NHS Organisational Reform: A Must For Survival

In terms of its original blueprint the NHS has already failed. Delays, ambulance queues, waiting lists, vanishing GPs, strikes and so on, put timely care out of reach to millions. Meanwhile the nation has scarcely ever been more unhealthy with lifestyle and diet issues undermining the wellbeing of millions. How to stay healthy is left to influencers with little useful input from the very organisation whose vocation, very reason for existence even, is the health of the whole population equally, without privilege or favour.

In my last post we discussed the misshapen funding model and how to resolve it. Today we look at the misshapen structure and the byzantine organisation it has been mandated by government to operate. I deal with this in my 2009 book 2010 A Blueprint for Change, but I want to revisit this because fourteen years on the NHS in a much worse state.

It now boasts 200 clinical commissioning groups, which replaced primary care trusts. These are supposed to interface with over 200 hospital trusts. However, of the 200 hospital trusts, 143 are foundation trusts, allegedly operating outside government control. How anybody can imagine that such a system can produce a joined up health service is hard to fathom, more particularly when we consider that GPs are technically self-employed out-sourced contractors, not under the formal management of the NHS chain of command.  That chain of command is itself distanced from government by a network of quangos, but contains within it no less than 2,200 non executive directors. Yes really!

According to the Cabinet Office, Non-Executive Directors (NEDs) in the NHS have a particular duty to ensure appropriate challenge is made, and that the Board acts in the best interests of the public. They should bring independence, external skills and perspectives, and challenge strategy development. NEDs have a range of roles and responsibilities to fulfill within an NHS foundation trust. They play a vital leadership role in ensuring NHS boards act in the best interests of patients and the public. They bring different perspectives and provide constructive challenge from a strategic viewpoint¹.

Non-executives use their skills and personal experience as a member of their community to formulate plans and strategy. They bring independent judgement, external perspectives and advice on issues of strategy, vision, performance, resources and standards of conduct and constructively challenge and help develop proposals on strategy²

This is just absurd. A vacuous declaration of meaningless words and phrases. The goal of the NHS is outcomes not expressions. It does not need ‘independence, external skills and perspectives’. It requires  delivery of outcomes, responsibility and ownership of events. The three key words are delivery, responsibility and ownership. Who is the boss? What are they delivering? Whether they succeed or fail it is down to them. There is no need for committees, boards or wafflers.

My next post will offer a new NHS model which prioritises outcomes, pinpoints responsibility and abolishes not only quangos and regulators but infestations such as process before performance and reputation above responsibility.

It will also abolish targets and eliminate waiting lists. Watch out for it. Links will appear on Twitter, Threads and Facebook.