Thursday, January 04, 2007

Harsh medicine and tough love

I have noticed that there is a possibly interesting programme on BBC2 next week: Can Gerry Robinson Fix The NHS?

Now, the obvious answer is "no, he can't." As The Englishman points out, the NHS is fucked up beyond repair, with operations already being cancelled and the introduction of "fines for hospitals that operate too fast."; and we still have at least two months to go in the fiscal year. The Englishman is pretty definite about what should be done.
This is mad beyond the madness I can imagine. A system this wrong is beyond reform. The whole stinking pile must come crashing down and central command and control eradicated, the NHS offices razed to the ground, no stone to be left upon another, the sites to be ploughed and strewn with salt....

Of course, there is an alternative, as I have blogged before: demolish the monolithic NHS ziggurat, and privatise all of the hospitals. There really isn't any point in introducing privatisation to the NHS piecemeal, as the utter fuck-up that is the Private Finance Initiative has shown all too well.

Gerry Robinson is essentially attempting to run an NHS hospital as though it were a private company; inevitably, he finds himself up against all of the problems that you would expect, i.e. endemic buck-passing and entrenched laziness.
The troubleshooting business guru has agreed for this series to take on his biggest challenge yet: an NHS trust. Two days a week, he visits a hospital in Rotherham, South Yorkshire, to attempt to shorten the waiting lists. And, judging by his face (he spends most of the programme wearing a grimace somewhere between horror and torment), he soon regrets it. Robinson stumbles on a streak of entrenched tribalism that is depressing. Managers, consultants and nurses all disdain one another. Even the simple question "Who is in charge here?" brings a confused set of answers. "It's laughable!" he cries, though the lack of leadership is no joke. One scene, where he paces round operating theatres that are empty despite huge demands on their precious time, speaks volumes. "At the end of the day, nobody wants to work on a Friday afternoon," is the depressing explanation, or part of it.

There is an interview with Robinson in the Radio Times [not online (that I can find)] and there are a few choice snippets. When asked what the biggest obstacle to improving the hospital was, Robinson's reply was absolutely no surprise.
"Nobody felt that they could actually change anything. This can't go on for long in the commerical world as, if a company isn't working properly, it can't compete. But in large, government-funded organisations, inefficiencies can continue for a long time without thhe shit hitting the fan."

This is, of course, because they will always be bailed out by the poor, fucking taxpayer. But it is possible to change this culture of sloth and inefficiency. [Emphasis mine.]
"In child health [Rotherham General Hospital]'d been trying to cut the waiting list for 15 years. I got it down from eight weeks to two without spending any extra money. We got the consultants seeing one or two more patients per session, while still working within their contracts. It took two months, but in NHS terms, that was an instant result."

So you see, it can be done if we employ half decent managers into the NHS. Unfortunately, the public sector (in particular) seems to be dogged by the piss-poor, the feckless and the stupid. A couple more snippets from Robinson...
Didn't you feel like banging heads together?
"Definitely, but you have to work at it. You have to get on the shop floor and ask, "What's the hold-up?" Often I'd go back and nothing had happened. It was hard to pin down responsibility.

So who's in charge—the managers or the consultant doctors?
In theory, the managers, but most of them have come up through the Health Service and they're in awe of the consultants. That has to end. Managers have to tell consultants, "Your contract says you start at 9am; you can't continue to come in at 9.30."

Which is interesting, given the number of articles that you see demanding that the running off the NHS should be put in the hands of the clinical staff. I have never subscribed to this idea at all; the clinical staff should be doing clinical work, not trying to manage a hospital. Just because someone is a good doctor does not make them an efficient manager.

Unfortunately, the NHS seems to be utterly devoid of efficient managers amongst the management, and hence the utter bollocks that we see today; hence this fucking useless cesspit in which, despite the doubling of the funding to £2 billion a week, the median waiting time has actually increased (from 43 days in 1999–2000, to 51 days in 2005–2006).

So, good luck to Gerry Robinson, and I shall watch this programme with a good deal of interest (and so should every fucking politician and NHS manager for that matter; I bet they won't be though, the workshy cunts): 9pm, Monday–Wednesday on BBC2...

UPDATE: some more on this over at Strange Stuff...

14 comments:

Rigger Mortice said...

'endemic buck-passing and entrenched laziness.'

couldn't have put it better.from poltician all the way through the admin depts to the wards

Mark said...

Mate, we'll start listening to your quotations regarding other people's 'endemic laziness' when you get a fucking job.

I'm all in favour of privatising the nhs, mind: little scrotes like you wouldn't be able to afford any insurance, and the first time illness befell you, onto the street you'd go, to roll around in the gutter with all the rest of the detritus.

Fuck off, you cunt.

nicknospamplease@backlash-uk.org.uknospamplease said...

"Which is interesting, given the number of articles that you see demanding that the running off the NHS should be put in the hands of the clinical staff. I have never subscribed to this idea at all; the clinical staff should be doing clinical work, not trying to manage a hospital. Just because someone is a good doctor does not make them an efficient manager."

The problem, though, is that managers aren't good at all at identifying clinical need and nor is a good management procedure (with nurses doing the examining) a very good replacement to trained medics (as Dr Crippen might argue).

That is a problem with health (and a few other goods)... that the people who are best at providing a service are also, in some cases, the best people at identifying who needs a service (with all the potentical conflicts of interest that entails).

I would personally not want to put manager in charge of a hospital. In the same way, I wouldn't want to put a general manager in charge of a law practice because I feel people with a vocation or a profession are the best people at being the eventual organisers in their field. Not that they aren't capable of delegating to a management team that they feel is able to fulfill a certain role.

Of course, where we agree is that we wouldn't need to discuss this if we had a free market in hospital provision because either both views would find a place in different health providers, or one would prove more efficient and become the dominant form of provision.

Good to hear you are coming to the smoke, by the way.

Vesalius said...

"endemic buck-passing and entrenched laziness."

"Even the simple question "Who is in charge here?" brings a confused set of answers."

In many instances, this does not happen by chance, it is deliberately planned to help muddy the eternal waters of accountability and having an extra few hours to go shopping on company time.

Funnily enough, I was discussing the calibre of modern NHS management with a colleague, just before Christmas. We mourned for the days when managers came up through the medical ranks, or similar, and who had great personal integrity and presence. Today's lot, well, comparing them to double glazing salesmen and estate agents, would be an insult to those professions.

Devil's Kitchen said...

Mark,

Of course one expects personal attacks when writing a blog, even when one is summarising someone's else's words, but I can't help thinking, Mark, that it is you who is the cunt here.

Mate, we'll start listening to your quotations regarding other people's 'endemic laziness' when you get a fucking job.

Mate, I have tens of thousands in the bank: I will get a job when I find something that I want to do, rather than being stuck in the crappy, dead-end jobs that I have been for the last decade.

I'm all in favour of privatising the nhs, mind: little scrotes like you wouldn't be able to afford any insurance, and the first time illness befell you, onto the street you'd go, to roll around in the gutter with all the rest of the detritus.

*Sigh*.

You see what happens when you don't follow the links? You end up making a prat of yourself. Go and have a look at the post which I was kind enough to provide you a link to (look, I'll do it again), you stupid little cunt, and you will see that I have envisioned provision for the unemployed and low-paid.

The NHS is not free, you silly sod, only free at the point of use: the unemployed pay no National Insurance: do we leave them to "roll around in the gutter with all the rest of the detritus"?

Besides, even a moron like yourself must realise that there is a world of difference between privatising the hospitals and privatising the funding? For what its worth, I would support something far nearer France's combined system than the US's pure insurance system.

Healthcare funding is a difficult issue, but the laziness and incompetence of some people in healthcare, both clinical and managerial, is beyond dispute.

Now, you go back to studying your GCSE texts, like a good boy, and the rest of us will write about better things.

DK

sloshed_nurse said...

One scene, where he paces round operating theatres that are empty despite huge demands on their precious time, speaks volumes. At the end of the day, nobody wants to work on a Friday afternoon," is the depressing explanation, or part of it."

Bollox. Utter bollox. Too right that's only "part of it." Yes, operating theatres are standing idle - but it's not because lazy-ass public sector staff can't be bothered to work friday afternoon. All over the country, scrub nurses & surgical teams just want to get on with their job - but are prevented from doing so, thanks to NuLab's ridiculous target culture and enforced pseudo "competition" via the use of cherry-pickin', poor value ISTCs. Or else, theatre time is the victim of dumbass cuts in clinical staff - if there's nobody around on Friday afternoon, it's probably because, er, there is actually nobody around. And overtime has probably been banned. And last ditch efforts at booking bank/agency staff have probably failed - because, frankly, there are other things you can do with your time (and for more money, respect & a better quality of life) than deal with shitty emergency theatre cases (if Robinson thinks that resus can be a business like any other, he's going to find it hard going).

Patsy has overseen not just the fcuk-up of the NHS, but the evaporation of coalface goodwill & service ethos that kept things going, and - gasp - even saved some lives. We could, if we wanted, have decent, publicly-funded basic care (i.e. emergency + critical provision - topped up a la the French & Germans) in this country. We could be getting on with the task in hand, quietly and sensibly. We are pissing it away, instead.

Robinson talks a certain amount of TV turnaround show horse-sense - but nothing more than yer average ward grunt could have told you, especially given that there are already enough consultancy goons crawling around. Indeed, his general stance seems to be conveniently close to NuLab's penchant for covert privatisation & the wonders of perpetual "change", regardless of the consequences (ask yourselves this: given that PFI is such an obvious fcuk-up - obvious even to a 5 year old - why have the CBI been so consistent in their praise?). And I have little time for the kind of spin that suggests that clinical staff are lazy fcukers. We are working very fcuking hard.

The best thing that could happen is for mendacious control-freak politicos to just get out of patient care - and let "localisation" commence. But I think it's too late. Vacuous soundbites and ideological point-scoring - we are all fiddling whilst Rome burns. Taxpayers will be paying for Blair's vision and legacy in more ways than one.

Mark said...

See, mate, this is what really fucks me off about so-called libertarians like yourself: you don't actually believe in your own shit. The correct response was 'fuck the poor'. I would at least have had a level of intellectual respect for that. Instead you link me to an ill thought-out piece of toss.

No interest in fisking it properly, but a couple of central points. You propose a) abolishing NI and b)the govt paying private health insurance for wasters such as your self (hmm small govt my arse) c) paying this debt off over a number of yrs. Now it's not clear (as usual) from you disjointed piece exactly how b & c tie together, but firstly, surely you are aware that at the moment those of us who actually contribute tax/NI are not the primary users of the service. Your scheme will change nothing: us taxpayers will still be paying for the healthcare of the wasters. Oh yeah, and by telling them they have to pay it back when the get a job, you have provided an additional disincentive to work. Well done.

DK, you are a deeply inadequate individual: you stand screaming at the the sidelines at anyone and everyone for the inadequacy of their efforts, while never (by your own admission - dead end jobs etc) having made any contribution yourself. It's very easy to decry the efforts of others when you never have to put yourself in the firing line'

Versalius said...

"we are all fiddling whilst Rome burns"

I have just heard from my 'friends' in Commissioning, that some major suppliers are now asking for money up front before completing their delivery of services and equipment. I wonder if they have become tired of paying tax on invoices not paid in over a year, or like the rest of us, are looking for some of that huge amount of money splashed about like a bottle of Brut.

Devil's Kitchen said...

Mark,

See, mate, this is what really fucks me off about so-called libertarians like yourself: you don't actually believe in your own shit. The correct response was 'fuck the poor'. I would at least have had a level of intellectual respect for that.

Really? Then you are even more of a prick than I realised. To say such a thing would display the kind of intellectual absolutism that I despise. To say that I am a libertarian does not mean that I believe in leaving people to starve on the streets or, in your charming phrase, "to roll around in the gutter with all the rest of the detritus."

I'm sorry, but I don't think that "fuck the poor" is the correct response: possibly from an anarchist's point of view it would be, but I have never claimed to be an anarchist: I am a minarchist libertarian, which means that I do believe in some kind of state which should carry out those things that we, as individuals, cannot do. I do think that there should be some kind of safety net, e.g. the Citizen's Basic Income.

Instead you link me to an ill thought-out piece of toss.

But never mind, you are going to tell me, in detail, why it was "an ill thought-out piece of toss" and propose some more sensible solutions of you own, aren't you? Oh, no: you aren't...

No interest in fisking it properly, but a couple of central points. You propose a) abolishing NI and b)the govt paying private health insurance for wasters such as your self (hmm small govt my arse) c) paying this debt off over a number of yrs.

Not quite, Mark. First, I propose abolishing NI (which is paid to the government) and instead bringing in a system of private health insurance. Now, whether or not it should be compulsory (as in France) or not is another matter and one that I am undecided on. The point is that your money should go towards your health insurance, instead of paying for MPs salaries and government quangos. This system would also ensure that you pay for your lifestyle, e.g. I smoke and should therefore pay more.

Second, I propose that the government pay part of any benefit that the unemployed receive directly to a private health firm, in the name of the person concerned. This ensures a) that people are covered, and b) that the government does not piss the money up the wall.

Third, I propose that -- if by some severe oversight or utter stupidity (which compulsory donations would, of course, do away with to a great extent) someone has no insurance -- then they would be able to pay off any medical expenses over a few years, rather than having to pay the whole lot there and then. This is merely an emergency measure which would plug the old "he wasn't treated because he didn't have his credit card on him" crap that we get from the critics of the (far from perfect) US system.

Fourth, Mark, I do wish you'd fuck off and stop making silly assumptions about my private life. For your information, I have paid tax and NI since November 1998 until start of December 2006. At present, I have a fuck load of cash in the bank and no need to work, so I am not doing so until I find something that I want to do. I have never, ever claimed any sort of benefit. Is that clear enough for you?

Now it's not clear (as usual) from you disjointed piece exactly how b & c tie together, but firstly, surely you are aware that at the moment those of us who actually contribute tax/NI are not the primary users of the service. Your scheme will change nothing: us taxpayers will still be paying for the healthcare of the wasters.

I'm afraid that that is always going to be the case, to an extent (provided, of course, that you believe that there should be a safety net (and anything else would be political suicide)). What I would like to ensure is that we taxpayers pay the minimum possible, that the money is used as efficiently as possible, and that marginal deduction rates are as low as possible (not the 90% odd that they can be these days).

Oh yeah, and by telling them they have to pay it back when the get a job, you have provided an additional disincentive to work. Well done.

The situation described could happen to an employed person just as much as unemployed; in fact, were one not to make health insurance compulsory for workers, then it is much more likely to happen to someone who is employed than someone unemployed (whose insurance would be paid automatically by the government).

If someone unemployed was in that situation, the payments would be deducted from any benefits (as happens currently with criminal fines). So not really removing an incentive to work at all; actually providing rather more of an incentive, since they would have to live in less money otherwise.

DK, you are a deeply inadequate individual: you stand screaming at the the sidelines at anyone and everyone for the inadequacy of their efforts, while never (by your own admission - dead end jobs etc) having made any contribution yourself. It's very easy to decry the efforts of others when you never have to put yourself in the firing line'

Here you go again with these rather offensive assumptions about my private life. I am a graphic designer who has always worked for small companies: the prospects for promotion were limited (zero, in fact) and so they were "dead-end jobs". I could amplify, but since it is none of your damn business, I won't. As I said, all you need to know is that I have worked full-time -- and paid all my taxes -- for the last eight years. OK?

The only inadequate one here is yourself: you sit here screaming at me in my comment boxes, criticising my offered solutions, insulting me personally and, most importantly, offering not one single solution yourself. Seriously, if my attempt to sound out ideas -- my "screaming at the the sidelines" -- makes me "inadequate", then what does that make you? It makes you someone screaming from the touchlines of the touchlines: it makes you look like the very zenith of inadequacy.

DK

Vesalius said...

Just in case you missed my post, sandwiched between Mark and DK's broadside, extraordinary things are now taking place within the NHS. Suppliers refusing to honour bona fide orders without money up front, is just one of them. The end is in sight.

Devil's Kitchen said...

Vesalius,

And who could blame them? Let's face it, if the NHS are anything like the rest of the public sector (and other some private comapanies; banks being one of the worst offenders, actually), then you won't get paid, as a matter of course, for about 60 days after your invoice has been submitted.

If you suspect that a client is about to go bankrupt and refuse to honour their agreements, then of course you'll want paid up front. Although NHS Trusts cannot really go bankrupt, obviously some companies fear that the government might turn around, cut 'm loose and let them go down the pan... sorry, "restructure" them.

DK

Vesalius said...

Hi DK,

I certainly do not blame them for wanting the money up front. It's just that has struck me as qite a new development in this sad saga.

60 Days!!! wow, some suppliers would be happy with sixty weeks.

mark said...

It makes you someone screaming from the touchlines of the touchlines
LOL
most importantly, offering not one single solution yourself
I ain't the one with the blog.

chris said...

to Gerry Robinson saying that:
Managers have to tell consultants, "Your contract says you start at 9am; you can't continue to come in at 9.30."
To which the rely would be, 'oh, you want me to do exactly what the contracts says? Well I've already worked far more sessions than it says so I guess I'll be off then.' Since all the clinical staff do much more than is required of them, and should they only work the contracted hours the entire system would collapse.

Mark:
Perhaps you should get a blog? The you can then fuck off and vent your spleen there where I'm not going to read it. As for:
so-called libertarians like yourself: you don't actually believe in your own shit. The correct response was 'fuck the poor'.
where does that come from? But I can guess from it that you are a socialist and therefore don't understand Libertarianism. Liberalism and Libertarianism is fundamentally about freedom, freedom for everybody rich or poor. People exercising free choices tend to lead to better outcomes for everybody than government coercion and centralised planning.