YP Letters: Business sense is sorely needed to make the NHS work

What can be done to improve the management of the NHS?
What can be done to improve the management of the NHS?
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From: Paul Rouse, Main Street, Sutton upon Derwent, York.

OVER the years, I have found that the NHS in all of its forms suffers from mismanagement at a senior level. Furthermore, the various organisations tasked with monitoring the activities of hospitals, GPs and even research activities are either not up to 
the task, misguided as to what they should be looking for or following some strange nonsensical agenda all of 
their own.

My local hospital, for example, was highly rated until 2012 when the Trust chairman agreed to take over an ailing NHS Hospital Trust situated 42 miles away. I was horrified to find that he had no mergers and acquisitions experience, and therefore no idea what he was getting into, but had decided to go ahead anyway as he thought it could be his ‘legacy’. Inevitably it was a disaster.

Many GP practices are now effectively small businesses. Although they are inspected by the Care Quality Commission, the CCQ is concerned only with quality of care given and has no brief to look at the management or finances of a practice to see if it is being run efficiently, or if the NHS is getting value for money.

However, my top prize for how not to do something has to go to the custodians of the NHS drugs budget, currently around £16bn per annum. Most GPs know that some patients are taking drugs on repeat prescriptions that should be stopped because the risks are beginning to outweigh the benefits. The situation is aggravated by the recommended drug regimens that follow serious illness and hospital procedures. These often continue unchecked for far longer than they should. GPs are even incentivised to follow them as ‘best practice’. It should be a simple matter to set up a review of this situation with the aim of establishing a system of deprescribing. Not a bit of it.

Unfortunately no one involved in such research projects thinks in those financial terms. It is almost as if it is beneath them.

So what’s to do? In my opinion, we should take steps to improve the management and oversight structures in the NHS immediately. No senior business person, for example, should be allowed an honour of any kind until he or she has served for five years in at least one NHS non-executive director role. That would improve the management and financial knowledge at the top of these organisations. At present many of the non-executive roles are filled by the great and the good, who have no idea how something the size of an NHS Trust, or organisation, should be run.

If we want an efficient NHS, such thinking must follow the money tree into extinction.