Action needed to halt the culture of waste that pervades our NHS
demoralise staff by pursuing targets and building empires.
Patients and the public seem to have an ever-decreasing influence over the way services are run. Earlier this year, the Scottish Public Services Ombudsman Jim Martin reported: “The NHS unfairly rejects more than half of complaints made – leaving patients feeling ignored; I remain convinced we are continuing to fail to learn from experience, and this is increasingly a failing we can no longer afford.”
In November 2011, the Scottish Parliament’s Sport and Health Committee was told that, during the lifetime of the Parliament, the health budget had tripled with no gain in productivity and conferences were constantly convened and reports commissioned that rediscovered existing evidence. One participant remarked: “There has never been a greater need, or opportunity, to do things differently.” But nothing had been done to halt the culture of waste that pervaded the NHS.
NHS quangos are a further extravagance, generally benefiting only those employed in or by them. According to its website the Scottish Health Council (SHC) aims to improve how the NHS listens, and ensures patients, carers and the public are able to influence the planning and delivery of NHS services, helping strengthen public confidence. But the SHC cannot represent views that oppose policy adopted by a governmental or public authority. Surely this severe restriction should be made clear on its website to those who participate in consultations and other events?
Other quangos of questionable value-for-money include National Procurement Scotland, the 14 regional NHS boards and some of the special NHS boards (for instance NHS Education for Scotland). A large number of smaller organisations and initiatives also purport to improve public understanding and health, for example Care Information Scotland, the Knowledge Network, Scottish Health on the Web and Health Rights Information Scotland. No attempt has been made to meld this bewildering array of disparate organisations into an integrated and efficient system of care and support. The involvement of private companies in what are portrayed as NHS services (NHS24, for example) is not made clear.
Regional NHS boards are a particular concern. Application forms are tortuous and difficult to understand, except for those in the know. There is little or no influx of new blood. Board membership increased greatly 15 years or so ago (to 28 or even more non-executive members) but some contribute or attend rarely. Board chairmen and women and members are often repeatedly reappointed or rotate between similar posts in other public bodies. Often the relationship between board chairs and the executive is cosy, with the board failing to lead or restrain and board members, with one voice, merely rubber-stamping what has already been decided by the executive.
What NHS Scotland, patients and taxpayers in Scotland need is a new broom to sweep away all of the unproductive activity that pervades the higher echelons of the NHS and focus a greatly reduced management tier on ensuring front-line staff are able to deploy their energies and enthusiasms to the greatest possible good effect. Sir Gerry Robinson, perhaps?