Right diagnosis - but the treatment will kill the patient
Suggesting we haven’t money to pay healthcare workers when we’re still bailing out banks that are ripping people off is laughable.
In a recent article for the Daily Telegraph, CQC Chairman, David Prior, spoke of the need for “a radical shift in the culture of the NHS.” Without “transformational change”, he wrote, the NHS would “go bust.” He described it as being infected with outdated working practices and old fashioned hierarchies, widespread bullying, the “ritual humiliation of those deemed to fail” and targets that skew priorities and have unintended consequences, with clinicians and managers occupying opposing camps.
Few nurses working within the NHS would disagree with this diagnosis. And no surprise, really. As Chair of the CQC, one would assume Mr Prior not only has unique access to the big picture of the inner workings of the nation’s healthcare system but also the views of those making key decisions affecting it.
What treatment does Mr Prior then prescribe? More competition. “Successful” hospitals taking over “failing” ones and, for good measure, more private sector providers.
Reading this, I wondered how he came to such conclusions. Surely, it was exactly these measures that were, at least in part, responsible for the increasingly toxic state of the NHS? It reminded me of the mantras of Tory politicians in the 1980s, telling us that if it wasn’t hurting it wasn’t working, as our industrial base was destroyed, public services were damaged, unemployment soared and the social fabric of entire communities was undone.
Then I saw Mr Prior is not just head of the CQC, that supportive, well managed, scandal-free organisation that everyone in the NHS respects and looks up to. He is a former MP and chairman of another august body, the Conservative Party.
When Sir David Nicholson, the Chief Executive of the NHS, stated that additional billions of pounds would be needed to help the NHS through its programme of change in the next few years, I thought there might be hope, a more rational perspective. But wasn’t this the same chief executive who was in charge of an organisation that is on the verge of collapse because of its working practises?
“Wasn’t this the same chief executive who was in charge of an organisatuion that is on the verge of collapse because of its working practises?”
So maybe the Health Secretary might have a better view? Well, Jeremy Hunt’s predecessor was the architect of the Health & Social Care Bill that’s contributed to this mess and Hunt’s most recent contribution has been to demand health workers (doctors and senior managers excluded) effectively subsidise the NHS by foregoing the miserly 1% pay rise other public sector workers are getting.
If only he’d suggested MPs do the same…
Has Ed Milliband, Labour’s leader, anything to offer to the debate? Well, he wants to ‘empower’ patients. Not about the structure or organisation of healthcare. There, presumably, Mr Miliband wants power to rest firmly with politicians and those employed to do their bidding. Patients can have greater control of their care plan. Even if there isn’t a clinician to provide the care. His ‘policy’, such as it is, supports Tony Blair’s doctrine of ‘choice’ and ‘competition.’
Of course, it was Blair’s government that created the climate, culture and organisational circumstances that led to Mid Staffs.
No official nursing leaders are saying much. We have the six Cs, initiatives galore, ‘reforms’, pious promises, hand wringing. But surely the structural problems are clear. Most importantly, there’s no coherent response to the continued political onslaught that has characterised the Coalition’s period of office, just as there wasn’t to the managerialism of the Blair government.
Nicholson and Prior get their analysis right but deny their own role in the problem, and the political ideology that has driven the process blighting the NHS for the past 35 years.
“Nicholson and Prior get their analysis right but deny their own role in the problem”
So what’s missing from their suggestions? Well, ending top-down targets would help. Ending competition and generating collaboration between services would transform not just the clinical culture but also the managerial culture, particularly if the model is one of localised management involving staff and the local community. Making organisations significantly smaller, with systems of shared governance, could aid responsiveness to their local communities, as well as making them easier to manage effectively.
There will always be tension between central and local organisations in a national health service. But any government that genuinely wants an effective, efficient NHS will have to promote greater local democracy and establish structures that facilitate an enabling approach from the Department of Health, with policies aimed at genuine partnership.
More money is essential. Suggesting we haven’t money to pay healthcare workers when we’re still bailing out banks that are ripping people off is laughable. Not having the money to fund essential services is criminal in one of the richest countries in the world.
But those in power – and who want power - will listen to David Prior. They won’t pay any attention to nurses. Unless we think about how we can articulate our arguments coherently and cogently. And what we will do to get them heard.
Chris Hart is consultant nurse in forensic and intensive care nursing, South West London & St George’s Mental Health NHS Trust and principal lecturer, Kingston & St George’s University of London.