NHS In Crisis!

Many people are familiar with scenes such as the one illustrated, of run down hospital wards in old Soviet Bloc countries in which healthcare workers struggled to provide for the needs of their patients under circumstances of understaffing, lack of resources and the crushing weight of a self-serving bureaucracy.

Most people recognise also that one of the cardinal features of the Communist mentality and the system that so oppressed the old Soviet Bloc countries was a compulsion on the part of those in authority to control and direct the actions of those under their command, despite the clear evidence that such over-regulation placed a ‘dead hand’ upon the services for which they were responsible, stifling the zeal and initiative of their workers, doctors and nurses alike.

We should not be surprised therefore at reports coming to light of institutional incompetence and failing healthcare at a number of major NHS hospitals. Such shortcomings; a direct consequence of the introduction of NHS performance targets by the last Labour government – targets which were retained by the current coalition government; a consequence of the current climate of public spending cuts; and a consequence of the growth of a vast administrative bureaucracy created to manage and ‘monitor performance’. This was a recipe for the creation of a healthcare system that would replicate the conditions that we had observed in the old Soviet Bloc and it was a disaster in the making.

Anyone who has worked in business, particularly in a sales organisation will immediately recognise the pathology of a performance monitoring system that measures arbitrary activities rather than activity which impacts directly on the desired outcome. Therefore, with the news of NHS targets being oriented around waiting times, numbers of patients treated and expenditure control, rather than objective measures of the health of the community served, it became obvious that junior NHS managers would manage the health service in such a way as to produce the reporting figures that senior NHS managers wanted to see, rather than in such a way as to facilitate the highest standards of care for patients.

Anyone who has worked in business could have predicted that boxes will have been ticked, and figures compiled showing reduced waiting times, greater numbers of patients seen and improved financial efficiency, all of which is completely irrelevant if overall patient care has diminished as a consequence.

The key outcome must be some objective measure of the health of the community served by hospitals and served by GP practices, not the number of boxes ticked, and until the minister responsible for the NHS establishes such a system of objective measures and NHS staff are managed in such a way as to improve those measures, the NHS will continue to fail.

It does not matter how much waiting times have been reduced, if patients are dying through subsequent neglect and conversely, we should pay no heed to waiting times as long as mortality and morbidity rates are declining within the population served by any particular institution.

So, how has it come to pass that our once great National Health Service, once the envy of the world has come to be so disastrously mismanaged? Why is it that successive government ministers failed to realise that they were employing a ‘recipe’ that could only ever result in the creation of a bureaucracy ridden, excessively micro-managed, Soviet style healthcare system?

For two reasons:

Firstly, too many of our politicians come from privileged backgrounds where they have never done a proper days work in their lives, let alone had the opportunity of experiencing and analysing the impact of performance monitoring systems on the efficiency of any organisation.

Secondly, too many of our politicians come from backgrounds from which they have acquired a mindset in which ideas of rigid central planning, intensive micro-management and political correctness are regarded as laudable objectives in themselves. The kind of people who would make ideal functionaries in a Soviet style, Communist state.

It comes as no surprise to many therefore to find that the current Chief Executive of the NHS, David Nicholson, is revealed on the Daily Mail website to have been a member of the Communist Party for six years.

The Daily Mail state, “As a young NHS trainee at the height of the Cold War, David Nicholson idolised Soviet leader Leonid Brezhnev.

“At the same time as starting work in a mental health unit, the Bristol University graduate joined the Communist Party in 1977.

“He was no ordinary revolutionary. He was on the hardline, so-called ‘Tankie’ wing of the party which backed the Kremlin using military action to crush dissident uprisings”.

If this is true, it answers a lot of questions that will be in the minds of those aghast at the recent decline in standards of our NHS.

We need to return to an NHS; in which patient care is uppermost and in which promoting good healthcare is objectively measured in terms of reductions in mortality and morbidity rates; in which our hospitals are run on a day-to-day basis, not by bureaucrats, but by experienced healthcare professionals who have worked their way up through the nursing ranks and who know from years of personal experience precisely what it takes for a hospital to run smoothly and efficiently and in the best interests of patients.

Let us make cost savings by cutting away the layers of overpaid bureaucrats, and by appointing once again, Matrons drawn from the ranks of experienced ward Sisters. Furthermore, let us once again recruit into the NHS the legions of home-grown young doctors and nurses that were once a feature of all large hospitals, instead of recruiting our doctors and nurses from the Third World.

Let us also have an end to the mindset in which we encourage bureaucrats who have no perception of what a business is, to attempt to run our hospitals ‘as a business’ and in which they are obsessed with outsourcing every conceivable ancilliary service in the hope of making cost savings, when all that happens is that standards decline because of trying to do everything on the cheap.

Everyone over the age of 50 will remember the hospitals of old that were kept spotlessly clean by in-house cleaners, with in-house catering departments delivering hot food to the wards, with in-house maintenance departments ensuring that the fabric of our hospital buildings was well maintained and freshly painted.

Furthermore, we all remember a time when one could go to hospital with confidence in the service that would be provided, efficiently, competently and lovingly, by British people and not the dubiously trained overspill of the Third World.

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By Max Musson © 2013