David suggests….that we're going round in circles and getting nowhere

Personally, I don’t think with 1.1million employees and an annual budget of circa £121 billion, the current NHS is as good as it could be.

However, radically changing something as monolithic and as unplumbed as the sacred NHS was always going to be a mammoth task and one, frankly, only achievable by a strong government with the mettle to carry it through. So yes David, I think the initial reforms probably were a challenge too far, particularly for a relatively weak coalition government that has enough on its proverbial plate dealing with the economy and the other problems bequeathed by the previous administration.

But you rightly ask ‘where do we go from here?’ Reform is not going away and can’t be held in limbo for long.

Part of the problem, as you illustrate, has been trying to placate every one of the many and varied stakeholders. This is a modern political foible, borne out of politicians placing too much emphasis on image and popularity rather than effectiveness.

Government is about making difficult decisions and with each one there are losers and the aggrieved, it’s part of a ministers remit to cope with that. I’ve long felt that until the NHS has patient care at the heart of its strategy, rather than what is best for its staff and structure it will never be as good as it could be. So, perhaps there should be less focus on the needs, whims and desires of the NHS workforce and more on delivering the goods to the ‘service user’?

In hindsight NHS reform should have been held until the economy had settled and a stronger government elected with proper mandate. Until then the industry, along with everyone else, will just have to keep alert and get ready to react as things emerge. Not exactly ideal and will, no doubt, have some serious impact on many businesses in our industry whose strategies, investment and growth plans are as much in limbo as the NHS reforms.

Interesting comments from Angus but in truth simply stating exactly what we already know and also know is a problem.
From a practical view point it makes no sense at all to deliver sound bites that talk about 'Patient centered service' or 'Putting the patient care at the center of the decision making process' because at the end of the day the patients do not have a co-ordinated voice or union talking on their behalf. The only sensible long term strategy is to identify the strongest party (staff) and bring them to the fore in having a control over their own destiny. As a management technique it is like getting Turkey's to vote for Christmas but unless you get the commitment required it will continue to be a free for all with each interested party trying to protect their own interest and not look at the wider picture. A long term education of the service providers is probably the best chance of enabling and empowering these providers to make informed, rational decisions that are in the long term interest of the NHS rather than their own immediate requirements or job security. There is probably not a single NHS staff member who could not look at their own department and identify a better way of doing things. It may be as simple as reducing agency staff numbers in favour of permanent staff or it maybe changing a process of work. But the whole idea is that the biggest cost centre buys in to the concept of reducing their own costs and then the internal culture changes to one of ownership rather than conflict. A long process we know but actually less expensive to us all.

Alastair

Your analogy of Turkey’s voting for Christmas was very apt. One only has to look at the culture of the public sector to realise getting a commitment that will instil any significant responsibility and accountability will be filibusted to death by all the varied vested interests at loggerheads. Which was my main point?

As it happens patients are represented, by the Patients Association and they along with the likes of the BHTA should have greater say in delivering a NHS.

Recently I was fortunate enough to be invited to a seminar about bringing closer scientific and economic ties between Sweden and Northern England. The Key Note Speaker was Dr Robert Sinclair, MD, PhD, and Senior Medical Advisor, to the Swedish Department of Health Care.

Similar to the UK, Sweden has a tax funded health service that ensures free healthcare for all. Although there is some national administration, the majority of the tax collection, structure and delivery are devolved to a regional level. But perhaps the biggest difference to the UK system is that in Sweden there is a greater use of, and acceptance of, private hospitals and clinics working alongside public ones to facilitate the delivery of healthcare. Also the relationship between primary and secondary care is much closer to ensure that resources are better targeted at addressing the overall care needs.

The Swedish delegates I spoke with were rather perplexed at the apparent hostility by many in the UK to the idea of private organisations and investment into a publicly funded health service.

The Patents Association website is at www.patients-association.com