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Politicians must acknowledge the problems within the NHS before any serious steps can be taken to save it…

November 13, 2014 Leave a comment

David Cameron And Jeremy Hunt Visit A Hospital To Mark The 65th Anniversary Of The NHS

It is because we can all identify or agree with the principles of our healthcare system – to meet the needs of everyone; to be free at the point of delivery; and that it be based on clinical need and not the ability to pay, that it has become such a focus and play thing for successive Governments and the politicians within.

It is also why the NHS now finds itself at a point in its history where these very Principles may have now placed it at the most significant risk.

In time, the size of the milestone which was the creation of the NHS, may be fully appreciated for the very rare moment in time that it was when the political classes delivered a set of policies and principals which were genuinely created to be in the best interests of all.

Such moments are extremely rare. Governments such as those led by Churchill and Thatcher created and determined legacies which still affect us now and which their successors may only ever hope to emulate.

But the arrival of the NHS, much like the formalisation of working democracy through the creation of our Parliament following the Civil War, has the power to touch us all – even if we don’t or won’t openly acknowledge it.

Sadly however, once the principles upon which the NHS was formed were agreed and indeed became cornerstones of both our culture and society; what were soon to become the long-term political arguments over how their processes should operate soon began.

Today, the NHS might be best described as a series of industries within industries; of silos within silos; business unit lapping up against business unit; as an entire ecosystem where ideas, concepts and yes – even Jeremy Hunt’s ‘innovation’ [aka ‘commissioning] are actively competing against and ultimately all working against each other with the regrettable endgame firmly in sight, when some future Government will have no choice but to admit to no longer being able to afford it. Funny perhaps that it’s never this particular one…

Generations of the political masters of the NHS do themselves carry much of the blame for the crisis which the Organisation is in, with it having become the ongoing vogue to stake ideological claim to ensuring the future of the service.

Ideologies are all well and good, but it is such a cultural reliance upon specialists for every function outside of medical practice itself that has bloated backroom functions and created an ideal climate for non-clinical managers to lay claim to the most important responsibilities within what should have always remained a predominantly clinical-led world.

Add the performance-choking and burdensome elements of protectionism which have been fuelled by European red-tape and employment legislation; litigation culture and the motivation of many to look for almost any reason to create blame, and you can soon see why temporary staff, commissioning and the recruitment of managers who can surely only manage if they have a degree or an MBA has become the norm.

The pseudo-sciences do indeed have a lot to answer for not only within the NHS. Somebody somewhere will soon need to realise that blue sky and out-of-the-box thinking are reflections upon the ability and understanding of an individual to apply what they know. It is something which itself can rarely be taught, and the way in which qualification is prioritised above experience is really quite perverse in the age of equal opportunities. The text book technocracy which is now populating all tiers of middle and upper management threatens whole industries, and not least of all the NHS.

As discussed in a previous blog about Government, the NHS is not a business and should not in any way be treated like it is one.

One of the greatest ironies of Jeremy Hunt’s plans for making savings by cutting the hire of temporary staff, is the fact that many of them have and are being employed to manage and grow the processes of commissioning which he himself is stewarding – attracting daily rates for self employed ‘consultants’ which can easily reach £400-500 per day; plus expenses; plus the fees which the Recruiters and Agents who facilitate their ‘employment’ will be charging themselves.

Whilst sold to us as the way to streamline and make healthcare more affordable, commissioning is not only an extremely expensive process to manage, drawing funds, staff and resources away from areas where they are needed most. It is also a major step in the direction of privatisation.

Health service providers – government, NGO, not-for-profit and privately owned alike – are invited to bid to provide services, and all of them will be primarily thinking about the bottom line, and not the holistic level of care they will be giving the end user – i.e. you and me, as they do so.

The Government itself usually recognises a bottom line from fee generation as profit, whatever the legal status of the organisation behind it. The biggest question about the future of the NHS must therefore be how it can possibly be so that other organisations can now provide better services at lower cost whilst they are also making a profit, when the Government itself cannot deliver the same directly and without the need to pay an additional premium fee?

The NHS, like Local Government and many of our NGO’s is in serious trouble, not just because the Country is now effectively bankrupt and cannot actually afford to continue providing the services that it already does. But because it is also incapable of addressing the fundamental need for transformation and use innovation in its real sense to enact top-to-bottom change in working practices and the legislative areas that support them.

Politicians are not prepared to talk about the real issues that the NHS faces, even when they are themselves cognizant of them, because they fear the electoral implications of actually being seen to do so.

Meanwhile, the default approach to making savings is being employed yet again, and whilst savings can almost certainly be made, the decisions which lead to them should be based on the knowledge and experience which comes from the clinical end of the scalpel, and not from the money-counters and political theorists that populate the very fat end of the other.

image: blogs.spectator.co.uk

 

Change is what we need; not revolution. And it’s all about getting the basics right…

November 13, 2014 1 comment

images-13For all politicians, the opportunity genuinely exists to revise and create new polices which will work for the benefit of all. It’s not an option which is restricted to Ed Milliband and Nigel Farage who both hope to have very different roles in power from May; but one which even the Coalition Government could begin to embrace right now.

Sounds quite a stretch when you think about it though. Tribal politics and the media chasing political circus that Westminster has become, has, after all created a cynical and disenfranchised electorate; one which in the majority experiences little each day, to make it feel that the system actually relates to any of us in any way.

Perhaps without even knowing they do it much of the time, even the most modest members of the political classes somehow succeed in exploiting this very real perception to their benefit, using the media and disingenuous rhetoric they employ to leave individuals and families feeling as if they are themselves alone in going through what for many has become a very trying experience.

It wouldn’t be so bad. But being left feeling guilty because you cannot afford to buy food; to pay bills; to buy clothes; to pay for transport or because you are having some other form of negative experience of life which you really shouldn’t be have in 21st Century democratic Britain is certainly in no way fair.

It is certainly not what you would call right in an age when equality has for a long time been sold to us as a given.

Its not what you expect when successive political generations have told us all that they, and only they, possess the holy grail to putting everyone first.

When you have Government after Government run by people whose only true priority is to gain or retain power, it stands to reason that many people do not see or feel that the electoral system is working for them.

Ignoring elections, or throwing support in the direction of a new Party which is at the very least attempting to sound like it is in touch with the issues that people are facing, then for many becomes an attractive proposition indeed.

Regrettably, such a political environment like the one we are experiencing today provides a wholly fertile seedbed for popular voices advocating seismic change of a kind that would be more akin to opening the Pandora’s box which accompanies public unrest, rather than heralding the arrival of some new and golden age. However well intended, Russell Brand’s recent political outbursts and the publication of his book Revolution are in reality little more than an aspirational touch paper of anarchy – based on the views and interpretations of many other Writers – promoting the release of one terrible genie that any sensible person – however frustrated with the system they might be – really does not want to see let out of it’s bottle.

images-12Overnight change – which is essentially what revolution is, doesn’t usually end well. It is more likely to lead to a situation far worse than most will have experienced before, and one which will probably be a lot harder to change.

We have to work to make what we have better, rather than breaking up the workable framework that already exists; throwing it all in the air and then leaving it all to pure chance to see – and then experience where the unconnected pieces will then all fall.

It is top to bottom reform and change that are essential across public services and all areas of Government Policy, before people are in any way likely to feel they are being treated fairly.

This will not come about by continuing to base arguments and disquiet on wealth or demographic class, and whilst advocates of wealth redistribution may find an audience which is very receptive to the idea that either taxing or simply stripping wealth from the rich, and sharing it out equally amongst the poor may give them all a much better life; this idea is indeed as illusory as the money is itself.

Non-earned wealth will in most cases disappear just as quickly as it arrives – if not through private spending, then through the exponential and inflationary economic changes which would almost certainly accompany the instantaneous arrival of so much personal wealth.

The aim of solving the problems of breadline Britain or the cost of living crisis will no better be served by penalising the potential of high earnings, than it will be by enacting an unsustainable rate for the Minimum or Living Wage.

Such solutions may provide a temporary fix, and give a moment of perceived justice to many. But those with money will soon move away or lose the incentive to keep earning – whether they are companies or individuals; whilst those who have found themselves with more money in the bank at the end of one month, will soon lose it the next when employers and the suppliers of all the goods and services that they think they can now afford put their prices up to support the rises in wages that they have themselves had to pay.

No. Dealing with problems in isolation simply does not and will not work, because by attempting to solve one problem in this way, the process soon leads to the creation of many more – if it doesn’t just make the original one a whole lot worse for those who are experiencing it.

To build a better life for all, getting the basics right is the very first step. It is about reviving, living and promoting a sense of ethical balance and consideration for all.

This will most likely be achieved by ensuring that at the most fundamental level, adults can afford to feed, clothe, and house themselves – and any dependents that they may have – to a minimum and workable standard. A benchmark level which cannot be subjected to the influence of any third party.

Working to address the many issues that require policy changes will not be simple. But Politicians are elected with the expectation that they can deal with complexities on behalf of the people they represent, and if they have taken their election that seriously, this is exactly what they should now do.

The possibilities for solutions are probably endless. But solutions are indeed possible if the needs, benefits and consequences for everyone are considered properly.

If politicians genuinely want to help and provide a level-playing field where there is opportunity for all, why are they not looking at policy areas that have the potential to make an immediate difference. Examples might be:

Releasing the restrictions placed on employers AND employees through Legislation such as the European Working Time Directive: The days when legitimate business thrived on the unbridled exploitation of the working classes have long since passed and we today have some of the most restrictive working practices on the planet. If everyone in the workplace was completely happy, furthering and maintaining the cause of such horrific levels of bureaucracy would make sense. But many people want the opportunity to work beyond the requirements of their contracts of employment, whilst employers would benefit greatly from increased input and flexibility from existing – and often more experienced staff. The real key to ensuring fairness is simply allow workers to do additional work when THEY want to, or just as they have formally agreed. Employers have to be trusted not to embrace unsafe working practices and the nanny state has gone too far in basing industry-wide restrictions on the behaviour of the unscrupulous few, or upon idealistic views of bureaucrats of how business actually works. Imposing business-breaking fines – and being seen to do so, would be a far more effective way of encouraging good working practices and management, rather than allowing officials with no business experience to attempt to direct industry professionals on how they can staff their business.

Stopping the escalation of property prices:The UK is culturally obsessed with property and its financial value in a way that few other Countries are. Prices have continued to inflate at dangerous levels which keeps borrowing artificially high, and makes rental prices equally excessive for entrants to the markets who have to rent, but desperately want the opportunity to own. Government could and arguably should step in to regulate the property industry and introduce policies which keep prices as they realistically can. The potential need for a resetting of property values is very real, and whilst Government behaves as if the answer to all problems is to build, build, build, while prices keep on going up (When do you ever see new developments come on to the market with prices that are lower than the local comparative market?), Politicians are never going to solve the housing problem or the massive drain that property prices has become for young people entering the market. Putting this problem off until tomorrow has long been the way; but tomorrow may already be here!

Working with Utility companies to keep prices manageable: The term ‘utility company’ has been a misnomer since privatisation, when the priority switched from the supply of services that are essentially supposed to be for the public good, to shareholders who will almost always be looking for a profit. No man can serve two masters, and the monopolistic strength of these companies has equipped them with the ability to write their own ticket, whilst ensuring their profits are secure. In the absence of Government regaining ownership, it should nonetheless step in to cap profits, or at the very least buy supplies direct for those who qualify at rates which reflect the wholesale purchasing power that the Government could and arguably should have on our behalf.

Buying services and goods direct from suppliers for those on benefits and low incomes or using smart card technology to deliver just the same: A massive opportunity exists for Government to step in and buy products and services on behalf of those on low-incomes and on benefits. Without the need to provide subsidies, Government could easily realise all the benefits of procuring food, fuel and essential goods as a significant bulk-buyer, just as big companies like supermarkets already do. The immediate concern that would be raised by the implementation processes such as administration, distribution and monitoring could be easily overcome through the use of IT, and whilst we hear horror stories about the stupendous cost of government-wide software implementation projects, the technology already exists to provide such a system through the use of personal smart cards, without big business profiteering, or the end user having to collect goods from anywhere other than the stores that they already use.

Creating a ‘retail’ arm to the Bank of England: Provide full current account services and not-for-profit based lending for pay-day-loans and to support small business – just seeking to return the operating costs for the benefit of everyone.

Lining up what are just a handful of suggestions makes it sound simple. But nobody would have unrealistic expectations for delivery from a Government that communicates with the public using openness, honesty and respect.

People do know that they deserve something better than what they currently have, and the time has come for a kind of Government which actually gets the basics right, rather than just talking about it before the usual grandstanding begins.

Whether income for those on low incomes comes from earnings or in-kind from benefits, there exists a cultural expectation for British Government to ensure a Basic Standard of Living.

Whatever the Political Party in Government might be, it is time for the philosophies, protectionist policies and ideas which benefit only the few to be binned and replaced with delivering something better as the priority for all.

When Government has these basics right, the many dominoes which stand beyond will very quickly begin to fall.

 

 top image – imgarcade.com

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