The NHS: A Seriously Failing Public Service With no Internal Robust Financial Management Systems

Written by admin on December 5th, 2010

I am sick and tired of  hearing that the NHS is in financial crisis and that they have to axe front line services to balance the books.  By threateneing cuts in front line services and trying to lay the blame on the Government, they know they can manipulate the media and public opinion without having to accept any responsibility for how they are blatantly wasting public money on serving their own itnerests.  It is about time sympathy for the NHS came to an end.

The NHS, by their own admission, is now in receipt of record levels of Government Funding.  The Modernisation Agenda funding was allocated to secure significant improvements in patient services, choice, modern treatments, hospital at home, increased numbers of front line staff such as nurses, physiotherapists and occupational therapists and shorter waiting times.  Has the money been spent on one or any of these.  No it has not.  It has been used to create tiers of non-essential management posts (very highly paid but with little responsibility), job re-evaluations so that basic admin and management jobs were upgraded thus affording the opportunity to award themselves huge pay rises (not commensurate with the level of responsibiloity attached to the posts), give GPs a hugh pay rise so that their salary is now a scandal given the limited sphere of responsibility they hold and the fact, given recent news stories, that they make so many mistakes in diagnosis, they fail to assess symptoms properly and thus fail to refer patients to specialist assessments that pateints are either dying, being left seriously disabled or are suffering in pain because the G.Ps won’t listen or revise their medical opinions.  This huge pay rise came with a decrease in their responsibilities and allow Consultants to charge upwards of £3,000 (to their employers the NHS) to come in on a Saturday morning to manage a clinic to clear the backlog of the waiting lists which they create by prioritising their private clients over the NHS clients – who they are paid by the public to prioritise not relegate to third world status on their waiting lists.  So they get paid a salary by the NHS, spend most of their time doing private work lining their own pockets, creating waiting lists in the process and then charge their employers unacceptable fees to come in and clear their waiting lists.  Nice work if you can get it!

The Audit Commission once noted in a Report on the NHS that it was populated with a large number of middle managers who had very small spheres of responsibility and were very highly paid.  It is worth noting, as the public generally don’t know the inner workings of the NHS, that there are, in most Trusts, no robust financial management systems.  The impact of this is, if you hold a budget you can use that money how you like without accountability.  You can create jobs for example, which might not be necessary and without scrutiny  from your Managers so you can do a nice little line in ’empire building’ thus, then being in a position to significantly upgrade your own job and award yourself a huge pay increase.  In one Mental Health Trust I had professional dealings with, a group of Local Authorities handed over millions of pounds of their Mental Health Service budget, including staffing and establishment budgets to the Trust and the Trust promptly created 4 new tiers of Management.  None of the posts were advertised so all the Managers automatically became upgraded to the newly created post above them and, within three months, the budget was half a million pounds over spent.  They refused to attend hospitals to do mental health assessments, refused to fund appropriate EMI placements, refused to fill social work vacancies to deliver the level of service previously provided by the Local Authorities and refused to attend meetings.

In another instance, I attended a training course on Knowledge Management.  There was a presentation given by the Head of Knowledge Management of Guy’s NHS Trust.  They outlined how they used to be in charge of the Library at Guy’s Trust but quickly realised how they could create themselves a job as Head of Knowledgeme Management.  Thus, it seemed to me without any rationale, the new post and a new deparmtent was created so the Trust had a Library Dept and a Knowledge Management Dept – a serious duplication of effort and again, the incumbent post holder got a signifcant pay rise.  Now, I might be naive but knowledge management is not high on the list of NHS priorities – front line patient service are – so, I roughly estimated the cost of the new Knowledge Management Dept at around no less than £350,000 – money that should be going into patient services.

I saw an advert for a Director of Performance Management for one PCT (when the Strategic Health Authorities were created to undertake all strategic, planning and performance functions for their Regional NHS services).  I duly sent off for the application pack and found that the structure went like this:

Director of Performance Management

Head of Performance Management

Performance Manager

Now, in a Local Authority as in any other organisation, this would not be allowed to happen, performance management would be part of a Department which delivers Quality Assurance, Strategic Planning and Performance Management all under one umbrella with one Manager. I can probably take an educated guess and suggest these non-essential jobs were created in the same vein as the Knowledge Management Dept at Guy’s Trust.

I have worked in Trusts where there are such non-posts as Advanced Patient Pathway Co-ordinator when in fact, although there are excellent Patient Pathways for things likes strokes, hip replacements and Mental Health because, if you ask the Consultant or Nursing staff where in the pathway a patient is, they look at you blankly because they are not implementing the pathways – to the detriment of the patients.  There has been excellent Government Policy and Strategy to improve key front line services backed up by serious money to deliver them – but the NHS have simply failed to take any notice of them – preferring to serve their own interests than the patients to the extent that they no longer know or care what their core business is.

There a reams of other ‘non-jobs’ such as specialist Multiple Sclerosis and specialist Motor Neurone Disease nurses who do not provide any clinical care or support – just advice – well, the voluntary sector organisations can do that.  These posts are paid at management level so what you have is a hugely expensive advice service.  Similarly, the ‘specially trained nurses’ who undertake Continuing Health Care Assessments are paid as Team Managers when they are front line, clinical assessors and which, incidentally, not very good ones at that given some of the very basic CHC assessmetns I have seen – you know the type – two lines in every box, no analysis, no summary, no comprehensive assessment of the needs and abilities of the patient and no analysis of impact on the patient.

The list is endless so I will leave it there.  However, CHC is a key issue which, thanks to the Parliamentary Ombudsman for Health, has led to a new National Criteria which teh NHS cannot manipulate as easily as the old one.  However, Doctors, Consultants and Nurses dig up all sorts of strategies to avoid having to say a person meets the eligibility criteria for CHC such as, even though the diagnosis is that a person is at the end of their life and the vidence is incontrovertible, the Consultatns and Doctors will refuse to give a proper diagnosis or decision.  They will down play key nursing needs, leave out information, not provide proper clinical decisions so as the NHS do not have to fund either end of life or long term CHC care.  The result is Social Services have picked up the funding to the extent that their budgets are now near breaking point and the patients have had to sell their houses to fund their care which should have been funded by the NHS.

Contrary to public opinion, Nursing, Physiotherapy and Occupational Therapy are now very very highly paid jobs given the limited nature of their responsibilities.  At the end of the day the latter two are essentially now very highly paid technicians – since they became a Profession Allied to Medicine.

When I hear David Cameron say he is going to ‘scrap targets’ and give the NHS more money, I wonder just how much more he is going to give them.  The four key features of a seriously failing organisation are:

An inward looking, self-interested, self-protectionist philosophy which dominates the organisation and puts the interests of staff and managers before people using the service;
Budgets that are out of control and the organisation not knowing where the money is being spent, where their service hot spots are, what the needs of the market are and a lack of robust financial control and oversight on expenditure;
A lack of interest and conversely knowledge, of the needs of the people who use the service, what services are required to meet need and demand and a lack of insight into whether services that are delivlered are done so in a timely, efficient and relevant manner and which are of a type and quality which minimises risk and maximises efficiency
A determination to avoid scrutiny of their operations by inappropriate management of complaints, a defensive, arrogant approach to identified failures in their services and a lack of willingness to change or employ the right type of managers who will improve services and bring quality and experience to the organsation

The NHS meets all these four points with a vengeance.  So, I would say to Mr Cameron THERE IS NOTHING WRONG WITH PERFORMANCE MANAGEMENT, TARGETS, OVERSIGHT OR SCRUTINY OF PUBLIC SERVICE OPERATIONS, espcially when there are billions of pounds of

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