A Hard Look at the Cancer of the UK NHS – John Gelmini

NHS BMW RRV (Photo credit: kenjonbro)

The exchanges in the House of Commons were unedifying because the NHS has been unfit for purpose for years, possibly as far back as the 1970s in the days of Jim Callaghan.

Under Margaret Thatcher, attempts were made to reform the NHS via competitive tendering, PFI and money following patients with a purchaser provider split to drive down costs but even under her the number of managers in the NHS grew by 189%.

In addition, the problem of NHS consultants deliberately creating waiting lists to build up their private practices was not addressed effectively and the drug companies were free to overcharge the NHS with the NHS’s procurement practices remaining in the dark ages.

Subsequent attempts were made to reduce the explosion in the numbers of managers but most of them came back in Lazarus like fashion as interims and consultants on even more money than before so there was no real reduction in overall numbers.

After Margaret Thatcher’s removal from office, following a decision at a Bilderberg meeting made in 1991 when Kenneth Clarke a member of that organisation’s steering committee delivered the coup de grace, the new “heir apparent” to the Prime Ministership became Tony Blair. Under him, various reforms were tried but once again the civil servants and his Ministers were outflanked by the BMA, the consultants, COHSE and the mendacious NHS managers whose numbers increased by a further 225%.

In previous posts, I have mentioned the Gordon Brown/Wanless Review which sought to solve the problems within the NHS via targets and a further £7 billion gbp. All that money was consumed in higher wages and higher NI contributions and productivity, already very low, fell by a further 5%. On top of that 20% of the entire NHS budget goes to lawyers, payoffs to sacked employees, gagging orders and insurance.

Under the previous Labour Government, there were many PPP/PFI deals which were totally one-sided and benefited the private sector contractors. Some of these were so badly negotiated that one would have to conclude that there was either widespread incompetence on the part of civil servants and the NHS, or perhaps even another worse explanation.

We are now under the Cameron/Jeremy Hunt regime; David Cameron having failed to back Andrew Lansley and having failed to renegotiate the disastrous out of hours contract which the BMA achieved at the expense of everyone in the country – this time due to the incompetence of civil servants, many of whom Sir Jeremy Heywood (the Head of the Civil Service) has publicly branded as lazy.

The revamped Cameron reforms of the NHS designed to produce £20 billion in efficiency savings by 2015 will not do so because, once again, the NHS Chiefs and managers are gaming the system.

Between May 2010, when the Coalition came to power, and September 2012, 2,200 NHS staff were re-employed by the NHS following redundancy – a new form of “revolving door”, in which as one wag put it, “You go to someone’s leaving do, then a few weeks later they’re back.”

Since 2011, 1341 NHS employees have received redundancy payments of more than £100,000 gbp; among them 438 who received £150,000gbp or more, and 173 who received in excess of £200,0000 gbp. Examples of those who left only to come back for more include Sir Neil McKay, who left with £1 million gbp having been CEO of Midlands and East Strategic Health Authority and Derek Smith from Hammersmith Hospitals NHS Trust who left with a 6 figure payoff only to reappear at Leicester NHS Trust for 6 months at £205,000 gbp.

The system clearly needs to be reformed under the principle “When they are gone they are gone” and the people undertaking transformative interim work should be from outside the NHS so that real reform and real progress is actually made.

John Gelmini