At this rate, Labour will never fix the NHS
Lord Darzi’s report on the state of the NHS, released today, is damning. His review found that waiting times have worsened, very little progress has been made on early cancer diagnoses and the health service has been starved of capital investment.
For a while, it looked like Wes Streeting was the man to come in and fix this. To many, the Labour Health Secretary feels like a breath of fresh air in his observations on the NHS. He basically thinks it’s broken, and had said as much. Many, many people agree, and all of us wish it weren’t.
The whole piece is quite short, what it says is well known among those paying attention, but it is still worth reading as a reminder of the solution Labour cannot tolerate.
It is simple. At the moment, money comes into the NHS from the top. For it to perform better, much, much better, money has to come in at the bottom. No ‘privatisation’ is needed (although it might be welcome in some areas); no more money is needed (at least not at the moment); no new ‘targets’ are needed. No new layers; no new ‘Trusts’ or confederations. All that has to happen is the money comes in at the bottom.
What do I mean by this? It really isn’t rocket science. Where does the money come into Tesco? Or Amazon? Or Netflix? Or indeed, any one of the millions of companies worldwide, large and small, that do the best they can with the resources they have, and which have over the last few decades, indeed the last century, enormously improved our lives in every possible way.
5 comments:
For most bureaucracies and most big businesses the 'natural' response to changing circumstances is to 'reorganise'. Internal divisions are split and merged 'for efficiency', job titles revised, and the higher bosses paid more for their increased responsibilities. Such reorganisations are usually top-down.
And yet reorganisations rarely achieve anything worthwhile for you have the same people doing the same things within a different organisational chart. It does give brief comfort to those who worry about the need for change though. Until the need for another reorganisation rears its head.
I don't see any politicians who have the backbone to do the required scalpel job on the sainted NHS. Given that it was a liebour child from the off I would have thought that Two Tier Stalin would see returning it to its roots as a sure vote-winner among the faithful.
DJ - "the same people doing the same things within a different organisational chart".
It's difficult to see the NHS ever doing more than that under any government and difficult to imagine the upheaval which would precipitate it. It would have to be evolutionary, driven by the need to stay in touch with the rest of the world perhaps.
Jannie - I can't see TTK taking the NHS beyond its roots either. More targets and some futile meddling perhaps, but nothing more.
All of this brings to mind a favourite euphemism of reorganisations in the private sector - 'downsizing'. Back in the early 90s, I was visiting a car manufacturer's head office to provide a progress report on a project I was leading as a consultant. That very day, there was a drastic 'downsizing' required to balance the books and I was greeted by the sight of a hundred employees handing over their company car keys, packing their stuff in boxes and waiting for a taxi. It was a dire thing to watch. Awful, but necessary to the survival of the company. I had a cast iron contract so my project was unaffected and the manager I was dealing with thankfully didn't lose his job.
My point? That's what needs to happen in the NHS. Apart from frontline medical staff, the NHS is overstaffed. I've seen it first hand taking my wife to hospital. One-third of staff doing the job and two-thirds filling out paperwork.
It will not happen, of course.
Cheers Yet Another Chris
Chris - interesting and I imagine it's the kind of experience you never forget. During his career, my father once had to deal with a drastic downsizing and tell people they were no longer required, but I've never seen it in the public sector. As you say, won't happen in the NHS.
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