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NHS - Failure as usual

150 health centres, 100 GP practices, a £100m injection - Times Online
Lord Darzi’s review, Our NHS, Our Future, promises a fair health service for all, tailored to the individual patient, and delivering safe, effective and innovative care.
NHS may be sick, but this won’t cure it | Nigel Hawkes: Analysis - Times Online
Take a blank canvas. Talk to 1,500 NHS staff. Spend 12 weeks thinking hard. And then come up with the ideas you first thought of.

That, in a nutshell, is a brutal but not inaccurate summary of the review of the NHS by Lord Darzi of Denham, published yesterday.

Astonishingly, it identified as problems exactly the same things the Prime Minister and the Health Secretary have themselves been talking about for months: access to family doctors out of hours (Gordon Brown) and MRSA (Alan Johnson). Surely, in a system that now costs £90 billion a year, employs 1.3 million people and treats a million patients a day, Lord Darzi might have identified issues not already flagged up in a hundred tired political speeches?

To a tiny degree, he did. He correctly points out the glacial slowness of the NHS to adopt new ideas or buy into new technologies.

He then goes on to propose the wrong solution, a centralised health innovation council to “champion” change.

Such bodies have come and gone as swiftly as the dew on an autumn morning.....


Perhaps the most depressing thing of all is not what the report says, but the reaction to it.

Almost all the great and the good who have backed every half-baked intitiative for the past decade emerged to say how pleased they were.

Not only has the NHS stifled good healthcare; it has bought off those who are supposed to act as candid friends, and made them complicit in perpetuating its failures.

Comments

A pretty accurate analysis except for one thing:

Such bodies have come and gone as swiftly as the dew on an autumn morning.....

These bodies may appear swiftly and frequently, but they never disappear. The apparatchiks continue to inflict their peculiar brands of failed micro-managment on the front line while drawing fat salaries. Their pernicious effect on the health of the nation is not sequential as Mr Hawkes implies, but disasterously cumulative.

I felt a certain resonance with your phrase ''the trick to survival as an NHS manager is to change nothing and balance the books'' because inadvertently some of the system reforms have created this behaviour.However I would rather try to suggest ways we could improve the system than be cynical as there are many examples of good practice at local level. For my money the biggest problem the NHS faces is being monitored in silos by which I mean finance, clinical activity and workforce performance monitoring by the centre is often sent out a differential timescales and the measures are not joined up.This makes creating a set of sensible clinical priorities at local level nigh on impossible.The pay reforms are a good example as they could have provided a huge opportunity to create a more flexible workforce to improve patient services had the negotiations for them at the centre not taken 6 years and the monitoring measure placed on trust been getting all staff on to new contracts in a year rather than the point of them i.e. any evidence of using the new pay systems to change the way things are done.

I think a set of integrated strategic principles set for each provider and commissioner would be better than prescriptive input based targets. Why? It would allow local clinicians, patients and managers to be creative to meet the very diverse needs of their populations not suggest one size fits everyone

I felt a certain resonance with your phrase ''the trick to survival as an NHS manager is to change nothing and balance the books'' because inadvertently some of the system reforms have created this behaviour.However I would rather try to suggest ways we could improve the system than be cynical as there are many examples of good practice at local level. For my money the biggest problem the NHS faces is being monitored in silos by which I mean finance, clinical activity and workforce performance monitoring by the centre is often sent out a differential timescales and the measures are not joined up.This makes creating a set of sensible clinical priorities at local level nigh on impossible.The pay reforms are a good example as they could have provided a huge opportunity to create a more flexible workforce to improve patient services had the negotiations for them at the centre not taken 6 years and the monitoring measure placed on trust been getting all staff on to new contracts in a year rather than the point of them i.e. any evidence of using the new pay systems to change the way things are done.

I think a set of integrated strategic principles set for each provider and commissioner would be better than prescriptive input based targets. Why? It would allow local clinicians, patients and managers to be creative to meet the very diverse needs of their populations not suggest one size fits everyone

I felt a certain resonance with your phrase ''the trick to survival as an NHS manager is to change nothing and balance the books'' because inadvertently some of the system reforms have created this behaviour.However I would rather try to suggest ways we could improve the system than be cynical as there are many examples of good practice at local level. For my money the biggest problem the NHS faces is being monitored in silos by which I mean finance, clinical activity and workforce performance monitoring by the centre is often sent out a differential timescales and the measures are not joined up.This makes creating a set of sensible clinical priorities at local level nigh on impossible.The pay reforms are a good example as they could have provided a huge opportunity to create a more flexible workforce to improve patient services had the negotiations for them at the centre not taken 6 years and yet the monitoring measure placed on trusts was getting all staff on to new contracts in a year. The measure should have been the point of the reforms i.e. any evidence of using the new pay systems to improve services to patients.

I think a set of integrated strategic principles set for each provider and commissioner would be better than prescriptive input based targets. Why? It would allow local clinicians, patients and managers to be creative to meet the very diverse needs of their populations not suggest one size fits everyone

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