Last week, health secretary Sajid Javid outlined his plans for tackling the waiting list crisis. In the name of improving outcomes and increasing efficiency, Javid is pressing ahead with what is reported to be the most significant NHS leadership shake-up in forty years.
What’s the plan?
Are these plans merely bluster, an effort to distract attention from the planned increase in national insurance contributions, or should we take them seriously? Regardless, the government is once more attempting to find someone else to blame for the crisis in the NHS.
Under the proposed changes the health secretary would be able to take control of hospitals considered to be performing poorly, possibly replacing the whole leadership team with higher performing neighbours or business leaders.
The independent management review will be led by recently retired Vice-Chief of the Defence Staff, General Sir Gordon Messenger. Messenger’s qualifications for the position, presumably stem from his recent appointment as head of operations for the government’s community covid testing programme in Liverpool and appeared at several Downing Street press briefings during the pandemic.
Messenger will report back to Javid early next year. The government will then publish a plan committing to implementing any agreed recommendations. The department of health says any recommendations could be “rapidly implemented to make every penny of taxpayer’s money count” by setting out a delivery plan with clear timelines on their implementation. The review will aim to “improve processes and strengthen the leadership of health and social care in England.”
The NHS needs investment and end to privatisation not new managers
The government would have us believe that parachuting people into the NHS from the private sector (and now ex-military like Messenger), is an alternative to funding it properly and bringing it back into complete public ownership. We disagree.
There are currently 5.6 million patients on hospital waiting lists in England and this figure is predicted to rise to around 13 million as the full extent of those who could not access routine procedures during the pandemic becomes clear; it’s no wonder the government is looking for quick fixes.
However, these shocking figures should in no way be attributed to a lack of efficiency or wastage or the expense of having too many managers, as is so often proclaimed. The problems facing the NHS are because government policy not its management structure.
Despite this, and of course the huge impact of the pandemic on all aspects of the service, the NHS carried out millions more tests, checks, treatments, and operations this summer compared to last.
Dr Jennifer Dixon, Chief Executive of the Health Foundation said:
The starting point for any review should be to acknowledge the high commitment and skill of NHS staff, and the significantly lower resources available to them relative to health systems in neighbouring Western European nations. It should also acknowledge that the NHS performs well by international standards, having been assessed as one of the top global performers for administrative efficiency. And NHS productivity had increased at a faster rate than productivity across the wider economy in the decade before the pandemic.
Far from being over-run by ‘pen-pushers’ as certain sections of the media or those in government would have you believe, managers make up less than 5% of the NHS workforce and some of these have been known to literally roll up their sleeves and assist clinical frontline staff during particularly busy times. Only around £1 in every £100 is spent on management, and NHS managers must deal with ever shrinking budgets in the face of ever-rising demand.
We’ve been down this road before...
This is not the first time the Conservatives have drawn upon industry managers to ‘fix the NHS’. In 1983 Prime Minister Margaret Thatcher attempted to solve problems by bringing in boss of supermarket chain Sainsburys, Roy Griffiths as a key advisor to the government on the NHS. Roy Griffiths spent his tenure advocating removal of long-term care from the NHS, means testing and privatisation, resulting in the current lamentable state of social care.
In 2015, Prime Minister David Cameron employed the former boss of Marks and Spencer in much the same way. He came up with 19 recommendations, none of which were implemented.
Historically managers from big business have never stayed for long, perhaps the enormous challenges the NHS poses or the salaries offered just aren’t worth the hassle. Those with clinical and/or specialist backgrounds who are better suited to take on these roles and choose to do them, should be encouraged.
When all else fails, blame the staff
The Conservatives have been trying to do more with less for well over a decade now. The scapegoats are NHS managers. The Times front page on Tuesday announced that NHS bosses will now face the sack for failing to cut waiting times, as if any of this was remotely within their control.
On Monday, Mr Javid repeated the oft-used saying that opponents of the NHS like to employ, namely that governments must stop “throwing cash” at the NHS, telling conference that “it can’t just be about resources, there has to be ... some significant reforms that make that money go a lot further.” Just how the current (or indeed proposed) amount of funding can go further with over 100,000 NHS vacancies and lack of at least 17,000 beds, has not been addressed.
The danger is that this review and explicit threat of sacking will only exacerbate the staffing crisis, encouraging even more hard-working NHS professionals and managers to retire early or work elsewhere.
Following this announcement, the chief executive of Managers in Partnership, which represents health and care managers, Jon Restell told The Independent: “For this kind of thing to be coming out of government just before we go into winter will be upsetting for some NHS managers and will anger a lot of others... We have a lot of experienced managers wondering about whether this is the time to leave.”
Mr Restell said that a recent survey of NHS managers by his union found that 68% had seriously considered quitting after the trauma and pressures of the past 18 months, while 37% agreed with the statement "I would like to leave the NHS as soon as possible."
According to The Guardian, NHS bosses have called the review “a slap in the face”. One NHS chief said: “It’s hard not to interpret this as an attack. This will go down really badly, like a vat of cold sick.”
This government has failed in so many areas while excelling at passing the buck. If managers really are the problem, then perhaps the ones at the very top running the country should also face the same repercussions Javid suggests. Indeed, the proposed new Health and Care Bill would give the health secretary a raft of new powers, allowing him to effectively manage areas directly himself.
NHS managers are ultimately being scapegoated for the failure of government. Staff are an easy target to offer up to the public, exploiting myths of waste and inefficiency to undermine a public service and provide an excuse for bringing in corporate managers more amenable to government bidding.
The appointment of an ex-army General to conduct a review would in many ways, seem fitting. Conservatives have long been at war with the NHS and, not content with turning frontline staff against them through years of underfunding and neglect, they have now turned their attentions to alienating its managers.
Could it be that they want the health service to fail?
Press Officer for Keep Our NHS Public