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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

 

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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