My NHS@65: ours to destroy?

I joined the NHS on a nice round number, in the year 2000.  At least that makes it easy to remember how long I’ve “been in”.

That was the year of the NHS Plan.  “The NHS Plan outlines the vision of a health service designed around the patient: a new delivery system for the NHS as well as changes between health and social services, changes for NHS doctors, for nurses, midwives, therapists and other NHS staff, for patients and in the relationship between the NHS and the private sector.”  Two of my fellow NHS Management Trainees organised a debate between North West England bigwigs called “The NHS Plan: rhetoric or reality”.  I’m not sure it was really an actual debate – neither side seemed convinced about reality.  And that sentence about the vision could probably be replayed for every new document since then.

My first management job was at Trafford General Hospital – the birthplace of the NHS – and now part of Central Manchester University Hospitals.  I had the privilege of having a 10 week ‘cooks tour’, meeting with staff, shadowing, trying my best to be a porter, catering assistant, healthcare assistant etc and sitting in on management meetings.

It was an absolute nightmare.  I genuinely didn’t think I’d last a week.

Vacancy rates were 30%.  Then there was sickness on top of that.  We weren’t supposed to use agency, but bank and agency staff combined didn’t fill the gaps.  NHS management seemed to be a finger-nail clinging profession, desperately stuggling against impossible odds to keep patient care above the water-line.  And to help out, this was being done in the context of general derision from other staff and the public.  A midwifery manager actually told me she felt sorry for me because I would never be able to do any thing useful, not being a nurse.

Surely, I thought, this beast is too sick to live – should we just put NHS (and me)out of its misery?  Probably kinder…

So why am I still here?

Because the NHS is worth it.  We certainly haven’t solved the problems, but at least we now perhaps know a bit more about them. And I am absolutely convinced that privatisation is not the solution.

Those who believe in the NHS need to fight for it.  The King’s Fund alternative guide to the NHS demonstrates part of the complicated system we’ve managed to generate (they sensibly missed out a bunch of stuff – including most of the research agenda).   The CLAHRC for Northwest London animation demonstrates some of the complexity of trying to build capacity to improve it.

The NHS is the nation’s asset; the people’s asset; our asset.

We need to see ourselves as a population that owns our NHS, that wants to keep our NHS providing free care at the point of delivery to those in need.   We need to stop destorying it with infighting, professional jealousies, the constant sense of doom that pervades so many conversations in hospitals and pubs.  We need to take back the power together as clinicians, managers, citizens and academics to embed and deliver continuous improvement.

Research findings presented at the HSRN symposium a couple of weeks ago demonstrated that managers undervalued.  They are more influential than they or others realise, they are in the middle creating organisations that mirror the messages from the board (Boards focused on safety have better staff survey results than those focused on targets) and that they are also the group least likely to access the evidence base to make improvements.  Anecdotally a senior hospital manager told me only 2 out of their 38 managers believed they had the knowledge and skills to make necessary improvements.

Why is this?  And what can we do to ensure that management are valued, recognise their own power, and have the skills, time and space to use it to implement continuous improvement.

For more about what I want to achieve see about me, and for what I’ve been doing this last 6 months.