Sponsored by
Paul Charlson: We need a new start for NHS on the critical list
My local Primary Care Trust and Hospital Trust are millions of pounds in debt, a situation that is repeated around the country. Yet the Government has said that the books must balance this year.
This can only be achieved by cutting services and jobs, a process that is already under way.
After several years of unprecedented spending, the NHS is about to hit the buffers. It is reminiscent of the stop-go economy of the 1970s. The NHS needs real reform if it is going to deliver what we all want – a safe reliable patient-centred service.
In 1999, our health authority split into four Primary Care Groups which later became four Primary Care Trusts (PCTs). They recently merged into two PCTs.
Each re-organisation was accompanied by new strategies and management structures with recruitment and redeployment of staff. Many managers simply moved organisations or changed job titles. To avoid redundancy, some managers were placed in roles for which they are unsuitable.
Meanwhile, the Government attempted reform by producing endless unclear and contradictory guidance. This created a culture where managers feared taking decisions.
The problem is that the Government has interfered too much. It needed to concentrate on strategic vision, allowing local managers flexibility to implement it. Local flexibility is the only way reform will be effectively achieved.
Sir Gerry Robinson's recent television series about Rotherham General Hospital discovered that management did not listen closely to the staff. It is obvious that the people working at the coalface will know what is going wrong and might know how to fix it.
Rotherham is not alone. PCTs have consistently failed to listen effectively to clinicians who have increasingly become disengaged with them.
The first thing the NHS must do is put clinicians back at the centre of decision-making processes. This should not just be at the level of local Primary Care Trusts, but in the Strategic Health Authorities and also the Department of Health.
The NHS financial problems are also reducing innovation. We set up an innovative scheme for dermatology, involving patients being seen in the community by specially trained GPs and consultants.
This has been a real success, with high levels of patient satisfaction and it has been designated a DoH pilot site. Yet, despite ticking all the Government boxes, we are down to bickering over a few hundred quid. The situation is that bad.
In the same service, we planned to employ a part-time dermatology nurse two years ago. Despite many meetings, the nurse is still not in post. In my practice, we decided to employ a new nurse practitioner and she was in post within eight weeks.
Without innovation, you cannot have reform. Without reform, the NHS will fail to achieve its potential.
Our practice trains medical students and they are fearful of unemployment. It is estimated that 9,000 doctors are unable to find training posts. When you think of the motivation and effort it takes to get a medical qualification – not to mention the 250,000 it costs to train them – it is a scandal. The situation is even worse in nursing and physiotherapy.
The budget cuts have hit training posts hard. It means that newly-qualified staff cannot get the further "on-the-job" training needed to become really effective parts of the workforce.
Furthermore, staff made redundant return to virtually the same post as agency staff – at twice the cost.
An urgent manpower review is required. We need to ensure training posts match the needs of a reformed NHS and put an end to the contracting out of staff to agencies.
Apart from failing to control costs, the Government has made some new very expensive commitments. One of these is Connecting for Health. This is the central computer system encompassing, among other things, a central medical record and the ability to book outpatient appointments from the doctors' surgery.
We started to use Choose and Book nine months ago. The system is supposed to come up with appointments virtually instantaneously. The first time I used it, I looked like a real lemon, staring at a blank screen for five minutes.
The patient went away without an appointment and my secretary spent ages creating an appointment for her. This was repeated many times by our practice before we gave up. Even the National "hit squad" is struggling to sort out our problem.
We are not an isolated case. Three things seem to have gone wrong with Connecting for Health.
First, the time scale for its introduction was hopelessly short.
Second, many good systems that were already operating around the UK have been dumped.
Third, an IT system must assist its users to do their job better. This is not happening.
Choose and Book should be suspended until it can made to work properly. Current systems should be supported until they can be integrated and there should be more consultation with clinicians in future developments.
Last Saturday, the Yorkshire Post highlighted the growing health divide between the rich and poor. Despite huge additional NHS funding, this divide is widening. The current system is failing to deliver.
The NHS has a golden opportunity to address the health divide, but it must change to achieve this. The Government's reforming vision is good, but its implementation has been poor. The current fiscal belt-tightening will hinder the required system changes still further.
Reform, an independent think tank, suggests writing off the current debts rather than forcing organisations to make drastic cuts. The new start would involve much tighter financial rigor and planning, with patients and clinicians driving the changes. This is what the Government wanted in the first instance.
But, thus far, it has patently failed to deliver this vision.
Dr Paul Charlson is a GP in East Yorkshire and member of Doctors for Reform. He was previously a member of East Yorkshire PCT executive committee.
Email to a friend
Print this page- Leeds lose Ward to Palace: Is there anyone they can afford now?
- Sheffield Wednesday leaving it late to hijack Leeds United over Ward
- As Snodgrass dithers over Leeds, Warnock throws a lifeline
- Ball is in Leeds United’s court over contract - Snodgrass
- Police turning blind eye to Asian voter fraud, says MP
Looking for...
Featured advertisers
Jobs
Search for a job
Motors
Search for a car
Property
Search for a house
Weather for Yorkshire
Saturday 26 May 2012
Today
Sunny
Temperature: 9 C to 21 C
Wind Speed: 17 mph
Wind direction: East
Tomorrow
Sunny
Temperature: 9 C to 22 C
Wind Speed: 13 mph
Wind direction: East
