David's Views: Health - NHS
The NHS is the largest organisation in the country and the most centrally controlled. It is also the one organisation in the largest mess with many health trusts reporting large levels of debt. Yet no one has suggested that the health service is performing unnecessary operations or giving over elaborate treatment. In most cases the complaint is generally the exact reverse.
The NHS is too centrally planned and run. This means the government is both the poacher and gamekeeper, for example the government determines a hospital trust's budget without reference to its costs and the government will then blame the hospital trust if it overspends its budget.
One of the most constant themes in the NHS is planned operations that get cancelled at the last moment because a more urgent case takes the operating slot. This treats people like meat that needs packing, this is wrong, after all the NHS is a health service not a sausage factory. So the systems have to change to cope with both an elective surgery and emergency cases.
So my views on running hospitals are:
- More capacity in NHS hospitals is required. At present NHS hospitals are run with a very high level of bed occupancy. This means it is almost always the case that any emergency case displaces an elective case.
- For me more capacity means more hospitals, more doctors and more nurses locally available to the patient not higher turnover and greater throughput of the existing system.
- More capacity would give the ability to cope with peaks of demand and that requires a flexible workforce and management. This flexibility must be built into all aspects of running the hospital because people don't get sick on demand and a hospital must be ready to cope when they are.
- Flexibility also means thinking of the employee's whole needs this includes child care, travel to work, household shopping, as well as the more normal overtime payments or extra time off for extra work done. Staff flexibility means at times the staff fitting their life round the NHS. Therefore the NHS must help staff fit the NHS into their life.
So my views on the NHS structure are:
- Clear responsibilities need to be defined and the only way to do that is break up the over centralised control system and assign clear responsibilities to each level of government and to each element of the health service.
- The central government in Westminster should be responsible inspection and setting the minimum standard of care that everyone should expect regardless of their postcode.
- Regional government should contract/commission the large regional health service providers in their regional area i.e. the large general hospitals and the specialist regional centres for medical areas like heart operations, cancer etc.
- Local government should contract/commission the local health service providers in their area i.e. the smaller district hospitals, the GPs, dentists, midwifes, district nurses, health visitors, care in community services etc. Each local government authority should also define to the regional government what general hospital and specialist health services it requires the regional authority to provide. The regional authority must then provide it.
- Health service providers should define their own budget and define the level of service they will provide for that budget.
- These changes would lead to a bottom up and not a top down NHS structure that would be lead by local people and local health service providers, in which the people making the decisions could be held to account.
So my views on the health service providers are:
- They should have complete freedom to design the service they wish to. This should lead to services being tailored to the local area because no one knows the health needs of an area better than the health professionals in it.
- All health service providers should be run as non-profit organisations. So that any taxpayer money spent on healthcare is spent either on patient care or invested in future healthcare provision. The emphasis of the organisations should be on generating healthy patients and not healthy profits.
- They should be freed from government paperwork to concentrate on patient care. They should only have to provide the normal level of paperwork that any employer has to provide to Government. If the government wishes to have more information it should be able to get it from any half-decent accounting system and the normal inspections that would be performed.
- They should be paid a basic income for providing the agreed level of service and they should invoice the regional/local authority for each procedure performed.
The bottom line:
- The NHS needs to be locally controlled and it needs more capacity .i.e. more doctors and more nurses and fewer pen-pushers.