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

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

 

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