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Two rights can make a wrong


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Friday, 11 January 2013

Two rights can make a wrong

Here are the headlines of the five “most read” stories in the HSJ last night with the number of readers’ comments in brackets.

•    Redundancy threat for 3,500 NHS managers (33)
•    Nicholson insists he should survive to implement Mid Staffs recommendations (50)
•    Chief executive resigns at Midlands trust (8)
•    Kershaw backs dissolution of South London Healthcare (7)
•    Providers to roll out integrated care across Kent (0)

You don’t need to read the HSJ to guess the nature of most of the comments.

On some of his early outings Andrew Lansley appeared confident that cutting managers would be a crowd pleaser, particularly with the clinicians he was so keen to get in with. He couldn’t have been more wrong. The public perceived restructuring and the consequent blood-letting as an attack on “our NHS”, while any pleasure doctors may have taken in the fate of NHS managers quickly melted away as they realised they were the management now.

The conflation of arguments for more clinical input to commissioning, better management practices, efficiency, cost-saving, modernisation and relaxation of central control, all as worthy as the “patient centred” rhetoric used to glue them together, go to show that several rights can easily make a wrong.

The mistake was to confuse the need for reform with radical structural reform, which comes at high cost and with a high risk of failure, the main one being to impede the change it is designed to enable. The irony for managers who find themselves “at risk” (to use the quaint NHS euphemism) is that one of the justifications for reform – removal of unnecessary layers of bureaucracy – is looking increasingly shaky as the same “unnecessary” managers migrate to new posts in the NHS Commissioning Board, CCGs and commissioning support units and the other paraphernalia of the newly slimmed down system.

All of which helps to explain the strength of feeling in the comments on the story about the NHS chief executive, Sir David Nicholson, who told the HSJ he does not believe he should resign over Mid Staffs. Sir David’s view is not apparently shared by the readers of the HSJ.

No doubt there will be consequences as a result of the Francis report. There will certainly be column inches, calls for resignation and protestations that it should never happen again.
But inquiries and reports, like structural reforms, will not address the crisis of care facing the NHS. Mid Staffs is not an isolated scandal just the most obvious of many scandals of substandard care and poor management that will continue long after the dust has settled on the Francis report. 

The inquiry will inevitably conclude that a particular set of circumstances, a unique coincidence of failures or an unusual configuration of planets is to blame. It may or may not produce villains for the executioners of The Guardian and The Daily Mail to entertain us with. 

It will, of course, produce lessons for the system; it may even blame the system, but it is unlikely to reach a verdict of “systemic failure”.

The point of the headlines is not to wallow in gloom but to note that the only story of any real consequence is the one no one has bothered to comment on.  Describing a county-wide programme of integrated care, the deputy chief executive of Kent Community Health Trust told the HSJ: “We’re probably the only area that is doing it across a whole economy, across a whole county… It is ambitious.”

Our readers’ poll in late December asked about levels of optimism among NHS staff.  Eighty per cent of respondents expect things to get worse. Even allowing for flu, norovirus and the dark winter mornings this is a depressing result.

We do not know how many times the NHS chief executive ticked the “very optimistic” box, but should he make it unscathed through the next few months, perhaps he could set a new Nicholson Challenge:  to end the waste of spirit in the NHS, which is every bit as urgent as the quest for the missing billions.

anoop.maini@gmail.com says:
Jan 11, 2013 12:17 PM
Agree. too much time has been wasted. There has been little change to services. And nothing has been done to make it easier to innovate to create new services. Public or private sector: providers can either manage the difficult ' day job of providing services' or try to come up with new 'integrated' ideas. There is inherent risk in trying new things - they might not work, if they work they may not get bought by commissioners. Until something is done about this basic and fundamental issues, to make it easier for 'the man on the street' to innovate, to provide solutions that work for patients - then nothing will change! And we will see more stories of failure. Nicholson will go, his successor will go - and all will wonder why they could not do anything. The NHS will be replaced, in part, by a system in which those who can pay will get the service.

So whats the message. Lets agree to do something to make it easier to innovate. If you want ideas on what the solutions might look like - happy to continue this interesting debate.
harry.longman@gmail.com says:
Jan 11, 2013 01:43 PM
I'm looking forward to see the system failings pointed out as a cause of Mid Staffs - but that does not remove responsibility from those who built and operated the system.
More importantly, what does it mean for changing the system. "Lessons will be learned" is a phrase I've learned to dread, coming as it usually does from those who were in charge of the broken system, and still are, but can't see what's wrong.
PeterCooper says:
Feb 17, 2013 09:51 PM
I really wonder how people conceive of leadership in the NHS. There certianly seems to be a deficit and no exffective means to build leadership capability