• Sites and sounds – Trying to explain the current NHS 23 October 2017 | View comments

  • 23rd October 2017 | By David Jolley

    A friend has given me a link to the King’s Fund’s Animation which offers ‘a whistle-stop’ tour of how the NHS is at present and how it might be working: Here it is https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work

    The essence has to be much as ever was: overall control and responsibility with the Government of the day. This leaves the organisation at risk of change motivated by political fashion, personal quirks and wishes to stamp their presence from ministers and others. The vehicle is the Department of Health: ‘slimmed down’ with delegation to NHS England and NHS Improvement.

    These layers pass on money and guidance to others, some directly within the public sector healthcare, some from social care, the independent sectors, voluntary sector and so on. There is ‘commissioning’ and there is competition. There are Vanguard sites demonstrating new approaches which are thought (by people upstream) to be more effective and/or more economic. Flashing through as one of these I see the development of memory clinics run by specialists within Primary Care. Hurray for that – people upstream have been listening – let us hope that one catches on.

    But it does seem complicated. One of the most memorable and chilling phrases in the video is: ‘the NHS never stays the same for long’. Trying to make progress on shifting ground is harder work than when you can be sure of your footfall and take the basics as ‘read’ – You can then get on with the business of caring, treating and giving priority to the individual patient and their family.

    I am not convinced that the series of management changes which have occurred since the first of 1973 have made for better care of better use of resources. http://navigator.health.org.uk/content/nhs-reorganisation-act-1973

    That system gave responsibilities to Regions from the Department of Health and Social Services (DHSS). Regions related to Area Health Authorities, and they to smaller units such as hospitals and community services. GPs were independent practitioners, often working in partnerships. It worked well. There was no ‘commissioning’, no competition: we were working together to get the best use out of resources given to us. We had planning.

    The wonderful quotation: “We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization."

    Comes – I am told – not from the Roman satirist Gaius Petronius Arbiter, but from Charlton Ogburn Jr in a passage in Harper’s Magazine January 1957. Less romantic for its recency, but satisfyingly true to our experiences.

    Interviews of applicants for senior clinical roles too often consist of determination of the candidates’ knowledge of the latest actual or possible organisational map, rather than their clinical competence and nous.

    We are grateful to the King’s Fund for their enlightening animation.

    Might it be possible to ask that: ‘the NHS never stays the same for long’ be challenged and be replaced by: ‘‘the structure of the NHS never changes, but within this there is flexibility of response to changing needs and possibilities’?

    And before we do that – Can we please return to something rather like 1973!

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