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Sunday, 28 December 2014

The Rose Report on the NHS - not an arty subject, but then, there are other things in life.

wightpaint


    Publish it now.
    The NHS - and I'm intimately familiar with only a relatively small corner of it, while having a longstanding wider involvement - is crippled by its management structures, imposed by the last two governments.
    The separation of commissioning and provision - introduced, apparently, to satisfy the EU's competition legislation - is a flagrant absurdity, leading to two levels of bureaucracy within every NHS region where one would be far more efficient. There is little or no cooperation between the training and provision element - so that we have severe shortages of qualified staff in whole areas of expertise (particularly haematology) and no means of directing medical students into the needed disciplines - we don't have enough nurses, so are forced to recruit from the Phillipines, and insist on degree-level training for basic carers. And we have a dog's breakfast of scrutiny systems - one at local authority level; another, allegedly independent, in Healthwatch; another, with the Care Quality Commission; yet another, with Monitor, whose function seems to be to enhance the march towards privatization.
    We have Foundation Trusts, with a membership system which is expensive to maintain and offers absolutely no measure of public involvement in running the NHS, although that's its ostensible purpose. Each of these Trusts is responsible for establishing its own governance arrangements and - subject to the scrutiny of these outside bodies - clinical standards. We have a proliferation of such Trusts, some responsible for specific hospitals, some for mental health within a region, some with no very obvious purpose at all, and a gap between all of them, demonstrated by a lack of common standards: except that occasionally they realize they don't have a policy on which they're likely to be examined, so speedily rush to establish one under the heading of 'sharing the learning'.
    You wouldn't run a sweet-shop, a springs factory, a Glee Club like this - you wouldn't scrutinize such a complex system as this - in this way.
    The NHS management structure is a shambles - one disaster built upon another largely as a result of cack-handed government reforms, the worst of which were kicked off by that utter, dangerous, incompetent fool Alan Milburn, and built on by a succession of lamentably stupid Secretaries of State and a dysfunctional and generally lick-spittle Department of Health ever since.
    Not only that, but they LIE about it! They pretend that the intention all along has been to strengthen the voice of the patient, the GP, those who work in the NHS - all of whom have been the passive victims of this incompetence because none of us were ever consulted!
    We're told that Andy Burnham is going to scrap the Health and Social Care Act. Good. But then what? Are we to revert to the Milburn/Reid shambles? Are we still to be lumbered with the Foundation Trust model, the separation of commissioning from provision, the ever-open invitation to the private sector to suck whatever meat remains on the bones? Is there going to be investment in the service and a serious, severe rationalization of management? I don't know, and I wish to God I could believe that Andy Burnham does, but nothing he has said, or been allowed to say, so far gives me even a hint of confidence that the Labour Party will take on this crisis of unwieldy, unmanageable management.
    The NHS still manages to be efficient, whatever its numerous critics claim; it still manages to keep its head above water in international comparisons. How it does this, I don't begin to understand, given the hobbles around its ankles placed there by this government and the last one. It can't be expected to meet the challenges of the future for so long as its entire management structure, from the Department of Health downwards and including its fantastically incompetent 'watchdogs' and regulators. remains in place. It doesn't work. The service functions despite the systems within which it's required to operate. It is crippled, in so many areas, by PFI debt, and dependent upon the fairweather 'support' of the private sector, whose interests have nothing in common with maintaining a national health service free at the point of provision.
    Publish the bloody report, and while there's still time to save the NHS, let's start a real conversation to determine how the blunders of the last 20 years can be reversed.

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