Nigel Hawkes, Health Editor
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The Government sought to regain the initiative over the NHS yesterday by announcing another review.
It was heralded by Alan Johnson, the Health Secretary, as “unprecedented”, and will be conducted by Sir Ara Darzi, a distinguished surgeon who has been drafted into the Department of Health as a junior minister.
The main aim of the review seems to be to win over NHS staff to the reform agenda, but critics are interpreting it as a sign of weakness.
Mr Johnson promised that the review would be different from the one two years ago that led to the White Paper Our Health, Our Care. He acknowledged that staff morale was low and affecting the public’s perception of the NHS.
“We’ve put a lot of money in, but that hasn’t led to a lot of happy bunnies,” he said. “If there’s a problem with morale, it’s our responsibility, and it’s our responsibility to put it right. The bit that has gone wrong is taking the public with us.”
Sir Ara, who will travel round the country gathering information, has been given four tasks:
* Putting clinical decisions at the centre of NHS care;
* Improving patient care, particularly for those with long-term and life-threatening conditions;
* Making care more accessible and convenient;
* Establishing a vision for the next decade based “less on central direction and more on patient control”.
His problem will be that the reforms of Tony Blair were not intended to make staff happy, but to change the NHS culture, inctroducing market forces and the private sector. Persuading staff that further reforms are in their interests may be difficult.
In a statement to the House of Commons, Mr Johnson said that Sir Ara’s review represented a “once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable”. But the announcement provoked a sceptical reaction.
The British Medical Asociation and the Unison union welcomed the review. The pressure group Keep Our NHS Public said that it did not go far enough.
Nick Bosanquet, Professor of Health Policy at Imperial College, London, and consultant director of the Reform think-tank, said: “It is not clear why another review is needed to go over these general issues again which have been well covered in two reviews in the last five years. A year-long review risks damaging delay when practical solutions are needed now.
“Urgent problems include the redefinition of [the Private Finance Initiative] to a more local programme, the need to empower local staff to get value for money and the [removal of] barriers to the involvement of independent sector companies. All these issues need clear action and a way forward in weeks rather than years.”
Andrew Haldenby, director of Reform, said: “This is exactly the wrong moment to kick health policy into the long grass. The evidence is mounting that the Department of Health’s reform drive has lost momentum just as the service’s big funding increases come to an end.
“The focus of government should now be on delivering reform rather than reopening a debate on the direction of policy that was actually resolved years ago.”
Niall Dickson, chief executive of the King’s Fund think-tank, said that the proposed review must be not be a signal to reverse important reforms to the service and that the terms of engagement must be clear. “It is important that the Government does not raise expectations among staff or the public that cannot be met,” he said.
Andrew Lansley, the Shadow Health Secretary, told the Commons: “The only thing the Secretary of State seems to have understood is that morale in the NHS is at rock bottom. Where is the autonomy and accountability that the NHS is so calling out for? Where is the leadership and direction that the NHS so badly needs?”
* Mr Johnson also announced another £50 million to help to tackle infections such as MRSA and Clostridium difficile. This will be used to double the size of the department’s infection improvement team, groups of experts who advise NHS trusts on developing plans to cut infections.
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Poor morale is the symptom widespread amongst all staff of the NHS. The cause? Well itâs largely due to the way that the NHS has been completely remoulded to be 'patient centred' and 'choice driven' so that the staff are used as pawns in a business model of the NHS which frankly does not apply to real life. A major example is how thousands of our brightest students were heavily recruited into oversubscribed places for medical school, only to come out at the other end facing chaos. Make no mistake; the medical profession is well aware of the underlying reasons that the government has devised MTAS, taken power away from the Royal Colleges and disempowered the GMC. It is so recruitment is centralised and they can control (or not as the case has been) workforce planning. Itâs a policy of getting consultant bums on seats (like keeping a supermarket shelf fully stocked) to give the public the appearance of a fully staffed NHS. The reality is disenchanted individuals, staring at greener grass
Dr D Patel, Bradford,
Poor morale is the symptom widespread amongst all staff of the NHS. The cause? Well itâs largely due to the way that the NHS has been completely remoulded to be 'patient centred' and 'choice driven' so that the staff are used as pawns in a business model of the NHS which frankly does not apply to real life. A major example is how thousands of our brightest students were heavily recruited into oversubscribed places for medical school, only to come out at the other end facing chaos. Make no mistake; the medical profession is well aware of the underlying reasons that the government has devised MTAS, taken power away from the Royal Colleges and disempowered the GMC. It is so recruitment is centralised and they can control (or not as the case has been) workforce planning. Itâs a policy of getting consultant bums on seats (like keeping a supermarket shelf fully stocked) to give the public the appearance of a fully staffed NHS. The reality is thousands of disenchanted individuals, staring at greener grass...
Dr D Patel, Bradford,
The use of an eminent surgeon as Prof Darzi, recently drafted into the government, and with a record of carrying out 'reviews' that always agree with government policy, to carry out the latest review is frankly pointless. Hewitt was simply wrong. No review will put that right!
Far better to correct the obvious errors immediately, especially the junior doctors training place fiasco, so that the dangers ensuing from a lack of junior doctors in the NHS in August are reduced and the potential tragedies avoided where possible.
Reviews of this type are known to the 'Yes, Minister' generation. It is simply trying to gain time for further obfuscation, instead of decision making.
As many other eminent physicians and surgeons have been advising for months, the time is running out. An immediate expansion of the junior's training post provision to meet the numbers of juniors should not be beyond a government advised by such erudite professors!
David L. Cox, Loggerheads, UK
The review will fail in getting NHS staf fon side, particularly non clinical staff without whom clinicians cannot function. Of these the majority suffered very badly both in terms of loss of salary and loss of worth during A4C. Those who did not lose salary have been to a degree alienated from the less fortunate colleagues as there is not very definately an A4C devide of haves and have nots.
In addition becuase of the number of at risk staff (mainly nurses) being redeployed into the higher banded A&C posts, career development is virtually impossible.
Unless urgent steps are taken, prior to the review, cooperation will be impossible to attain.
Cristina, Oxford, UK
I am delighted that Mr Johnson announced £50 million to help to tackle infections such as MRSA this is good news for the patients. In relation to accountability ?I hope Sir Ara Darzi looks at the Chief Executives David Nicholsons role in all this?I refer to an article in the Health Service Journal dated 3rd August last year ,when two of Mr Nicholsons crony's gave a personal account of their friendship with him,the people involved went on to be appointed to key roles in his team!!!!!!!!despite leaving serious problems behind in their previous areas of responsibility.How is that being held to account?Leeds is still trying to sort out the mess.Morale in the NHS is at rock bottom WHY?Poor Leadership by the people mentioned earlier in this e/mail.I would like Sir Ara Darzi to look at the database I collected as an unpaid member of the Patient and Public involvement forum? I am sure that would give him all the answers he needs to resolve/improve both Morale and accountability in our NHS.
Mary E Hoult, Leeds , Yorkshire
My husband who is employed by the Scottish ambulance service in the last review lost £3,500 from his yearly salary and his new job description hinders him from doing a third of what he was traind for, and the ministers wonder why there is a lot of unhappy bunnies in the nhs.
Helen, Ayr, Scotland