General who led Iraq invasion runs rule over health service in war on waste and wokery
In any crisis worth its salt, there comes a time to send in the military. So it is that Sir Gordon Messenger, a general who led the Royal Marines’ invasion of Iraq, has been appointed to lead the “most far-reaching review” of NHS management in 40 years.
The challenge facing the health service is unprecedented. Even before the pandemic, it was struggling to meet a host of waiting time targets, with more than 100,000 vacancies.
Now the service is battered by the most difficult two years in its history – and growing impatience from a public who “held back” demand on services in an effort to “protect the NHS” – sometimes with deadly consequences.
Waiting lists stand at a record 6.4 million, with forecasts they could double. Twelve-hour waits for A&E are at a record high, heart attack victims can wait an hour for an ambulance and ambitious pledges for cancer look increasingly precarious, with eight years since all existing targets were met.
Who would want to be an NHS manager, trying to grapple with the chaos? How are the best leaders recruited and retained? And what persuades them to take on the most difficult challenges?
Sir Gordon has been charged to answer exactly those questions.
His findings, due to be published this week, following conversations with more than 1,000 frontline staff, come after an “astonishing” explosion in central bureaucracy in the NHS.
The doubling in the numbers working in NHS England and the Department of Health and Social Care – with sharpest rises seen at the highest levels – over the last two years come at a time when the nursing workforce rose by just 7 per cent.
The figures show the central workforce rose from 7,883 to 14,515, with the number of senior officials rising by 125 per cent, as the pay bill went from £42million to £83million. The findings by think tank Policy Exchange come amid concern that an extra £12billion a year funding boost, funded by a 1.25 per cent National Insurance hike, will be swallowed by management salaries.
This week ministers will update the public on how the NHS is delivering the “biggest ever catch-up programme”, with a vast expansion in scans and tests in community clinics. Since February the number of patients waiting more than two years for treatment has more than halved, they will point out.
Within the Government – most markedly from the Treasury – there is clear concern about efficiency, and spending on bureaucracy.
But some of the questions facing Sir Gordon are rather different.
The merry-go-round of health service management, with hospital chief executives staying in post for an average of four years, means failure can be rewarded – or recycled.
Sir Gordon is understood to be concerned that too much NHS management energy is focused on immediate and short-term tasks, with too little attention paid to the longterm agenda; and the need for more fundamental changes in the way care is delivered. He will also consider the vexed question of money – and a whether the best deserve more of it.
The review is being asked as “whether the right pay and an incentives are in place to foster good and excellent performance and rec recruit and retain the best b leaders from start st of career to retirement”.
Latest data shows the number nu of NHS executives exec
earning at least l £250,000 a year rose by more than 50 per cent last year. The official figures show more than 1,000 senior NHS managers on at least £130,000.
But attracting the best may mean paying for it – even if the political stomach for such moves is limited.
NHS leaders are also working in a highly politicised system. A decade ago, ministers introduced radical changes to the way the NHS is run, in an attempt to foster more competition. Many have since been quietly reversed, with efforts to ensure complex health and social care systems work together.
The measures also introduced a new body – NHS England – which was supposed to mean the NHS had some operational independence from the Government. But during the pandemic it became clear that the number of different organisations responsible for aspects of healthcare could make for a lack of accountability.
Sajid Javid, the Health Secretary, has promised to be “watchful of any waste or wokery” in the way record NHS funding is spent. The recent appointment of former TSB executive Richard Meddings as chairman of NHS England reflects Mr Javid’s desire for a “radical shake up” of the NHS, with an “outsider’s eyes” keeping watch.
The Health Secretary is understood to be working on a major NHS Reform White Paper, which aims to turn around failing organisations and could lead to the creation of “superhospitals”. Some GPs could also be directly employed by hospitals, instead of running their own practices.
Many ideas about how to improve the calibre of leadership and support those in the toughest jobs are familiar to those with experience of the NHS.
With record funding being pumped into a most precarious service, the challenge for those running the NHS has never been greater.