Whilst the NHS has been applauded for its response to the Covid-19 crisis, it highlights the fragility of the system given the need to reduce support for other medical issues e.g. cancer detection and treatment. This brings into question the organisation and management of the NHS. It can be said that the NHS would have a superb organisation were it not for its patients.

The first significant attempt to re-organize the NHS was the Griffiths Report in 1983. Sir Roy Griffiths was the Director of Personnel for Sainsbury when seconded to conduct his review. The application of management techniques to process thousands of common items (tins of baked beans et.al) do not necessarily apply when having to process thousands of individual items (patients with unique characteristics). However, the current system seems to ignore this essential difference.

I have benefited from the services of both private medical support and the NHS (Two triple bypass operations, colon cancer and current kidney cancer) and, prior to retirement, been a Governor for Papworth Hospital. Throughout this period I have been able to observe the differences that apply between the private and public sectors.

The main difference I have noted in the public sector is the considerable number of staff with labels that indicate they are administrative rather than medical. I also find it difficult to justify the fact that many of the Senior Management in NHS Trusts are not medically qualified but influence medical outcomes and are paid salaries far in excess of what would apply to comparative posts in the private sector. Quis Custodiet Ipsos Custodes?

One other obvious difference relates to funding. In the private sector the money comes before the required action.

Another area of significant change has been the role of the General Practitioner. I used to have a ‘Family Doctor’ who brought me into the world, removed my tonsils and later my appendix, all done at the local ‘Cottage Hospital’. He knew me and my medical history. At my current Surgery I have no idea what Doctor I will see due to the high turnover of medical staff, partly as a result of the generous retirement packages made available. This ensures that there is no continuity and at each visit to a new Doctor time is taken up reviewing my medical history. It is also noticeable that there is a prevalence to refer patients to a higher authority with consequential longer waiting times for attention.

The many significant advances resulting from medical research and consequential applications to patients’ treatment has generated ever increasing demands for medical attention requiring more specialisation within the system with more expensive and complicated equipment. It would be morally indefensible and political suicide for any government to reverse this situation..

Given the foregoing, what are the challenges and opportunities facing the NHS.

First, Staffing. There needs to be a thorough job evaluation conducted throughout the NHS against a background which recognises the primacy of those medically qualified with front line operational responsibilities. Having been involved in such an exercise in industry, I have no doubt that the roles and responsibilities of nursing staff would place them at a much higher salary level than is currently recognised.

Second, There needs to be a strategic review of the processes for delivering medical services. The current set-up where hospitals are expected to cover the full range of medical procedures, from the simplest to the most complex, is not sustainable. The establishment of the Cambridge Medical Campus combining formerly separate institutions is the way ahead, but requires the provision of a second tier of facilities to deal with more basic procedures. This second tier could be achieved through the amalgamation of separate surgeries within defined areas., in effect the re-creation of ‘Cottage Hospitals’. These would provide for continuity and a recruitment resource.

Third, Funding.,the most difficult problem that has to be faced. The present system bears no relation to the required outcomes, and will not be able to provide the funding that future pressures will demand. Whilst the provision of medical services free to all is commendable it removes any sense of responsibility from the recipients of those services. The only was to resolve this is to require those seeking attention to pay a proportion of the cost for access. There are a number of alternative systems to achieve this, what is now required is a commitment to move in this direction.

Fourth, Preventive Action. There needs to be as much attention paid to tackling issues which guarantee subsequent medical problems as has been paid, successfully, to reducing smoking. Such campaigns need to be national, properly resourced and sustained.

As Dickens said….”It was the best of times, it was the worst of times”

There has never been. nor will there ever be again, a better opportunity to make the basic changes that we need to cope with an ever more complex and potentially dangerous future. Tinkering will not serve, we require significant actions. As Lloyd George once said….” Your cannot cross a chasm in two bounds”.

 

 

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