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June 5, 2016

Private Eye Medicine Balls 1418
Filed under: Private Eye — Dr. Phil @ 10:16 am

Who wants to be leader?

Whatever the result of junior doctors’ July ballot on their proposed new contract, they will continue work shifts and hours that wouldn’t be tolerated in any other safety critical industry. The central issue was always that we don’t have enough junior doctors to staff the NHS safely, but then we don’t have enough at any level. NHS Employers produced a tactless report with the Nuffield Trust last week, inviting senior nurses and others to ‘fill in the gaps in the medical workforce’. Quite where theses senior ‘medical infill’ nurses would come from is unclear. From September 2009 to January 2016, the NHS dispensed with 2,293 nurse consultants and matrons.

On June 8, High Court action by the junior doctor group Justice for Health was due to start to determine whether health secretary Jeremy Hunt can legally impose the latest version of the new contract, as he has repeatedly threatened, if junior doctors and medical students vote to reject it. This has now been postponed until after the junior doctors ballot result is announced on July 6. Any contract is only as safe as the staff available to work it, and we’ll find out in August how many rota gaps need to be filled by imaginary nurses. Junior doctor campaigners have at least been given a good taste of how NHS politics work, how unpleasant, inaccurate and unaccountable the top of their organisation can be, and whether they want to be part of it.

Many NHS chief executives are pondering precisely those questions. One described the current state of the NHS in England as ‘the last days of the Roman empire. NHS England and the army of regulators brutally demand accountability, compliance with targets and ever more savings, and yet are completely unaccountable themselves. Try complaining about them and they make your life even worse. As for all Vanguard sites and all those bloody stupid new models of care they keep imagining, it would be far quicker to just burn the money At least with Jeremy Hunt, you can vote him out.’

The King’s Fund recently produced a report based on interviews with NHS CEOs at or near the end of their careers. It is not pretty reading. The mean tenure of an NHS CEO is less than three years, and the job is so unpalatable that many posts are either vacant or filled by interims. This lack of interest in being an NHS leader means that some truly shocking and incompetent CEOs are still in post, as well as some truly outstanding ones who have somehow managed to survive. Despite Hunt’s claims to the contrary, the NHS is going through by far the longest period of restrained growth in its history. Since 2010, allowing for population growth, spending has risen by 0.1% per annum and is likely to be stuck there until 2021. In 2009, we spent 8.8% of our GDP on health, now we spend 6.3%, and you get what you pay for. Social care services have collapsed, and there is still huge variability in access to, and quality of, NHS services. Try finding emergency dental or mental health care.

All this would be bad enough were in not for the Health and Social Care Act on top of the austerity. As the King’s Fund report observed; ‘There was barely a good word said for the 2013 reorganisation of health and social care…. The changes were ‘disastrous’ and ‘catastrophic’. Tim Smart, former chief executive of King’s College Hospital NHS Foundation Trust declared; ‘I think the system was broken by the Health and Social Care Act. And that’s a real shame.’

When MD first met Jeremy Hunt on January 8, 2013, he said ‘When I look under the bonnet of Lansley’s reforms, I’m pretty impressed with what I see.’ Hunt is now the longest serving health secretary in the history of the NHS, and yet not nearly enough good leaders want to work under him, in a chaotic competitive market where no-one understands how the system works, no one is overall charge and too many organizations are concerned with their own survival, rather than the survival of patients. For thirty years, the NHS has been run like a business and failed spectacularly. In the NHS, the more business you attract, the more likely you are to go bankrupt because there is no money to pay for it. And yet you aren’t allowed to close for business, and the regulators and commissioners can punish you for treating too many patients, especially the sick ones. Time to admit commissioning has failed and ditch the market. That alone would attract good clinical leaders to stay in the NHS.

MD is revolutionising the NHS at the Edinburgh Fringe