Friday, 14 March 2014

What we can learn from the NHS in England?

The problem, as I see it, for the NHS in England is it no longer knows whether it is fish or fowl. 

Is it patient focused or market driven? 

Is it co-operative or competitive? 

Is its job to deliver health care improvement or simply sticky plaster people back together to stop them falling apart? 

Is its job to pick up all the old folk who can not get a care package and bed block wards because the councils do not have the funds to meet actual care and health need in the elderly?

I have been involved in NHS England as a clinician, a clinical governance auditor and as a care process developer and implementer from 1987 until my ill health retirement in 2005. The problem does not lie in the NHS clinical and clinical support staff at Mid Staff's or where ever else, as has been spun by the current NHS England minister, but the constant politicking and bickering of the vested interests - Government, BMA, RCN, NHS Managers association and all the rest who have their sticky fingers in the NHS England pie whether for cash or gongs. They have ALL lost the plot as they busily defend their own little empires at the expense of the service they claim to wish to preserve. 

Mid Staffs was a result of mismanagement by a Trust looking for political 'brownie points' who failed to maintain the correct levels of staffing across their Trust to meet the criteria. A Trust who placed inexperienced and under qualified nurses and doctors in clinical decision making positions beyond their competence, which resulted in unnecessary patient deaths and iatrogenic damage and in turn all to meet UK Government set benchmarks which has little to do with patients' needs and expectations and everything to do with making UK Government Ministers look good.

The problem with the overall leadership and management culture of the NHS in England, from the top down, can be described as introverted, ineffective, inefficient, obstructive, negative, without a clear aim or objective as to what NHS England is supposed to be, do and deliver for the people of England.

My last job was working for a Scottish rural health board under the previous Labour / Liberal coalition in Scotland. My brief was to examine the declining provision of NHS Dental care in the board area and suggest possible solutions. This involved me in meeting with all the Dental GP's in their practices to assess the standard of provision, listen to their concerns and gain an indication as to whether or not they would continue with NHS provision. I also sat with the District Dental Officer, Board Member responsible for dental issues and the Board CEO to discuss the Scottish Government requirement, available additional funding. As a result I wrote a 10,000 word report with recommendations for the Board with a copy to the local MSPs.

The problem was the recommendations did not fit in with what the CEO wanted to do and I discovered three year's later, when I played golf with the board member responsible for dentistry, the Board had never seen my report and the gentleman was not best pleased after he had quizzed me on it. The CEO took early retirement around six months later - probably just coincidence. The opportunity to create something different and effective in terms of delivering NHS dentistry to rural communities was lost as the £1.5 million funding went on 'NHS dental premises' which are under used - just as my report suggested they would be - and the hospital the unit is linked to is about to be replaced by a new hospital on the edge of town which negates the reason for the new dental building in the first place. The decision by the CEO had little to do with health delivery benefits to a rural community but fitted in with top down Labour / Libdem PFI new build policies: his close links with the local Labour Party clearly had no impact on his decision. He even tried to buy me off by offering me the vacant local Chief Dental Officer role.

My research on the NHS in Scotland since 2007 indicates, to some extent, the service has reduced the worst excesses of politically driven 'bench marking' and vested interest system since Ms Sturgeon took hold and is thinking more about patient needs and expectations in a more joined up delivery of service and greater co-operation between the vested interests, who appear less defensive of the boundaries between them.The real concern is whether those 'new habits' have been firmly enough imbedded. Then again the major shift in the previously 'laisse faire' attitude at Edinburgh Royal Infirmary suggests a maybe they are. My own experience of NHS Scotland, in a rural area, is rather than trek 54 miles round trip to see my consultant he arranged to see me (and other of his patients) at a GP surgery 7 miles from my home. When I required a CAT Scan rather than going to Glasgow, I was scanned in one based in an articulated trailer which came to the local hospital.

It is a while since I have perused the draft constitution for an independent Scotland but it is important for us all the NHS in Scotland is clearly defined and protected in a Scottish Constitution. There is a need for consultation across all the parties involved but I would suggest the following as a starting point to prevent the loss of direction which has occurred in NHS England courtesy of political meddling and vested interests:

NHS Scotland Aims:

  • To deliver cost effective medical care within a defined government budget, free at the point of delivery, to the people of Scotland
  • To deliver Dental and Optical care in a manner which ensures and encourages maximum access by all Scottish people
  • To work closely with all other Scottish Agencies and NGO's in regards to the long term care and support of the mentally ill, elderly, disabled and terminally ill
NHS Scotland Objectives:
  • To ensure NHS Scotland pursues internationally agreed standards of 'best practice' at all times both in its clinical and management practices and delivery
  • To measure patients realistic needs and expectations to ensure NHS Scotland is achieving its primary aim of effective medical care
  • To encourage all staff and clinicians to review their own and their department's performance in an objective and open manner
  • By openly sharing review, satisfaction and performance measurement, at all levels, seek to continually improve and develop NHS Scotland for staff, clinician and patient's benefit

1 comment:

  1. Very interesting Peter,thanks.
    Health services in the developed world are facing the problem of baby boomers such as myself (hopefully) living much longer and how to fund the ongoing additional demand for services.
    I think that savings can be made through efficiency measures such as new technology and improved working practices although the expensive technology failures in the English NHS are not a good example of how to do that.
    Trying to enable people to have more healthy lifestyles would also help but that is probably a longer term solution.
    Raising taxes is probably going to be an option in iScotland because people are more amenable to that idea than our cousins in the south.
    We are fortunate in Scotland that we have a relatively small population so joined up thinking should be possible for service delivery which will be more efficient and care driven rather than budgetary.
    However,should we decide to continue to have Westminster rule,and we believe the Labour promise to do away with the Scottish Health Service as an entity,the future will be pretty bleak.
    Having to integrate the Scottish health service with the English one will be disruptive and costly with no clear benefit to patients,however that hasn't stopped Westminster politicians in the past so probably will happen again in future if we allow it.
    Our health service is not perfect but the point is that it is our health service and we can call local politicians to account when things go wrong or need least in theory.