January 20, 2017

NHS: hand-wringing is easier than action

Everyone agrees the Health Service is broken. The commonest solution is to put more money into an unchanged NHS.

Faced with the challenge of actually suggesting improvements, people fall back on process. Thus the Lib Dems call for a cross-party commission (or in translation, a table at which their deminished party can have a seat). Such a commission would aim for consensus, so its recommendations wouldn't tackle the big problems.

Pundits propose an "independent" body. Independent of any pre-conceived ideas or knowledge? As Sir Humphrey knows, pick the membership of anything like a Royal Commission in order to get the conclusions you want.

Both these routes would lead to a search for a big bang solution for the NHS. They would hear evidence over months if not years, then huddle in private to consider their verdict - more months - then issue a report and wait for a government to consider it. From debate to implementation would take years.

That's comfortable for outsiders but it doesn't get us anywhere anytime soon.

Much less comfortably, we can agree that the hospital service does need major changes, and make some now, address the institutional inertia head on, take some pain. So here are some easy hits.

First, stop paying for translation services. Dr Catja Schnitgen shows how the need for translation can slow things down for everyone. She suggests that entitlement to receive welfare could be made dependent on a willingness to learn English, and concludes
For too long, the British state has bankrolled social exclusion, and one of the results has been to increase the strain on the NHS. The current crisis means we must now take a more radical approach.
Ouch. You can hear the squeals from people who think that we should provide everything free to everyone. Alison Pearson puts the cost of NHS translation services at £64,000 a day - say £22m a year. That's worth saving.

But the point is action. Pilot scheme. Announce that GPs' practices in (say) London and Lancashire will be English speaking practices. If you can't speak English, it's up to you to bring someone with you. To start from 1 July. Review after three months, with the aim of rolling out to the rest of the NHS at the start of 2018.

Next, foreign nationals. Too many working in the NHS see themselves as basking in the altruism of a World Health Service. We can't afford to provide that. Other countries can identify foreign nationals presenting themselves for treatment. So can we. The NHS doesn't seem keen on collecting the money, so bills should be dealt with by private companies paid by results. The hospital or GP practice can use the rest. Six month pilot scheme in London hospitals, and GP practices in another area. Publish league tables.

Both these pilots will meet howls of protest followed by inertia. Make it clear to hospital managers who don't implement them properly that it would be considered gross misconduct by the Trust's chief executive. Yes, more howls.

Like University bosses, hospital trust chiefs pay themselves far too much, at our expense. So this is not just a Department of Health problem, it is a government issue. Compress the scales and the possible annual increases. Probably no one will walk away. Action on this is unlikely from within the management class itself, so ministers, if they have any say in anything at all (can anyone see the point of Jeremy Hunt beyond being a political lightning conductor?) should grip this issue.

While we're on the subject of gripping managements, there are still too many whistleblowers being victimised. Has any manager ever been dismissed for victimising a public spirited whistleblower? Make some examples. Don't say you can't. If you haven't got that power, why not?

Obviously this doesn't begin to be a full analysis of the NHS's problems. But there's too much analysis. Make a start by taking action to tackle areas which are obviously wrong.

Note to UKIP: Campaign for this and you'll be distinctive. Hand-wringing is easier than action.

1 comment:

Ed P said...

I've had a few consultant appointments recently, in a fairly new hospital with modern equipment. I'd estimate that for every consultant there are a sensible number of associated medical staff, but also at least three "receptionists". These people have little to do (except talk to each other) - one receptionist could easily manage all that's necessary for two consultants!
I think these extra people are left over from the previous two hospitals which the new one replaced, as no-one is ever sacked. The other possibility, that this imbalance between roles is repeated throughout the country is just too depressing.
Also, there are many people pushing trolleys of files (which look dog-eared & decades old) from one section to another, yet the new hospital seems to have embraced modern technology for actual medical care. My bet is it's some dinosaur-like union preventing improvements.