Opinion: Managing the NHS

nhs sign lrgI agree with Norman Tebbit. There, I’ve said it. The antique rottweiler was writing in the Telegraph in response to a number of intemperate comments made on another column about the service received from staff at the NHS. He said, among other things, “when things go wrong, as they have often done in the NHS, I believe it is right to blame the officers, especially the more senior ones, rather than the troops”. I agree with him whole heartedly on that point, though not on some of the other things he says.

On the same day, also in the Telegraph, the chairman of the Care Quality Commission, David Prior, was reported as saying that the NHS has become too powerful to criticise. “No organisation should be put on such a high pedestal that it is beyond criticism. Now it is getting more honest about our failings…” While this is a well founded criticism, I believe it is off target. He brackets the whole NHS, where I suggest he should be looking at the management structure.

He also thinks targets have become a bad idea. “Mr Prior suggested that the “target culture” imposed by Labour a decade ago fundamentally damaged the culture of the NHS, creating a “chillingly defensive” operation in which the truth was often sacrificed.

“The whole culture of the NHS became so focused on targets that it obscured what real quality was about,” he said. “The voice of the patient wasn’t in those targets.” (I am not sure if it is Mr Prior himself, or the Telegraph’s gloss that puts the blame squarely on Labour, given that the current government’s obsession with targets is easily the equal of Labour’s.)

He also thinks having chains of hospitals is a good idea. There I part company with him. Chains might under some circumstances be a good idea, but not the present in which balance sheets rule everything and managers know the cost of everything and the value of nothing. As it stands we will only get chains of hospitals that are run by the private sector, or by arms length, and hence fireproof, quangos, with all of the inflated administration costs and obsession with price that both of those states entail.

In another place I came across a blog post in defence of Trust CEOs. The writer solicits sympathy for Trust CEOs on the basis that they have a very difficult job to do. Forgive me, but when some of them are being paid more than £1000 a day, every day of the year, including Saturdays, Sundays, Bank Holidays, and Christmas Day, they should expect the job to be difficult. (Telegraph 4th November) (The average is £164000 pa, or £449 per day; but 11 were on more than £300,000 pa, and the highest was £570,000 pa.)

Hopson makes some half good points, particularly about a mismatch between power and responsibility. But he cannot get away from the central issue that CEOs are very well paid, and are part of the managerial target driven culture that turns away any hint of criticism that stands in the way of those targets being achieved – regardless of what the relationship is between the achieving of targets and the actual quality of patient care.

The NHS is an immensely complex beast, and micro managing everything does not work. We need to get away from the obsession with targets, and rediscover questions of value and of meeting the needs of the patient. That is what the ethos of public service is for. We threw that baby out with the bathwater. Perhaps we should go and look for it again.

* Rob Parsons is a Lib Dem member in Lewes. He blogs at http://acomfortableplace.blogspot.co.uk

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  • I think a lot of the problem with the NHS is that it is at the forefront of the complaint and compensation driven culture the point where it is paralysed by the need to investigate any allegation, however ill-founded and lacking in solid evidence.

    A close friend of mine has had to take early retirement from the NHS because of a series of spurious allegations by a colleague, bent on vengeance for some former perceived slight. Instead of calling them both into her office to sort it out by applying common sense, the manager concerned went for a full-blown disciplinary procedure, paralysing the department they both worked in due to the amount of time wasted. The accuser is now facing their own set of allegations, adding to the paralysis. I’m led to believe this kind of situation is widespread across the NHS leading to incalculable cost and waste of skilled staff time – the organisation’s most precious resource – which could be used in seeing patients.

    And on and on it goes.

  • Stephen Donnelly 30th Dec '13 - 9:05pm

    I don’t agree with Norman Tebbit! There is a concerted effort amongst Conservatives to undermine the NHS. Rob ‘s article gives too much credit to reports that have appeared in the right wing press, it offers no understanding or insight.

    My local trust has had seven CEOs in ten years, not including interim managers. The average term of office of a CEO is not a lot longer than a one year. The problem is that they operate within an unworkable structure, a highly politicised atmosphere and, and severe budgetary restraints. Add strong trade union to the mix and you have an impossible job.

    Blaming middle managers is too easy, even if they have high salaries.

  • Targets as described here deserve to fail. Targets bought into by a whole organisation, watched by the top bod but part of the operation at every level, should succeed.

  • Andrew Colman 31st Dec '13 - 9:48am

    A very insightful article on the economics of healthcare. Should be compulsory viewing for any politician involved in making decisions on healthcare, or any voter


  • Andrew Colman 31st Dec '13 - 10:35am

    A simple Beveridge system (ie one provider financed out of general taxation) is the “best” and most efficient way of delivering healthcare

    This is because of (a) Economies of scale – no need for duplicate management (b) A single buyer can minimise the price of drugs and (c) There are no shareholders, directors or PR people to fund.

    We Lib Dem s should be loudly promoting this option at every opportunity we get.

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