need to be in revolt against this government, and all who collaborate with it. GPs by nature are intelligent local actors, and have very good knowledge of what needs to be done in their own area.
DH apparatchiks in their Leeds Kremlin and London Lubyanka at Richmond House, and their local commisars in SHA and PCTs and their useful idiots amongst the medical twaterati have no idea at all what needs to be done.
The last ten years have shown the utter ineffectiveness of government by tax and spend, borrow and bend. The state of the NHS bears eloquent testimony to good intentions gone bad, and to the human tendencies to displace, distort and delete unpleasant facts at times.
The true state of the NHS is worse than voters and taxpayers realise.
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21 comments:
Excellent excellent post. I am all for revolt against the government and their fucktard policies. You guys can organise the doctors's army and I'll mobilise the nurses! ;) Let's roll!!
Dr Rant - I'm sure many of "the little people" reading your excellent post will be nodding their heads in silent agreement...........but;
[As yet] there is no unity or coherent opposition/vision amongst the grunts - notwithstanding sporadic demos against MTAS & health reforms, etc.
None of the political parties offer a meaningful alternative.
The momentum toward privitisation is gathering pace, epitomised by odious, self-serving ticks like Simon Stevens - I'm sure the good Devil, Wat Tyler and their right wing acolytes must be rubbing their hands at the prospect of UnitedHealth [as well as other private providers] getting a foothold in the UK.
To be fair to the marketeers it's hard to see how NuLab could have done any worse, although I suspect that this is more to do with destabilising the various professions [especially GPs] as a precursor to breaking up the NHS.
Of course once the NHS finally does a Titanic, we will have to get used to wistful, and endless paeons to the "good old days", as the harsh realities of a health market start to bite.
re: Simon Stevens article in The Observer - internet media still cannot provide the simple satisfaction of cutting out a photograph and using it as a dartboard.
a & e charge nurse, HEAR HEAR
Oi - a&e charge nurse ... what's this "little people" eh ?
You enclose the phrase in quotation marks, but no such phrase appears in Dr. Rant's posting.
I sincerley hope that you are not referring to non-medicaly qualified readers in such an arrogant and dismissive fashion.
Think yorself as one of the superior blogerati, do you ? Descend from your 'high horse' and explain yourself.
And I thought that only GPs considered themselves omnipotent !!
thanks vervet - actually I meant all of "us", not only the grunts who actually look after patients [rather than those who prefer talk about how it should done], but the general public as well.
My "little people" reference was meant to be analagous to the showbiz mindset where the big shots have little, or no regard for their customers, accept to the extent that they have to figure out the best way to squeeze a bit more cash out of them - it put me in mind of the DoH mandarins.
Sorry, if the remark gave offence, but there are many honest GPs, nurses, paramedics, physios, scientists, etc, etc [as well as patients of course] who would all like to make the NHS work, but the bigwigs tend to provide pens loaded with invisible ink whenever we are invited to make one or two suggestions about improving services ;o)
Calm down, Vervet - I think the term was used in sympathetic fashion. Leastways, that's how I read it.
Remember Helmsley's boast that "We don't pay taxes...Only the little people pay taxes"? Well, speaking one of those "little people", I'd like Simon Stevens and all his grasping kind to piss off.
ah, just ahead of me there A+E :)
("speaking as one of those..." - must...use..preview..)
Ahh, Leona Helmsley "the queen of mean" - I think she got her come uppance in the end [jail time], but not before amassing a fortune through real estate.
Oh to have an Elizabeth Baum [the housekeeper who testified against Helmsley] in the room while the politicos are setting out their REAL agenda for the NHS........until then we will just have to manage with Alyson Pollock's tour de force.
As well as Dr Rants sublime analysis I hasten to add !!
"Oh to have an Elizabeth Baum [the housekeeper who testified against Helmsley] in the room..."
Dr Rant - your mission, if you choose [and book] to accept it, is to disguise yourself as a management consultant...
lost_nurse - you are a f**king genius !!!
As well as Dr Rants sublime analysis
you want local councils telling you how to do your job? The local councils who foist massive wheelie bins on terraced housing and require us to decide, for purposes of 'recycling', whether a piece of card/board is 'card', 'thin card', 'thin cardboard' or cardboard? The local councils who resurface a road one month before they dig it up to renew the sewers? (Etc.)
(Oh yes, and, what was that about the NHS postcode lottery? -- I'll take NW3. Thank you.)
Fair enough, Jayann - local councils are irredeemably naff, and will always be linked in my mind to 1950's Britain and the sort of trades union character played so marvellously by Peter Sellars.
We are currently holding elections at our hospital [in the run up to foundation status] - but will that make a significant difference given NuLabs ongoing predeliction for micromanagement, and covert committment to the private sector ?
Perhaps we might just have to settle for the lesser of the two evils: local involvement [accepting some of the petty mindedness that goes with it] vs DoH mandarins dreaming up increasingly bizarre ideas such as the skills escalator [see Ferret & Dr Grumble].
Otherwise, I think most of what Dr Rant outlines sounds like a decent starting point, even if it means bringing on board the odd Boulting brothers character ?
to 1950's Britain and the sort of trades union character
aaarrrggghhh :)
Perhaps we might just have to settle for the lesser of the two evils:
it doesn't look like the lesser of two evils to me but then I'm mouldering away in in devolved Notional Health Service Wales.
(I do understand. I've been subject to Thatcherite and then New Labour targets too. My abiding memory is of, my abiding anger, against, the collaborators who joyously enforced the targets at other people's expense. But still, I understand.)
I think most of what Dr Rant outlines sounds like a decent starting point
I agree with his critique. I also agree with doing away with much of the 'management tier' aka boondoggle. I'm though far from convinced that
the government’s role would become one of service specification, standard setting and regulation
would, if it were effective, be less 'Stalinist' than now. IOW I think I'm in favour of a more intelligent 'Stalinism', given the trade-offs involved.
But as I said (and have said rather too often...), I'm in Wales, where some brave doctors argued that it would be better by far if the NHS were run, again, from Whitehall.
And now to sort out the cardboard; it's 'put out the composting bag' night.
lost_nurse - you are a f**king genius !!!
ha - the staff of a certain unspecified AMU would probably beg to differ.
It's a simple plan, but it will only work if the undercover Rants can keep their cool in the face of sustained idiocy - a formidable task indeed. They should practice saying "driving real and lasting added-value change in the stakeholder matrix"* until it's as smooth as their golf swing. Only then can they strike at the heart of the enemy - and be back home in time for tea and medals. Hurrah!
(*must be delivered with the correct degree of faked sincerity.)
GP surgeries 'could be run by Tesco or Vigrin'
'Every GP surgery in the centre of England's second largest city will be scrapped and replaced by franchised health centres run by private companies such as Tesco or Virgin under proposals published by its primary care trust.
The plans, described as "the most frightening document I've ever read" by a senior GP, include abolishing the 76 existing practices in Birmingham and replacing them with 24 branded primary care units, each predicted to see up to 15,000 patients a year.'
In The Telegraph today!
no one - christmas has come early for you ?
a & e charge nurse, naughty!
:D
Well, since the Midlands appears to be the epicentre of this new retail [medical] therapy, I thought "no one" might feel rather vindicated Jayann ;o)
I forgot he lived there! (I do know the kind of doctors and surgeries he's talking about, I've used places like that in the past, when I lived in run-down inner-city places.)
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