Wednesday, 7 August 2013

And suddenly ... nothing happened

Professor Berwick has no doubt been paid a lot of money for this report on NHS England's failings but all he is saying is exactly what was said in 1998 after the Bristol Royal Infirmary inquiry. 

Sir Liam Donaldson (Chief Medical Officer) by 2000 had a detailed plan to implement changes in NHS managerial and management practice but it was blocked by the Government of the day (because they would not be able to duck responsibility for failings), the medical vested interests (because it reduced their power significantly) and the NHS managers because it would put an end to their empire building.

Instead NHS England got a whole load of Quangos which did little for patient care and a lot to retain vested interests, the empires and Government ability to duck the issue of accountability.

How do I know?

I was at the meeting of QA health sector specialists at Harrogate in 2000 where Sir Liam Donaldson outlined his plan for reform and told the UK QA industry that our input would be vital to implementing his systematic reforms of NHS England based on established, internationally recognised and effective QA process management models. The QA industry watched with horror, but little surprise, as the Government, NHS vested interests and empire builders said they could manage without any outside help and proceeded to side line Sir Liam Donaldson's original plan as 'unworkable'.

The solution to raising standards of care and delivery in NHS across the UK remains the same, as does the effective solution to its ineffective and stultifying management systems. There is no political will to make these effective changes because the last thing UK Government wants is to be able to be held responsible for the impact of politically driven reform, its routinely negative impact on patient care and its failure to identify and address patients' core needs and expectations of the NHS.

While Nicola Sturgeon achieved a lot while health minister she was working within a system that continued and continues to protect vested interests and NHS Scotland empires. There remains a lot of core problems within NHS Scotland's management systems and their inability to establish accountability for problems so they can be resolved quickly in the patient's interest and improve quality of care.

The QA industry calculated that implementation of the program set out by Sir Liam Donaldson in 2000 would reduce NHS pay outs for 'no fault' compensation and litigation by 80%. Think about it: for every £100,000 NHS Scotland currently pays out in costs and compensation £80,000 would stay in the pool for care. In 2011 -12 the NHS in Scotland was estimated to have paid out over £55 million in compensation and litigation costs. The failure to implement real reform in the management of NHS Scotland meant that £44 million was paid out in 2011-12 that could have been used for patient care.

Maybe we should not be so smug about our NHS Scotland. Yes, we still have a recognisable NHS service in Scotland, true (ish) to the original plan laid out by Beveridge in 1942 but it still needs root and branch reform of its management practices to make it fit for purpose in the new century and a soon to be independent Scotland.

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