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Posts Tagged ‘NHS Reform’

COVID-19 has exposed just how sick the NHS and ALL public services were BEFORE this emergency began. Their future is YOURS to decide

April 28, 2020 Leave a comment

The flipside of so much focus on support for the NHS and frontline staff is the spotlight that has been shone on its supply chain, lack of resources and specifically the serious lack of PPE being stockpiled for a medical crisis before the COVID-19 Pandemic began.

Today, in the middle of the Coronavirus emergency, it would be hard to find anyone who wouldn’t agree that this really is not how things should be within our Health Service. Yet at any other time, the same people are more likely to nod politely and walk away thinking little more about it than that you were just having a whinge.

You won’t feel the blast from a bomb until the bomb has gone off and the NHS has suffered from a serious lack of urgency and attention because things like PPE have simply been one of those things that it seemed easy to put off until another day.

The lack of planning and consideration within the NHS for the ‘what ifs’, along with the serious staffing shortage that has now been highlighted too are pretty much the tip of the iceberg of the problems and difficulties that affect just about everything else within it too.

But it doesn’t stop there.

In fact, as perhaps the most recognisable face of public service provision in the UK, the real problems that the NHS is facing and the reasons that it is facing them are also being faced and experienced just the same across all parts of Government and the whole of the Public Sector too.

No. I’m not referring to a shortage of PPE across bodies like the Environment Agency, Highways England and local councils too – even though it could very well be the case. I am referring to the cultural rot that exists within all of these public-serving organisations that causes all of the problems that we only experience when they deliver their effects.

This isn’t a new problem and it has been building for a long time. Whilst they appear to be very different outcomes, the Rotherham scandal and the mechanics of the Grenfell disaster are sadly the outcome and effect of all the very same causes that have set the NHS up to struggle at the very time and in the very places that everything should feel like it has come together seamlessly as one.

Political correctness, the push for diversity, EU-derived employment legislation, protectionist culture where the buck gets endlessly passed to none of the above, political interference with ridiculous schemes like PFI, the creation of a massive backroom structure of managers with titles that were never needed before and a complete lack of understanding of how money being thrown at problems at the very top of Government only make the problem worse and push the problem into the lap of the next government or generation of politicians to skirt around another day.

These and others are all contributory factors to a public-sector-wide malaise where managers and those with responsibility have been conditioned to avoid doing anything that reaches beyond the confines of their own contract and job.

Some would call it a failure to use common sense. Others, that it is basic lack of appreciation of what public services are actually there for. But in many cases the whole lack of interest in really serving the public and tax payers that all of these jobs were created to help is made distinctly worse by the reality that the wages of those in these jobs will alwaysget paid.

The problems that the NHS has will not be solved by simply upping the budgets for any of the parts of it. The money will get spent, but it will never reach the parts that it really should do whilst the culture remains the same. Ultimately without top to bottom and above all cultural reform, the Key Workers and Frontline Clinical Staff throughout the NHS will not ever be valued and given the opportunities that they should have and we would all want them to.

Beyond the effort to ‘protect the NHS’, the Lockdown has began to cause massive problems that are set to reverberate throughout our society in the coming weeks, months and years. The impact of what this Government has done will cause harm to people and the country in many different ways that could have been avoided if we had different politicians in charge.

These are not the people who will put everything that is wrong in the NHS and the Public Sector right. Not now, not after the COVID-19 Pandemic is over, not at anytime thereafter.

The politicians we have today simply don’t and will not try to understand what is actually going on.

So if you love the NHS, the nurses, the doctors, the surgeons, the therapists, the healthcare workers and all of the key staff in our hospitals that make the real part of the NHS work, remember them at the next General Election or when this Government collapses – whichever happens first,  and bear in mind that is the point when you can help to make things different for all of them by making a different choice to the one you normally would, and choose an option that will not be available from any of the existing political parties that we know.

 

 

 

 

The NHS MUST be reformed after COVID-19 so that front line and clinical staff are valued as they should be whilst universal health provision for all remains something our Country can afford

April 13, 2020 2 comments

It is at the pinnacle of a National Crisis and not after the event itself that the most pertinent questions should be answered about how supply chains and service provision can be improved to ensure that the national response to the same thing happening again is future-proofed.

So much effort within, on behalf of and supporting the NHS and it’s staff is being expended during the COVID-19 Lockdown, that many people including the Media and our MPs too are failing to allow room to think about the lessons that should already have been learned.

From the responses to appropriate comments and questions on social media, that much is sure.

It is now essential for the Government to ensure that the future of our universal healthcare service for all is safe and that we can all be confident that in a time of a future medical crisis like there is with COVID-19 now – should a pandemic or similar be repeated – the Country will find it much easier to cope.

NHS Staff are doing the best that they can with the resources and the support that is available.

But the time it has taken to put resources like ventilators and PPE in place, the need for the recall of retired and specialist staff who had let their registrations lapse and the suggested need for the whole country to acquiesce to a Lockdown in order to ‘Protect the NHS’ speaks volumes about the problems that already existed within the NHS before the Coronovirus Pandemic began.

We must all ensure the Government is compelled to both consider and act upon these supply and resorting issues immediately and appropriately when the COVID-19 Crisis is over and done.

If the real and underlying condition of the NHS is not considered in this way now, the lack of political will to deal with real problems unless they are under the media spotlight will ensure that nothing like the change that has been necessary for a very long time will ever get done.

Don’t be deceived into thinking that the money and resources that are being thrown at our hospitals now without limit will make a difference to the Nurses, Doctors and health workers in the long term. It won’t.

The NHS has institutional and cultural problems that cannot simply fixed by providing the Health Service with more money at a rate that is neither sustainable or at a cost that the Country can actually afford.

What the NHS needs is complete bottom to top reform.

Comprehensive reform is the only way that real value can be given to frontline clinical staff and their support – both in terms of what they earn, the responsibility and influence that they have and the support they have from the Government and the Public Sector.

Money will never work as a genuine solution to the problems that the NHS has, even if it looks that way, because more money will simply maintain the service in the state and condition that it currently is. And the NHS is not a happy place to work.

What we have learned and are now likely to accept is the people who do frontline jobs in services such as the NHS, healthcare, waste collection, transport and working in supermarkets too all have roles which are just as important to our lives and existence as any celebrity, football player, company CEO, journalist or politician – if not more.

Everyone has a big part to play in making the wheels of the Country turn. Not even bankers are the untouchable gods that they would like us to believe.

WE ARE ALL THE SAME. WE ARE NOT AND SHOULD NEVER BE DEFINED BY WEALTH, JOB, INCOME OR ANYTHING ELSE THAT MAY APPEAR TO MAKE US LOOK DIFFERENT TO ANYONE ELSE.

The Government must now take steps to ensure that REAL value is attributed to NHS Staff not only financially, but in the public policy and measures that the Government can take to support ALL people who are currently underpaid in relation to what it costs to live.

One of the most ridiculous things that I have read in recent days was that an advert had gone out from one particular Health Trust to employ a diversity officer at about twice the wage of a frontline NHS Nurse. This kind of stupidity in the management of political correctness applied in the workplace represents everything that is wrong with the NHS today. It has to stop.

This is part of a massive problem that the Government can and should be tackling head on.

Things that the Government should do include:

  • Placing a ban on the use of agency and contract staff to fill frontline NHS roles to be enacted within 18 months
  • Placing a ban on the outsourcing of management work to contractors, freelancers and consultants to be enacted within 12 months
  • Management of all operational functions to be placed back in the hands of experienced clinical staff
  • Rescind the European Working Time Directive and replace it with legislation that allows each individual to work the hours they choose to, providing their doing so will not put others at risk and that they can only work hours above those they are contracted to do so as a personal, non-coerced choice.
  • The creation of a parallel extended vocational route (a genuine apprenticeship or time served route) to degree qualification as a Nurse for non-academically inclined candidates
  • The cancellation of tuition fees for Nursing, Medical and other NHS-related undergraduate degrees for academic candidates
  • GPs, Drs and Consultants who leave the NHS after receiving a UK education and on-the-job training with the NHS to be required to undertake 10 years service in their post-trained NHS role after the completion of training before they can ‘go private’
  • That any employee transferring from a commercial sector role be required to undertake a minimum of 6 months clinical operations experience before being able to take up their new NHS role, unless they have gained worked within the NHS as a full-time NHS employee within the preceding 5 years.
  • That no Public Sector employee should receive bonuses for carrying out the function that they were employed to undertake.
  • All purchasing to be carried out for the whole network by a centralised service with ordering only carried out at local level
  • The NHS ‘internal supply chain’ to be managed and operated by the NHS and not contracted out to external suppliers
  • The cancellation of all existing PFI arrangements
  • Removing the ‘right to sue’ from anyone who has not directly paid for NHS care in the event of something ‘going wrong’. (Directly to include those receiving private treatment on a private healthcare policy)
  • Set up a specialist NHS Adjudication Service to make judgement on any negligence claims from patients who have directly paid for treatment
  • Setting a basic standard of living level, ensuring that the providers of essential services such as utilities are either in public hands or run on a strictly not-for-profit basis and resetting the property market to ensure that standard housing is affordable to all.
  • Remove the ability of Unions to call strikes or any kind of industrial action
  • Set in law the requirement that the CEO of any health trust cannot earn more than 10 times the wage of the lowest paid member of staff in the trust – including any enhancements that come with the role.
  • Pensions to be brought in line with general requirements
  • The changes made by Gordon Brown to Pension Funds in 1997 to be reversed

One of the most important requirements of successful change for the NHS and equipping our Hospitals to be prepared for all future events is the acknowledgment that the NHS does not stand alone.

A significant number of people work professionally within the NHS and its supply chain. But by its very nature as a public service, the NHS and the people who staff it are effected by Public Policy right across the board.

It is therefore essential that the Government no longer treat the NHS like it sits in an isolated bubble – just as people outside of it understand Westminster and everything political to operate..

What the Government does for or to the NHS will have an effect on other public services and industry, just like what it does for them will affect the NHS too.

Some of the changes that need to be made are specifically related to the management processes within the NHS. But not all of them, as there are many more.

Identifying and implementing policy for the NHS and its staff that overlaps with other areas of life is beyond essential.

Without it, the next time we need the NHS just as we do with the fight against COVID-19 today, it will have long-since been placed in critical care.

 

 

 

 

 

The only genuine protection for the NHS is meaningful reform

November 9, 2019 Leave a comment

red-herringFive weeks until the General Election and there’s so many red herrings around, you could be fooled into thinking our MPs are trying to sell us a smokery.

The biggest pool of them all surrounds the Labour-led debate over privatisation of the NHS – a topic which is a continual source of dishonesty for the Labour Party, the Conservatives – now the SNP too, and very much a political ball.

The issue was in many ways fuelled by the recent Channel 4 Dispatches Documentary about big pharma and the USA’s probable attempt at assault on the way that the NHS buys drugs as part of a post-Brexit Trade Deal with them.

However, what Labour’s push of ‘we are the only Party who believes in the NHS’ fails to so spectacularly address is the real level of the problems that exist within our National Health Service, how those problems became manifest and have to be addressed, and how fire hosing money at this Public Service might keep the wheels turning, but in the long term it will not save the NHS and in fact could be making all of  the problems significantly worse.

The principle of the NHS is a very good one. We should ALL continue to have access to free healthcare at the point of access. But we cannot continue onwards thinking that its existence can be assured in the future simply on the basis of how much We spend.

Privatisation in its most literal sense is – on the face of it – a very big part of the problem of cost attribution within the NHS today. So for Labour to even suggest that they can stop privatisation when it is already present, is either disingenuous on their part, or demonstrative of their ignorance of how the service actually works.

Many of the problems with cost have come about because of deals that the Blair and Brown Labour Governments constructed under the guise of PFI. Others have snowballed because of the cultural steer towards the use of private contractors or consultants to undertake backroom management functions and the excessive use of temporary staffing agencies that were never required before all good sense in employment laws and conditions was excessively overstepped and the door was opened to unbridled levels of profit making which has gone on for so long now that it is simply the way rather than individual choice.

Fixing this problem so that the NHS once again becomes sustainable isn’t easy. And with politicians who don’t even understand how it all works, real or meaningful reform is not  even currently on the agenda, let alone being a political choice.

The MPs that we have had, their Parties and the People who lead them have no incentive to really get to grips with what is really going on. Their lack of knowledge and understanding is self evident each and every time they are interviewed – which during an Election Campaign is pretty much every time that we turn the radio or TV on.

Until this changes, none of the problems that we as People within this Country face will be dealt with.

Yet we don’t even have the option of Political Parties or Candidates on 12th December who even have an idea of what is really going on.

 

image thanks to unknown

Changing Politics for the better Pt 7: Social Care

September 6, 2019 Leave a comment

It’s very easy to forget that most of us will become old, and that 1 in 4 of us will require care in the later part of our lifetimes.

Whilst there currently some resentment of the ability for older people to influence politics with their Votes ‘because they won’t be here to see it’, the reality is that every single person in this Country should receive care and support at any time during their life – should they need it, whether it be just through the provision of education, access to the NHS, benefits or more specialised support, that includes Social Care for anyone who needs it when they become elderly.
Most of us would agree with this approach upon reading it. But the reality is that right across the provision of services to people who need them in this Country today, there are too many experiencing lower levels of service than it would be reasonable to expect from the Public Sector, and in some cases, they are not receiving help at all.
Of these services, one of the hardest hit by changes in local Government Budgets and the way that Local Authorities are now run is Social Care.
There is no longer the level of consistency of service provided to guarantee that the support needed, wherever or however that need might require, will be the same for everyone.
This must change.
But we must also address the causes of the problems with Social Care and Public Services first.
When we hear Politicians talking about Social Care and how they intend to address the problem, they will almost certainly suggest that the problem is all about money or lack of funds. Sadly, thinking that throwing money at every problem will solve it, is just something that current Politicians do.
Yes, in the short, but probably only the immediate term, additional funds can appear to make a problem like this go away. But without looking deeper into the much wider problem and facing up to the changes that must now be made, the problems with Social Care and all forms of Public Service Delivery are simply not going to go away.
In a Country as wealthy as the UK appears to be, we should all have unhindered access to the Public Services that we need.
Those Public Services should be affordable if they are managed and delivered in the way that they should be. And we should all be happy that the contributions that we make through Taxes and National Insurance will be spent appropriately and that everyone will receive help and support to cover all their needs, if and when they genuinely need it.
A good Government could begin by:
  • Reversing the European Working Time Directive and replacing any other restrictive working practices that make workers rights more important than the ability of the organisation or business they work for to perform economically.
  • Installing new legislation to protect employees that works sensibly and fairly for both the employee and the employer.
  • Doing away with any rules, regulations and laws that mean it is more cost effective for a Local Authority or NHS Trust to outsource or contract out any role, supply or service to a profit-making private contractor, than keeping the provision or service ‘in-house’.
  • Removing gold-plated and disproportionate pension schemes that are being subsidised by Taxpayers and the expense of service provision.
  • Creating new profiteering laws to prevent third party agents or middle men from taking profit from supply chains at any stage, without adding real value to the services or products offered.
  •  Legislating to prevent Councils and Health Authorities seeing Temporary Staffing Agencies as an easy option to overcome staffing difficulties.
  • Undertaking sweeping Public Sector Reform to ensure that Officers and those employed by any Public Service are ready, able, prepared and unhindered in doing their job, without the influence of blame culture, or fear of doing wrong.
And there is definitely much more….

What the Carillion collapse tells us about the unspoken truths governing public sector contracts

January 18, 2018 Leave a comment

Carillion

Carillion is the big news this week, and is likely to remain on the media radar for some time, given the impact that the collapse of a Company of this size is almost certain to have on commercial relationships that are now an integral part of the public sector.

Moments like this are important for reasons which go way beyond the impact that Monday’s announcement is already having on jobs and the potential closures of many small businesses.

It is providing one of those very rare opportunities to glance inside the incestuous workings of contract delivery on behalf of government and gain an invaluable insight into why private interests working at any level within the public sector is in clear conflict with very ideals of what public service delivery is fundamentally about.

Regrettably, the clear focus of the media and political classes has already fallen upon the question and avoidance of blame. Yet if they were to begin to look just a little further and be open with what have for too long been the unpalatable truths, there would be just the merest hope that questions such as whether there can be a future for the NHS when it remains in a perpetual state of financial crisis could perhaps be genuinely answered.

So why are contracts going to private companies outside the public sector?

The best place to begin thinking about the contracting or privatisation problem is to look at why private business is really even involved in the delivery of government services of any kind, when government exists to operate for, on behalf of and for the benefit of only the public.

Man can only ever have one true master after all, and if money is the true motivator, then public service will at best become an oversight – the unwelcome relative left trailing way behind.

Whilst it may feel counter-intuitive to believe or accept it for many of us, the ‘privatisation solution’ has been in the main part created by Conservative governments in response to the consequences of policies created typically by Labour in order to enhance the rights, working conditions and influence of public sector employees.

Positive discrimination and rights, enhanced working conditions, gold-plated pensions and union indulgence within public sector organisations all cost an ever evolving sum of money in an increasing number of different ways, which usually create even more roles and dilute responsibility further and further still.

The cost of employing people within the public sector on conditions which exceed those of the private sector outside – even when salaries appear to be less, has simply made the delivery of services too expensive for government itself to provide.

Against this backdrop, all areas of he public sector have had to go in search of more cost effective ways to deliver services, and have had to do so in ways which also meet the rigorous requirements of providing services and employing staff as a government based organisations.

This has made the ‘marketplace’ fertile for the entry of private contractors who don’t have the same considerations as these former public sector based service providers.

When you consider that private contractors are providing arguably the same level of service, just without the same levels of bureaucracy – whilst making what in some cases is an outrageous level of profit besides, you can soon begin to see that something is inherently wrong with the way that the government system is now designed.

So how does public sector contracting by private contractors become a problem?

Business loves a contract. Contracts give surety. Contracts themselves can be used as a solid-gold guarantee – and particularly so when they are agreed and signed with government. This gives business confidence which can be misplaced, misused, abused and is almost certain to breed a feeling of complacency.

After completing what should be a rigorous ‘tender process’ – the company will sign a contract with the government organisation which agrees what, when and how the ‘contractor’ will provide a service, whether that just be 1 person to sweep a street or 32 bin lorries to collect your rubbish every fortnight for 5 years. On signing this contract, the company will know exactly what it will be paid, know what it will in turn have to spend, will have worked out its costs and borrowing, should have kept back a little for a rainy day and then know what it will make in profit – from which it will pay bonuses to staff and dividends to shareholders after it has paid any tax requirement.

Good managers know that some things change during the lifetime of a contract – such as fuel prices going up, which would be a real concern for a bus service provider or a private ambulance services. But contractual devices or clauses that allow for some variation in charges are usually built in to any contract to allow for this.

As such, genuinely unforeseen events or those which could not have been predicted by anyone within the contracting company itself are very rare to find.

What government contracts don’t allow for however, are lack of knowledge or understanding of the service delivery area on the part of those designing and agreeing a contract. They don’t make allowance for unmitigated trust on the part of either party. They certainly don’t consider the potential greed or indeed malpractice of a contractor or its decision making staff, which cannot be planned for or predictably defined even within the scope of a government contract process.

When a contractor has only a single contract, transparency is bizarrely much clearer and for the management, much more important and kept clearly in mind.

But when you have many more and perhaps and ever increasing number of contracts, the potential for complacency and overconfidence can lead to otherwise unrealistic opportunities, which in more focused circumstances would have been denied.

It may be as simple as paying senior executives massive, over-inflated salaries. But it has the potential to be much much more in terms of investment, questionable projects and big payouts for shareholders when little in terms of adequate checks and balances has allowed an adequate safety blanket to be retained from payouts and quietly put aside.

The overriding problem with a company which has grown to the size, reach and responsibility of Carillion is there is so much in terms of questionable financial activity that it has the ability to very easily hide.

The responsibility for contract design and management doesn’t just fall on contractors themselves however.

In the background to all this and within the protectionist culture in which contemporary public sector commissioning is currently enshrined, purchasing officers simply don’t have the motivation or willingness to do their jobs as effectively as they should. When the money you are allocating isn’t yours, public service and best value isn’t always the overriding priority. Sometimes it’s all about doing anything which proves to be easier, and who gets what doesn’t always work out exactly as it should.

Whether its building maintenance, bin collections, public transport, prison management, forensic services or interim and temporary staff services that contractors provide, contractors are all making unnecessary profit at the ultimate cost to us as taxpayers.

So what can be done to solve the problem and when will anything happen?

What has been outlined here provides little more than a simple snapshot of a very big and complex problem, which those in power are through their actions are continuing to deny.

For these problems to be addressed, it would first be necessary for politicians to accept that the whole system of government delivery is broken, riddled with management focused upon self interest, making decisions based on theoretical premise, and that there are simply too many people operating within the system who are ultimately being allowed to take us all for a ride.

The ‘too big to fail’ mindset has now permeated through political thinking to a level where contracts are being awarded despite very clear warning signals which would tell even very junior civil service staff that something is not right.

This is no longer a question of let’s bail them out so that they don’t fail like Labour did with the Banks in 2008; this is all about awarding contracts because there is a view that they never will.

Solving this problem is far from simple. It is not just about political thinking. It’s about getting the market’s to think differently. But just as much, it’s about getting employees to see their roles differently; to accept that they have a part to play too.

In simple terms, the free for all has to stop.

This bonanza based on self-interest is no longer sustainable.

The perpetuation of the lie that government genuinely works selflessly for everyone has got to be stopped.

No business can perform effectively on the basis that it prioritises the working conditions and needs of its staff before the priorities upon which it was created to deliver. Yet this is how liberalism and rights culture has manifested itself within all parts of government and the public sector.

Not only has the NHS become hamstrung by lack of staff and inefficiency, it is being cut up by the cost of the staff it hires through contracts – thereby being destroyed by the supposed solution itself; by the very respite that additional money is supposed to provide.

Meanwhile local government has its own substantive bogeyman too, finding itself tied up in knots by the cost of the local government pension scheme – the destination of the better part of our council tax, in many of the Boroughs, Cities and Districts where most of us reside.

Then there are the PFI contracts upon which the last Labour Government so heavily relied. A coarse, deceptive instrument designed to hide public spending, whilst fire hosing cash at private contractors over 30 year terms. Just another financial time bomb legacy like the raid on pension funds by Gordon Brown which we overlook daily on the basis that out of sight is very much out of our minds.

The power rests with government to change all of this, if only they would try.

Regrettably, the will doesn’t even exist to even begin doing so today, even if the Government could begin doing so – something that a hung parliament which could last until 2022 will simply deny.

With a good chance that the next Government will be based upon or built around a militant form of Labour, the chances are that politicians will only continue to try and hide the truth thereafter, because action which doesn’t just look responsible is not a pathway to which they are inclined.

As Jeremy Corbyn made clear in his questioning of Theresa May at Wednesday’s PMQ’s, the answer is just to do everything to return everyone to employment in government jobs. No doubt based upon further borrowing, which to those who don’t understand business or economics is a perceived as a policy which when sold looks bullet proof.

images thanks to independent.co.uk, bbc.co.uk, wiltshiretimes.co.uk

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

 

What the US row over the regulation of broadband provision can tell us about the privatisation of public services and why we must maintain the basic right to the same level of ‘public’ services for all…

November 11, 2014 Leave a comment

images-10We have so much news available to us now that it has become very easy to miss the stories which may fail to catch the public eye.

Away from the headlines today, some of our news sources have been covering the growing row between US President Barrack Obama and the Industry Leaders controlling the supply of Broadband Services in the United States.

Obama appears to be pushing for a system of regulation which will ensure the same level of supply across the Net to all customers, whilst the Industry itself is apparently looking for its own kind of controls which will allow differing levels of supply – and ultimately a ‘fast lane’ or optimum service for those to be made available for those who will pay for it.

On the face of it, this could immediately sound like something and nothing. We do after all have a whole range of choices when we buy or arrange our own internet packages and right now, it now seems pretty normal to pay for every little thing that we have.

However, whilst the speed of the roll-out of superfast broadband leaves many of us knowing only too well that different levels of service currently exist and seem to leave us with little choice, this is in itself just an evolutionary or developmental stage of provision. It is much like the experience of the switch from analogue to digital has been for those of us who used the Web from the beginning, and can still remember the rattle and hum of the tones as we hogged the phone line and dialed-in.

We may not like it and in an age where we have been conditioned to expect everything at the touch of a button, slow internet is beyond frustrating. But right now, we are accepting of it, as we are culturally acclimatised to accept that there is a direction of travel at work, which will only see services improve. (Yes, 4G apparently will at some point exist, even if you have already been paying for it for many months…).

But what would it mean to you if the next generations of technology were simply kept from you, when you knew that they existed and other people or businesses had ready access to them?

Your immediate thought might be that you are pretty happy with your iphone 6, or perhaps a Galaxy Smartphone, and that will do you just fine. But technology is moving apace, and if you were to work on the basis of Moore’s Law, which indicates that the speed and capacity of technology doubles approximately every 18 months to 2 years – which affects functionality as well as speed, you can soon begin to imagine what you might be missing out on by the time you are thinking about the phone you will be able to buy AND operate fully in the year 2020. Apply this to the services you receive through broadband too, and there is perhaps no need to say anymore.

The speed of communication through information technology mediums has been and remains a game changer which has impacts upon us all, usually in ways that leave us feeling completely untouched.

However, it is this very speed, and the capacity to move significant amounts of data from one location to another – perhaps even across the world, in timescales that as humans we at present still remain cognizant of, which have for example equipped money markets and traders to create industries within industries which literally create money from nothing as stocks and shares change hands with the potential to do so again and again over the course of a minute, whilst speculators also ‘bet’ on the transactions and the way their vales will go over the same period of time.

Speed – and therefore time, is increasingly becoming worth money where communication is concerned.

Whilst this may not be a thought that drags many of us away from our phones and iplayer-streamed episodes of The Big Bang Theory today, it will surely stand to reason that those who supply much faster internet services will see the opportunity in being able to charge a considerable premium for the product they supply tomorrow; whilst those who have the most to gain from the almost guaranteed technological leaps that are coming, will already possess and indeed have the most to gain financially from paying what will to them be trivial sums.

Not a problem for many of us today. But if the supply of service did really become as diverse as it could, there is no reason to believe that like in many other areas of contemporary life, cost will not quickly price large numbers of people out of the latest technology marketplace, with repercussions that could easily lead to the imposition of a whole tier of barriers to entry to services, apps and anything else which has then become entwined with the internet age.

Look at the behavior of the Industry in the States, and it will suddenly become very clear why our own providers could be so resistant to Government led regulation, and the imposition of a level playing field which will never have the potential for the same levels of profitability as that of the alternative.

Regulation that ensures a basic level of service for all and which is not itself qualified by a premium is essential. It can only be offered by an impartial third-party organisation – ideally good government – which has no financial interest in the services provided.

Government is today painted as the bad guy for any industry that provides either a public-wide service, or one which can ultimately have that same effect on the population and is not currently regulated – or guided with a robust ethical code that prioritises access and consideration of the consequences of profit-making actions upon us all.

This applies to the inappropriately named utility companies; companies such as the telecom providers, and also to the companies within the financial and banking sectors, where perhaps the most clear example of what happens when the fee-earners are left to regulate themselves was demonstrated by the financial crash of 2008.

The relevance of the US example should not be lost on us, just as the importance and argument that now definitely exists for greater Government intervention to regulate what are and remain public services.

The core reasoning of keeping essential services in the public domain was lost to decision makers of that time, through prolonged periods of low productivity and the high cost of running industry sized monoliths which were inherently resistant to change.

Regrettably, the long-term gift of what are effectively now monopolies to the money markets was not considered in terms of the requirements of ethical or regulatory practice, and the escalating costs of heating and electricity are just a symptom of what happens when a service is provided to a captive market by companies that are allowed to focus on nothing but the bottom line.

Sooner or later, Government will have to address these issues which face and surround all of the public services which are now in public hands.

Ed Millliband has to date probably been the most outspoken of the Political leaders in acknowledging the need to tackle the impact of unbridled energy price rises. But as with almost everything else, inflicting price changes, freezes or any kind of formula without regard to the real implications of doing so is akin to madness – and certainly so if the Industries themselves are not given adequate opportunity to reform before doing so.

Existing problems will be very complex to address. But for services such as the NHS it is not too late for politicians to do the big thing and tackle the problems that exist with meaningful reform. With Internet Services, it is in no way too late to ensure that the market continues to serve the best interests of everyone, and not just the few who will otherwise stand to make the most money from manipulating its harnessed profitability to their best advantage.

There is much for Government to do. But before anything there must be a change of mindset to one that genuinely considers the impact of polices on other polices and ultimately upon the consequences for us all.

The Internet will only come close to achieving all that it can for good if access to it is essentially the same for all.

Government will need to address this, just as it will soon have to accept that the parallel world which the Net has created will require its very own set of rules.

The distance which the Internet has created between us is already removing the humanity from relationships. We now need to ensure that our ability to pay is not the system of qualification for improving our lives that we should now be able to take for more than granted.

image: thevoltreport.com

NHS and the predicted £30 Billion deficit: It’s time for change, but change is about much more than simply saving money

A NHS sign is seen in the grounds of St Thomas' Hospital in London

You can’t really help but admire the audacity of Sir David Nicholson, the outgoing head of the NHS, for his latest attempt to sidestep and cover the tracks of his questionable tenure by shining a light on what could become a £30 Billion deficit within the NHS.

His failure to fall on his sword over the Stafford Hospital outrage was beyond what many will agree as being in good taste and was compounded yet further by his indignant refusal to accept any form of responsibility, despite being the Executive Officer at the very top of the tree and arguably placed within the one position where there simply is nowhere to run or hide when it comes to carrying the can for mismanagement on what appears to have been an unprecedented scale.

The most regrettable facet of this latest twist is that the lack of respect which Nicholson holds with people now will surely deflect attention away from the cold reality of his message, which in a perhaps more capable set of hands would have not only been brought to public attention much sooner, but effectively acted upon too.

Many of us already realise and understand just how serious the problems throughout the NHS actually are. In local politics, where we closely scrutinize the real-world impact of ward and department closures; the centralisation of services, and the amalgamation of GP’s practices into so called ‘community hospitals’, there has been little doubt for us all of the real purpose of such changes for a considerable time.

Cost aside, the principles upon which the National Health Service were created and the application of universal care are still however very much valid even today.

But it is the continued compromise of those very principles at their heart which has led to the seemingly insurmountable financial and management problems that we face today.

These were principles that were intended to prioritise the care of the end-user; not the interests of managers, union leaders and politicians, who have all had something to gain at various points by moving those priorities elsewhere; often at everyone else’s cost.

Any commercially run business or ethical organisation is created and run to efficiently provide a particular product or service to its customers. It is not created or subsequently evolved to disable itself by prioritising the working conditions of its workforce and certainly not run for the benefit of harvesting statistics as part of some politically expedient mind warp which is simply designed to spread the message that things are running far better than they actually are.

Tragically, this is pretty much in a nutshell what the NHS represents today and evidence would suggest that people are dying needlessly as a result of it.

It’s not as if health professionals are oblivious to the realities of the situation either. Talking to a career nurse only a few weeks ago who freely admitted that she had been a lifelong socialist and Labour Voter, even I have to admit to my surprise when she clearly told me ‘Adam, I love the idea of socialism and what it stands for; but in my experience, it simply doesn’t work’.

Herein lies the greatest problem with the NHS; Its culture.

The culture within the NHS is the base issue which much be faced, understood and addressed if the Organisation as we have known it and the services that it provides are to be saved and our society is to be protected from the arrival of either tiered health provision across the board or UK-wide service which is only made available to those who can pay as they use.

Right now, we are all witnessing the preferred method of dealing – or I should say – avoiding reform throughout the NHS, NGO’s and the tiers of Government, which presents itself in the form of privatisation. Privatisation of any Government funded service has arguably become nothing more than avoidance of the need for reform at its worst because services are never the same when profit is the master. Furthermore, recreating public-run services once they are lost will be a whole lot harder than the reform which most Politicians already seem to see as impossible.

The only way we will keep and maintain the NHS as we have known and appreciated it in terms of what it offers the public will be the result of transformation and change which must begin with Government and work its way right the way through.

The NHS is strangled by the culture of workers’ rights, tiers of managers who barely understand what practical patient care is, Europe and the rise of the blame culture, where practitioners are increasingly forced to consider the bureaucratic pathways to treatment first, before addressing the urgencies and acuteness of clinical need. Ironically, such delays may of course be little hindrance to treatment for the people who will be looking for an opportunity to sue them either.

Government must act now to change and support the whole working culture of the NHS and put patient care back at the forefront of everything they do, rather than putting everyone else and the profit hungry ambulance chasers first.

It’s not an easy job by any means and most of us do appreciate that. But Governments get elected to take responsibility for big problems just like these; not so they can talk up the delivery of results when what they seem to be doing is looking for the easiest way out of problems they just aren’t responsible enough to face.

The patients of today and tomorrow don’t care about statistics or the money that providing treatment costs.

What they do care about is trusting that they can rely on getting medical help when they need it; where they need it and without worrying whether or not they qualify for it. Every day, the number of people who simply don’t have that trust are growing rapidly, and each new day is a sorrier one than the day before.

If Government keeps treating the problems in the NHS as if they all revolve around money, the cost of running the service will probably lead to its end.

It’s time for change throughout the NHS. But real change is about much more than simply saving money.

image thanks to http://www.channel4.com

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