Does the NHS need another top-down reorganisation or does the answer to its problems lie within? - Andy Brown
Wes Streeting has recently announced that he intends to save money by abolishing NHS England and reducing the layers of bureaucracy. He may well succeed. Yet there is also a risk that he has committed the Labour Party to spending the bulk of its time in office presiding over yet another messy top down re-organisation.
To make real progress on improving the service the main focus needs to be on implementing simple efficiency measures that are known to work. Top of anyone’s list should be getting more facilities in place for patients who need care not treatment. Estimates claim that up to a third of all hospital beds are occupied by people who don’t need to be in hospital because there is nowhere they can be discharged to
Dealing with that problem can’t be fixed by simply commissioning more privately run care services. The providers know that hospitals and local authorities are desperately short of specialist care facilities and can charge accordingly. Investment is needed in new publicly run facilities and staff shortages need fixing. That means freeing up the ability of local authorities to borrow and invest, increasing incentives and opportunities for people to build good quality careers in the caring professions and an easing of restrictions on immigration.
Getting more bed blockers into suitable care facilities and helping former patients to adapt their homes is the clue to freeing up beds. At the current moment even some of the best hospitals in the country have ambulances parked outside A&E wards and people with serious health issues waiting for hours before they can be admitted because there are no spare beds whilst those who no longer need treatment are occupying scarce specialist facilities.
Once inside an NHS ward many patients still report receiving an excellent service from some remarkably dedicated and patient staff. Many of those staff are incredibly frustrated by the systems they have to work with and their lack of ability to obtain information, make decisions and get patients the help they need.
Wards work best when there is a nurse in charge who has strong authority that includes an ability to know exactly what is happening to each of their patients and the ability to insist on highly paid consultants focusing on patient needs that the nursing staff have identified. Each patient needs a champion who is listening to their issues, aware of what stage their diagnosis or treatment has reached and is keeping them informed.
Points of authority and clear lines of control are vital in any large organisation. The best hospitals know that and have empowered their nursing staff to take charge and make decisions. The worst leave patients confused about what is happening as changing shifts lose track of key information and are slow to move patients’ treatment forward and free up beds.
Many people feel lost in a system that is geared up towards diagnosing problems with one part of the body and prescribing an appropriate drug or procedure. Those who have complex issues that straddle areas of expertise or require a holistic long term understanding of the person struggle to get help. Not every problem can be properly assessed in a 15 minute appointment with someone who only knows the things about you that they have been able to discover in a quick read of the notes.
At the moment too many experienced staff are becoming demoralised by not feeling they are doing their job as they would like it to be done and seeing little opportunity for personal progression and development. Staff need more opportunities to progress and develop not hefty fees for training.
It would be great to see a lot more staff start out doing basic tasks on the wards and then progress through a system that encourages them to become fully qualified and experienced doctors. Yet there are still too many barriers making it hard for good nursing staff to progress beyond traditional limits.
Front line staff need to be trusted instead of intimidated by a culture of target setting, fear of making decisions in case of legal challenge and misdirected drives to save money on frontline services instead of backroom operations. It is hard to explain why patient records frequently can’t be read by the person who needs to see them because they are sitting with a GP, in outpatients, or in a different hospital that uses a different IT system.
Despite all its flaws the NHS still delivers some fabulous treatment at incredible value when compared to any private insurance system. Some of our best and brightest people remain committed to working in a system that focuses on the needs of the patient regardless of their policy cover.
If we want to build on their loyalty and give them every chance of success we would do well to focus on simplifying their challenge and building on successful good practice from the bottom up. I doubt whether many of those dedicated front line workers have been crying out for another top down re-organisation.
Andy Brown is the Green Party councillor for Aire Valley in North Yorkshire.