Bob Bury

“NHS commissars are out of touch with reality”

Did your heart sink, as mine did, when you read this? Just what we need – an NHS Academy to teach ‘leadership’. We’ve been here before: do you remember the University of the NHS? In case, like me, you had forgotten all about this, it was proposed by New Labour in 2001; there was then the inevitable consultation exercise, but they went ahead with it anyway, and it was launched in 2003 before John Reid promptly ‘dissolved’ it in 2005. A two-year campaign under the Freedom of Information Act resulted in a report detailing the cost of the aborted NHSU, and the associated management failures.

And anyway, academy my arse, as Jerry Nelson would no doubt say. HMG are clearly realising the huge risk they have taken by pushing through their misbegotten Health and Social Care Bill (HSCB), and feel the need to have an indoctrination centre to impose Right Thinking on the workforce. Who would have thought that it would take a Tory government to lead the country down the Maoist route? In this echo of the Great Leap Forward, I can foresee early morning exercise sessions on hospital car parks around the country, as loyal workers chant their ‘clinical commissioning group good, PCT bad’ mantras, in the shadow of huge advertising hoardings carrying Andrew Lansley’s beaming image (or, more likely, his successor’s).

Still, it will provide an employment opportunity for all those men in sharp suits and over-promoted nurses who spend their lives cocooned in training centres and converted schools of nursing, apparently joined at the hip to their flip charts. I sometimes think we should update that old aphorism: those who can, do; those who can’t, teach, and those whose sad fate is to serve no useful purpose in life whatsoever … facilitate.

But perhaps I’m being unfair. Perhaps these chair bound administrators (yes Sir David Nicholson, that’s you) really do believe that you can teach leadership in workshops, breakout sessions and on awaydays in shabby hotels on suburban ring roads, but most of us rumbled you a long time ago. Although I try to avoid clichés, sometimes a cliché is just what you need, so I make no apologies for saying that leaders are born, not made. I came across a number of them in my service career, and even a few since I rejoined the NHS 24 years ago. None of them owed their leadership qualities to hours spent in a seminar room being addressed by people who had long since forgotten what it was like to do actual work at the sharp end, if indeed they ever knew.

This is not the only recent example of senior NHS commissars being out of touch with reality. The Times believes it has unearthed yet another health scandal – this time it’s the discharge of patients during the night due to the pressure on beds (abridged version here, the full though behind a pay wall version here). There are certainly large numbers of overnight discharges, but even the journalist admitted that a large and unknown number of these are at the patient’s own request, and it is by no means certain how often old people are precipitated back into their unheated homes with no provision for relatives or friends to care for them (the type of unacceptable occurrence being touted as the reason for the paper’s outrage). However, it was all news to Sir Bruce Keogh, the Medical Director of the NHS, who promised an investigation into why it happens.

Well Sir Bruce, I suspect that most readers of this blog could give you one reason why it happens. It happens because there are admissions queuing up in the A&E corridors (sorry – in the Clinical Decision Unit), and beds are needed to accommodate them. Those beds are not available because successive governments have slashed bed numbers to cut costs. You would think the Medical Director of the NHS would at least have raised that possibility rather than rushing to reinforce the impression the The Times has unearthed a real and sizeable problem, but presumably his is a political post (is it? – I genuinely don’t know. I hadn’t even realised there was a Medical Director of the whole NHS).

The Times have clearly tired of their campaigns for simplified adoption procedures and safer cycling, issues which seem to have relegated any proper news to the inside pages for the past few months, and now have their teeth into this new ‘scandal’. In a leader, they told us that the overnight discharges indicated how badly the NHS needed Lansley’s ‘reforms’. On the contrary, I suspect they indicate how badly we need more beds and the staff to service them. The HSCB, with its push for more private sector involvement, will only increase the tendency to close beds and cut costs, thus making matters worse.

OK, I expect it’s more complicated than that, and no doubt changes in the way we work might be able to mitigate the need for overnight bed recycling. It’s also clearly wrong to send patients home precipitately if the conditions don’t exist for their proper care. However, despite the anecdotes, there are no figures for how often this happens, and in the meantime it’s irritating to say the least to hear our leaders jumping on the press bandwagon rather than counseling caution pending the acquisition of some real data, rather than raw numbers.

And … relax, Bob.

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2 Responses to ““NHS commissars are out of touch with reality””

  1. Malcolm Morrison says:

    Statistics are never what they seem! It turns out that some of these ‘discharges’ actually DIED in the night! Obviously the statistics are taken from the ‘discharges and deaths’ figures!! It might be useful to distinguish between these slightly different ‘results’, ‘end points’ or even ‘finished consultant episodes’!

    What is so terrible is that these decisions should be made by clinicians – so who made them? And that our beloved ‘leaders’, including the medical Director of the NHS, seemed surprised and did not know it was happeniong – or why!

    Maybe they have not got to the bit in the ‘curriculum’ of their ‘academy’ training that states the ‘bleedin’ obvious’ – if you are going to have to admit emergencies, there need to be ‘spare’ beds to put them in!

  2. Dr Zorro says:

    In fact there isn’t a Medical Director for the whole of the NHS. There are FOUR – one each for England, Scotland, Wales and NI. As you point out, the post is an arselickers sinecure.

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