NHS: Bold Ideas for Reform

I have discussed in previous posts the bewildering systems of managing and funding the NHS, including the broad outline of a better financial model. Today it is time to look at an outline of a way a rejuvenated NHS can be built and managed.

We start with the general structure of control and direction. From 1995 governments started to tinker with the system of regional and local health authorities running the service. Independent trusts were introduced and later commissioning boards, watched over by independent regulators and quangos of various kinds. Hobbled within this spider’s web of management are the over worked and mostly underpaid medical staff of the NHS, who daily dedicate their lives to making better, and yes saving, the lives of others.

Priority is given to due process as the track upon which everything has to run, ensuring a continuous litany of failure at every level. Nobody appears to be finally responsible for anything. Outcomes vary, many from disappointing to non-existent. Nobody owns these failures, so nobody falls on their sword. If the failure escalates to a disaster, a judge led inquiry is the standard remedy. Overseeing all this chaos is the vast Department of Health and Social Care, which is itself under the political direction of no less than six ministers.

So I would start by sweeping the entire agglomeration described above, away.  We begin with scrapping the Department and returning to the old idea of a Ministry with the specific function of running the NHS. The Ministry of Health. The Minister would politically own the NHS and fall if it failed. They would have reporting to them the NHS Director General, below whom would be the Regional Directors, followed by District Managers. There would be proper interface at each level with emergency responders and other public services, but there would be no trusts or advisory boards. Nothing would be independent of anything else. This is a joined-up state service paid for by public money gained through taxes. There is no autonomy nor is there any escape. It stands and delivers on its promises or it falls as a concept.

So what are those promises to be?

If you need a family doctor you will be seen that day. If you need to be referred to hospital you will be seen within 5 working days. If you need more tests they will be completed then and there. If you need surgery or other procedures it will be done within 3 working days. If you are caught in a health crisis or an accident and arrive at A&E you will be seen immediately. There will be no such thing as waiting lists, ambulance queues, treatment on trolleys, a famine in GP appointments and all the unforgivable chaos which is now the new and accepted normal. Idiotic targets of four hours for this and six months for that are a cruel confidence trick to disguise a river of gross mismanagement and incompetence, starting in Downing Street, flowing through Whitehall and seeping into the lives of every citizen.

To achieve this transformation will require a quite different medical organisation and care delivery system. That will be the subject of my next post.

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