If there are cases of faulty management in the NHS, the solution is to identify those examples, and to try to correct them. The answer is not to introduce, necessarily, more private hospitals whose primary goal is to maintain shareholder dividend.
More than a decade ago, I used to do those terrible on-calls as a junior doctor. At various trusts I worked at, before the Working Time Directive came in, we used to be on call from Saturday morning to Monday continuously; you might be woken up at 4 in the morning to put in a catheter for someone who had been admitted in acute urinary retention and had referred himself to A&E, only to go back to bed at get woken up at 5 am with the words, ‘Cardiac arrest….cardiac arrest”.
Almost a decade later, I have completed postgraduate degrees in law and business (my Master of Law and Master of Business Administration). I’m sure that McKinseys are not worth the millions – in this particular case – that have been spent on them in implementing this complicated strategic change process as they have ignored the fundamental rule of strategic change; always get the principal stakeholders involved first! It has been a disaster that most of the Royal Colleges and the British Medical Association have been either inadvertently alienated or ostracised by this change process. I am, however, mindful of the fact that McKinseys have been well established in the Department of Health for the last thirty years. The solution would have been to involve the stakeholders and the GPs, as this change is not simply about structures in the NHS, but the incumbent organisational culture of the NHS which has built up over decades.
Doctors want to do medicine, and nurses want to do nursing. Doctors are normally heavily in debt at the early stage of their career, having spent six years at medical school before they qualify, and then working really hard in their first year of qualification. However, if it is the case that there are too many doctors, which I personally doubt (just go into an A&E of any London teaching trust on an evening), maybe some of them can get transferred to management with appropriate training? Their understanding of how the NHS works would be invaluable.
The fundamental issue is that running NHS hospitals as private limited companies to run a profit provides no compulsion for these companies to plough any money back into patient care. If money is currently going to waste on cleaning or procurement (and it’s essential not to extrapolate too widely from the Hinchingbrooke example), these simple ‘textbook’ errors should be eliminated by employing better managers in the NHS. Not all managers are bad – I am sure some are very good, but the fact that such examples exist is worrying, and I know first-hand from NHS consultants who are friends of mine how poorly some NHS managers are perceived within their own unit (but would never be able to criticise them publicly). Existing managers should also be focused on improving morale in the NHS, which is not easy to do with a workforce, a proportion of which has been reported as being disenfranchised from these important reforms.
As a cautionary point, it takes a lifetime for most professionals, doctors and nurses, to work out what a good quality health outcome is, and this may not necessarily be the holy grail of “key performance indicators”. Whilst it may be relatively easy for a manager to measure post-surgery infection rates (which is a perfectly valid outcome), the NHS does not offer products or services which are comparable. An outcome for a hip operation is different for an outcome of wellbeing in dementia care. Where this is relevant, in my belief, is that managers can use any mass of statistics to show that quality of care has improved, if you simply deselect ‘uninteresting’ statistics of hidden illness such as depression, and still enhance shareholder dividend. A service which is not national runs the risk of baffling the reasonable citizen with quasi-improvements.
As it is, we have already outsourced McKinseys to do a lot of NHS management without a penny being spent directly paid on patient care. The privatisation of the NHS is completely unjustifiable when we should be securing a well-run national service for all. This will protect everyone. Procurement of fewer but more suitable managers might be an effective start.
