We must make the NHS leaner but not meaner. The demand for healthcare will only increase with a rapidly expanding and ageing population. Present attempts to reduce expenditure by, for example, reducing treatment options nationally by NICE or local cuts by PCTs, are only pinpricks. Moreover the inevitable professional and patient anger induced by these measures more than outweighs marginal savings.
The NHS salary bill is the obvious target and courage will be required to achieve real economies.
It is not difficult to identify actions which would not only reduce the salary and pension provision costs but would also improve the quality and efficiency of healthcare as part of the massive de-regulation of UK health for which front line clinical staff crave.
In May 1940, before the Dunkirk evacuation, ‘useless mouths’ - the support troops not directly involved in fighting - were sent back to the UK. We must identify urgently the useless mouths in the NHS if we are to achieve improvements in patient care.
I’m urging the next government to examine the following proposals:
1. Abolish PCTS.
Strategic Health Authorities (SHAs) could fulfil their present role and the role of PCTs. Clearly SHAs would require development to assume their expanded role but should emphatically not re-employ the majority of redundant PCT employees.
The present local interpretation by PCTs of national health policy causes considerable inequity in the care of patients on opposite sides of PCT boundaries. The geographical region covered by SHAs provides the appropriate size and patient numbers to plan all aspects of healthcare. Clearly there would still be cross-SHA inconsistency but much less than with the current mosaic of PCTs. A small number of powerful SHAs responsible to the Department of Health and to their region could become the engines of expert health management.
2. Create a single inspection and monitoring agency for each SHA.
A myriad of inspection and monitoring agencies now besiege all medical facilities. This excessively complex and overlapping process, created by a micro-managing DoH, must be abolished as part of a clear policy of health de-regulation.
Hospitals are compelled to employ useless mouths to serve the monitoring machine and excessive monitoring diverts frontline clinical staff from their primary role in patient care. Assessments are box ticking exercises concentrating on process rather than outcomes and often mislead. One comprehensive inspection agency, organised by SHAs, responsible to the DOH and their own region, should undertake all assessments.
3. Reduce administrative staff.
The epidemic of bureaucracy which has brought the NHS to its knees has produced rampant expansion of non-clinical staff.
Many staff whose work is remote from direct clinical care could disappear from the payroll without any impact on clinical activity. Examples include communications staff, patient advice and liaison service staff, most inspection/monitoring staff, and IT and plant maintenance staff (whose roles could be outsourced to the private sector). Each trust must vigorously identify useless mouths and take action.
Those working shoulder to shoulder with clinicians would be retained: consultants’ PAs, good clinical service and finance managers, clinic reception and appointments staff and the like.
Well resourced and supported clinical teams should undertake all clinical and non clinical work required by their service. Ownership of their service would be restored. Professional self-respect would return and the current widespread feeling of impotence among clinical staff would be dissipated. If true leadership is restored to clinical staff then they could be judged on the outcomes of their services.
4. Outsource the maintenance of NHS buildings.
Inhouse maintenance and small works teams are inefficient, expensive and unresponsive. Outsourcing of all such work to the private sector, preferably organised locally, is the obvious solution. This theme of reducing numbers of non clinical NHS staff -along side a vigorous programme of de-regulation - must be another watchword.
5. Abolish NHS translation services.
The NHS’s expenditure on providing free translation services for patients with inadequate English language skills is significant. Patients with inadequate language skills seeking NHS care should bring a friend or relative who can help. Most visitors to the UK possess some English skills but a small proportion of UK residents lack basic English. Free provision of translation services sends the wrong message. Funding for translation services must be withdrawn.
There are many opportunities to reduce the numbers of non clinical staff in the NHS, saving huge sums of money without impacting on patient care. It’s time to abolish PCTs and dismantle Labour’s expansion of non clinical agencies and staff.
Dr Crisp has offered his ideas for making the £20bn savings required by 2105-16. What are yours? Continue the thread, or submit longer contributions to editorial@hospitaldr.co.uk
Any glorified nurse carrying a clipboard has gotta go - there’s got to be a fair few of them.
Some of the above is common sense but outsourcing maintnenance and cleaning activities to the private sector is certainly not efficient or safe. People take pride in their local hospital and need to take ownership of their own ward or clinical area and be accountable to the sister in charge not some outside agency. This will lead to cleaner wards and greater efficiency as it works with human nature not against it.
Reducing the huge burden of risk management related audits and meeting all kinds of nebulous standards, eg for CNST, will reduce the administrative work load by a huge amount. Choose and Book also creates vast amounts of unnecessary paper work and phone calls where previously one letter was sent to a consultant by a GP who knew the local services.
Is there any hope of this? Will any political party reduce their interference in the NHS? Unfortunately this is unlikely.
We could sack the parking control manager?