Nigel Hawkes, Health Editor
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Ministers should stop meddling in the NHS and allow it to be run as an independent body, a new report says.
They should have the courage to stand back if the health service is to be efficiently run without constant interference, according to Brian Edwards, Emeritus Professor of Healthcare Development at the University of Sheffield. Mr Edwards, a former chief executive of a NHS authority, makes the arguement in a report from the Nuffield Trust.
Ministers damage staff morale, decision-making, recruitment and doctor-patient relationships, he says. While accepting that anything that takes up almost 9 per cent of GDP is never going to be free of political influence, he believes that in some parts of Britain, the NHS is “in danger of being encased in political ice”.
The current arrangements skew decision-making and force the organisation to operate within short political time cycles, he says, when what is needed is a longer perspective and the ability to take tough decisions without anxiety about their political impact.
He said: “The NHS needs time to consolidate recent investment rather than another series of political initiatives. Change equals progress in the political world. Consolidation captures no headlines. It is time to give the leaders of the health professions room to move the system.
“Ministers can never escape their ultimate responsibilities for the health of the people of the UK and creating more space for the NHS to modernise will require an act of great political courage and wisdom. Standing back is not an easy option but the risk is worth taking.”
The Nuffield Trust commissioned the report in 2006 to provide an analysis of the issues that need to be discussed before a decision on the topic can be made, including detailed considerations of the various structures and models that could be adopted.
Kim Beazor, chief operating officer of the trust, said: “This report reviews the options available for alternative systems of governance that have so far escaped analysis.
“The Nuffield Trust commissioned this project to move the debate on to neutral territory, to explore through thoughtful analysis the governance structures from different angles, and to review the special position of the NHS. The Government is well used to developing regulatory structures for organisations such as the BBC and postal services. Observations and analysis of comparable structures are necessary for policy-makers and politicians at this important stage in the history of the NHS.
“This report looks at a wide range of models for policy-makers and politicians to learn from so that perhaps in the future the appropriate experience and structure can be applied to the NHS.
“With a new prime minister about to enter Downing Street, it seems likely that the issue of NHS independence will once again be on the agenda – and we hope that this report will help ensure a balanced and rational debate about a subject of interest to every citizen in England.”
The idea of NHS independence has captured a number of politicians and analysts. The Conservative Party is preparing its own NHS Independence Bill, the British Medical Association likes the idea, and supporters hope that Gordon Brown favours it, too.
This is questionable, as he has briefed journalists both for and against NHS independence and has never clearly committed himself. The main objection is that political accountability for the spending of £90 billion a year would be lost, and that an NHS without political direction would be conservative, inward-looking and opposed to change.
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The NHS is already "conservative, inward looking and opposed to change", partly because it is unionised. Nevertheless, that politicians wreak havoc by conflating change and progress is absolutely spot on. If the NHS had a fraction of the foresight and flexibility that the armed forces have shown over the last 25 years (however grudgingly at times) we would now have twice the service at half the cost. The NHS is a bottomless pit and the best way to bring efficiency to healthcare is to split the whole thing up, sell it, make a big tax cut and use an insurance based system, with government aid for those who cannot afford the premiums. We could even close down the DoH! Exactly the same logic needs to apply to education, with a (non-universal) voucher system, independence, tax cuts and the end of the LEAs and the DfES. We now know beyond any doubt whatsoever that "public service delivery" should be taken away from modern politicians for whom government is merely a marketing exercise.
Michael, London,
What a crazy idea. The NHS should be run by managers - managers who face competition and the loss of business if they fail.
Any health care system has only one of two reasons to exist. It really does deliver good health care the vast majority of the time at reasonable cost or it delivers adequate health care most or a large part of the time within a budget.
The electorate want the former. The NHS is the latter. The only way to square the circle is to manage the workforce better.
This is the task for the next Margaret Thatcher - tackle the public-sector wealth-drain.
eddie reader, birmingham, uk
Let's hope Gordon Brown choses this issue to show to separate from / develop the Blaire legacy. While independent is a word that we have painfully learned has many shades - the idea that thinking is based on cycles that make sense for NHS rather than politician - and the need to stop the sort of continuous circular meddling that would make the Grand Old Duke Of York proud - these are aspirations that all working directly with patients share.
Alistair Hall, Leeds, UK
Setting up an independent board of governers is the way forward for the NHS. They could assess treatments that work (and are affordable) and provide a stable framework/structure to deliver care.
The amount of reorganisations while I have been working in the NHS could have paid for all your new cancer therapies 10 times over. Stop meddling and let people with knowledge of the subject sort it out.
Rather than let PCT's select which services the public can receive we should have a national debate on what will and will not be funded.
ian , Durham,
I believe that if the NHS system is put into the hands of an Independent body, then there is a possibility that the body could become political, i.e. I presume that the body will have a Budget, thus if they do not have enough money for Cancer Treatment, then the Body can say, Sorry Mrs Smith, you cannot have your operation until next year because we do not have any money. Then this will get on the pages of the papers, then it will become political. Maybe it is time to look at the Australian model using Medicare.
Sean Ennis, Manchester, UK
The NHS is NOT being run by politicians, it's being destroyed by politicians.
Jennifer Hynes, Plymouth, England
Politicians have made a mess of the NHS, especially Hewitt who have "balanced her books" and has over 500 surplus as she claims, forgetting this surplus is the wages for all the health professional sacked + 135 million cut from junior doctor training! Now, come August, thousands of junior doctor will also be sacked for Hewitt to "save" more money! Those doctors cost 2.5 BILLION to get through medical school! That's how clever Mrs Hewitt is, saving 500 million and wasting 2.5 billion, she needs some elimentary maths classes IMO
Staff moral can not be lower and the establishment is neerly dead. Save the NHS for Britain, give the running of the NHS to the professionals, the doctors who know what the NHS is all about, curing people, they know how to make it better.
Nigel Hawkes, you are a top reporter, I am becoming a fan :-)
Sam, London, UK
It does not surprise me that new medical graduates will see the medical profession as a job rather than a profession: after all, they are certainly not treated as professionals given the farcical recruitment practices to which they have been subjected this year. If you want professionals, treat them as professionals; if you want self-interested, unprofessional, money-seeking clock-watchers, adopt the same attitude as John from Dundee and that's exactly what you will get. Apart from the 'money-seeking' bit, that is - I do not believe anyone goes into medicine for the money (or ever has), they simply couldn't hack it without really wanting to do it... particularly when faced with either nursing colleagues or patients with John's attitude).
A doctor, Wales,
Well, John, let's just see how you're going to feel on August 1st when all the Junior Doctors' post change and not all the posts are filled because some have gone abroad to at least have some certainty about their future and you need emergency medical care.
Why don't you log on to the Remedy Website (www.RemedyUK.org) and read jsut a few of the psoting by those most effected by the ongoing issues around MTAS & MMC.
How would like to have no idea where you will be working or even if you will have a job? My son has been lucky enough to have a job offer - for the Oxford deanery - which includes - Oxford, Milton Keynes, Ascot, Slough with no indication at present of exactly which hospital he might be working in! With even better luck he may yet get his preferred deanery offer from the North West so he can stay where his house, friends, life at present is, although this region is huge and he will have not idea until AFTER he has accepted a job offer which hospital he'll be working in.
Joanna, Ascot,
John from Dundee, you are quite wrong in a few counts
1. Anybody that is not a consultant in the NHS is a junior doctor, and they form the majority of the doctors in the hospital. Their pay is a standard scale throughout the country (except those in London), and there is no cash cow to be milk. They have no other employer except the state. They have no other income except from the government. They have no voice either
2. The march is about the TRAINING of these junior doctors. They want to be trained properly so that they can provide the best care to patients when they are consultant. They are actually calling for lengthening rather than shortening of training. The Government wants to have consultants that take shorter time to train and have less experience so that it can fulfill its "consultant led " promise - a con if you ask me.
3. I think nurses doing "straight forward" doctors job is good, but how do you define that? Taking blood - most don't even want to.
UF, Birmingham,
While doctors who see patients as no more than the way of achieving the next mortgage payment or the next new car are in charge and while these same people are allowed to block nurses from doing perfectly straightforward "doctors" jobs we will never have an efficient health service. The problem has been from day one that the doctors, private contractors to the NHS, simply see it as their cash cow, they see it as their business. What other business would leave the local trades union to run it as Brian Edwards seems to be suggesting? Doctors have so corrupted the NHS with their me, me, me attitudes that they have forgotten it was supposed to be a service for the public and not a business run for their benefit. But service demands humility and you see precious little of that shining out from the angry faces of doctors on all these marches they delight in having, ...... about their working conditions. Get rid of the BMA's all pervasive conservative influence and the problem will disappear.
John, Dundee, UK
How about Professional Administrators, kept under a tight leash, working with the Dotors.
Desmond Taylor, Houston, USA texas