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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 He described it as being infected with outdated working practices and old fashioned hierarchies, widespread bullying, the “ritual humiliation of those deemed to fail” and targets that skew priorities and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.

David Prior

David Prior

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.



Readers' comments (4)

  • Just a lot of hot air! It's time nurses in junior postition had seniors to help and check their work-load. It is not bully, it is back to the old-time of having someone in authority. More power to Sisters who should, in turn be responsible for outcomes

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  • Having worked in the NHS in the 1980's it was apparent then that the then Health Minister, Ken Clarke was in favour of privatising the NHS as he approved the go-ahead for privatising a particular service in the hospital in which I worked. Fortunately or unfortunately the management at the time decided it wouldn't be good for the hospital and if approved would have been the thin end of the wedge. However, every government since Thatcher has been in favour of privatising the NHS. Under Labour Independent Treatment Centres were established run by private companies. Many of the ambulance services are run by private companies such as G4S. Many hospital catering and cleaning services are run by private companies. Pathology, radiology, audiology and health screening services to name but a few are also run by private companies. Why doesn't any politician or senior NHS manager / CEO own up to the fact that the NHS is in many instances already privatised and this current coalition party is finishing off the privatisation started by the Tories in the 1980's. We should have transparency about who is providing health services to the public even if the privatised services are hiding behind the blue "NHS" banner at least the public would know the truth. And if we are to have a "privatised" health service with hospitals competing for patients and budgets, then the need is to focus on proper high quality outcomes that result in the patient benefiting with improved quality of life and not just silly targets that don't focus on patient outcomes which Labour introduced under Blair.

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  • The whole of our system is skewed towards the Banking/City bail outs. The real world of people comes as a secondary consideration.

    If an individual acted as the banks have done they would not be bailed out.

    All the research and facts indicate a failing NHS due to inadequate funding(aging population etc) and insufficient staffing levels. The Government needs to grasp the nettle and realise that the NHS staff are under pressure and are effectively bailing them out. This is a ticking time bomb, the problem being the people at the top are out of the blast zone.

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  • The NHS is failing because it is underfunded and understaffed. This is exactly the plan. Then the government can go to the tabloids and the electorate and say 'this is why it needs to be privatised.' It's all going fine.

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