The Labour Party is in turmoil and unable to provide an effective opposition and so the BBC steps up and does the job for them. There are changes being planned for the NHS and the BBC has decided to shout very loudly that, in its interpretation of a study, these are being kept secret for political reasons. That’s despite being told in no uncertain manner by the report’s author that this is not the case. The BBC has gone through the 90 page report with a fine tooth comb, ignoring the vast bulk that explains what is going on and carefully, very carefully, selected out, from a single, very small section, the few words or phrases that support its contention that there is a huge cover up going on and changes to the NHS are being deliberately kept from the Public.
As said the BBC knows this isn’t true as the report author on the Today programme made clear and an honest analysis of the report itself would show.
Here’s what Chris Ham from the King’s Fund said [08:34] in response to Justin Webb suggesting the changes were being ‘conducted on purpose in secret’….
‘Can I just say these plans haven’t been developed in secret…There hasn’t been a plan to consult on until the end of October which was the deadline for each of these areas to submit their plans….they’ve been developed by the senior [NHS] leaders using their expertise knowing public consultation would have to occur.’
Justin Webb then did a u-turn and agreed that it was sensible not to publish the plans before they were developed properly…
In a way its perfectly right that they hold these talks in privtae as the risk is that you get all sorts of interest groups getting involved early on and possibly skewing them in a way that isn’t good for the Service [NHS]…more political than sensible…’
And yet the BBC has consistently ignored that and instead throughout the day been reporting a sensationalised story about ‘secrecy’ which came from one passage of the report and wrongly gives overemphasis to it thus creating a dramatic and sensationalist story of that supposed ‘secrecy’…..the use of the word ‘secrecy’ is of course a highly suggestive one that gives rise to thoughts of sinister plots and underhand dealings….the BBC has deliberately chosen that headline for political effect…..
NHS bosses ‘trying to keep cuts secret’
NHS chiefs are trying to keep plans to cut hospital services in England secret, an investigation has found.
Full details of 44 reviews of services around the country – which involve closing some A&Es or, in one case, a whole hospital – are yet to emerge.
That is because NHS England told local managers to keep the plans “out of the public domain” and avoid requests for information, the King’s Fund suggested.
Managers were even told how to reject freedom of information requests.
The local managers said they had been told to keep the process “private and confidential”, which one described as “ludicrous”, while another said the leadership had made the “wrong judgement call” in its approach to managing the process.
Another person involved complained about being in meetings and wondering why there were no “real people”, such as patients and members of the public, involved.
The King’s Fund was told senior leaders at NHS England and NHS Improvement, which regulate NHS trusts, wanted to “manage” the narrative around the process, because of the sensitive nature of some of the changes.
Let’s just look at who else is peddling that line about secrecy…..
One of the most alarming aspects of the STPs is their secrecy…. In the world of the STPs, the public have no right to know.
And the left-wing campaigning group 38 Degrees
…..published an investigation into STPs that was covered by all major newspaper and broadcast outlets. News items focused on the ‘secrecy’ and lack of public consultation on the plans, as well as making frequent links to potential ‘cuts’, ward closures and the downgrading of A&E services.
The plans are so ‘secret’ that the report tells us…
STPs have attracted growing media attention since they were first announced
(see box, pp 14–5), particularly after some draft plans were published following an
early planning deadline in June 2016.The plans have also attracted growing political attention. A large number of
parliamentary questions have been asked about STPs since June 2016
The existence of the King’s Fund report itself suggests no ‘secrecy’, the information coming from the NHS itself…..
We carried out a series of interviews with senior NHS and local
government leaders involved in developing STPs in four parts of the country. This
report is based on analysis of data from these interviews.
The bulk of the BBC story came from this single passage on page 38 of the report…
As well as the timeline creating a barrier to meaningful public engagement, national
NHS bodies had also asked STP leaders to keep details of draft STPs out of the
public domain. This included instructions to actively reject Freedom of Information
Act requests (FOIs) to see draft plans. Two main reasons were given for this. The
first was that national NHS leaders wanted to be able to ‘manage’ the STP narrative
at a national level – particularly where plans might involve politically sensitive
changes to hospital services. The second was that national leaders did not want draft
proposals to be made public until they had agreed on their content.
But even then the BBC has opted to miss out the second reason for not publishing their plans…they hadn’t agreed on their content yet.
If the BBC had been honest it would have reported the real reasons for limiting consultation in the initial stages of drawing up plans….the very tight time constraints, the extreme complexity of the subject, the enormous number of people and organisations that would want their own vested interests considered and thus complicate and slow down the process enormously, engagement fatigue as a result of all that complexity and the inability of some groups or people to understand what was going on and, because of the complexity and number of groups involved, an inability to coordinate efficiently between them, as well as legal constraints on publishing and the fact that some plans had already been drawn up that had been through a process of public consultation and thus didn’t need to do so again.
As you can see there are many reasons for not immediately making the plans public…none of them due to a deliberate plot to hide cuts from the Public…the BBC has decided that the NHS wanting to ‘manage’ how the plans are presented, and to do so as a national issue rather than just local, is suspicious but isn’t that just common sense so that people get the whole picture and are not thenn subject to individual plans being hijacked and sensationalised by politicians or campaign groups out to cause trouble when a full, broader perspective might make the plans seem more sensible and reasonable?
Here the King’s fund lays out some of the reasons for limiting consultation in the early stages…..not quite as simple as the BBC makes out…..
It is important to recognise the context in which the plans are being developed.
The pressures facing local services are significant and growing, and the
timescales available to develop the plans have been extremely tight.The plans are also being developed within the fragmented and complex organisational
arrangements created by the Health and Social Care Act. In this context,
credit needs to be given to local areas for the progress made on STPs so far,
notwithstanding the major challenges identified in this report.It is important to recognise the constraints facing national as well as local leaders
in the NHS.•• STP leaders and teams have worked hard to develop their plans on top of
their existing day jobs and various other initiatives. This has not been easy.
The additional workload for most areas has been significant and is unlikely to
be sustainable in the long term. Management consultants are also routinely
being used to support the local STP process.
•• The limited time available to develop STPs has made it difficult for local leaders
to meaningfully involve all parts of the health and care system – particularly
clinicians and frontline staff – in developing the plans. The involvement of
local authorities has varied widely between STP areas, ranging from strong
partnership between the NHS and local government to almost no local
government involvement at all. Patients and the public have been largely absent
from the STP process so far.
Where good relationships already existed, these provided a positive foundation for joint
working on the STP. Some areas were able to draw on pre-existing plans
for service changes to take forward in their STP, and have made progress in
developing a sense of ‘common purpose’ between leaders. Where relationships
were poor, securing engagement in the process was a challenge in itself.The geographical context and the complexity of the system have also been
important factors.
Over the last year there are three points that stick in my memory.
(1) The NHS is seven times more bureaucratic than Obamacare.
(2) Because of Political correctness, the NHS does not plan for mass immigration, but without political correctness (3) The NHS can plan for the elderly, therefore Mass Immigration is the only unplanned for, increase in Patients.
So the NHS is heavily bloated by incompetent bureaucrats, who cannot bring themselves to sack 85 percent of the bureaucrats, and use the money to replace these worthless bureaucrats with more valuable human beings such as Doctors, Nurses and Cleaners.
So the NHS needs a Trump or Lord Sugar type Character to sack these social parasites and use the money to train Doctors and Nurses.
“So the NHS is heavily bloated by incompetent bureaucrats,”
Richard, the bureaucrats play an absolutely vital role in the NHS by maximising the distance between the Department of Health and the delivery of a service to patients. With several layers of management in between, whatever goes wrong cannot be the fault of the minister who made whichever stupid decision re-disorganised that part of the service. The priority at the top is not to deliver a service, but to ensure that the minister is protected.
You can then add in the frequent changes to the structure of the NHS, with means that at every level you have three distinct groups of managers – those keeping the service running, those implementing the last master plan and those working out how to implement the new master plan. At the provider trust level all three groups are trying desperately to shelter the clinicians from the chaos, so that patients can still get the treatment they need. But at every level a vital requirement is to produce the data that shows that tractor production is up.
The politicians (of all parties) think that the system will be more efficient if it is “reformed”, but every change makes it more complicated – which means more back office staff to run it. The catastrophic problem arose when the Labour government decided that all the different parts of the NHS that treat patients had to become seperate legal entities. Before then hospitals and health authorities could have service level agreements written on a few of sides of A4 – this is what we’ll do, this is how we’ll measure activity and outcomes, and this is what you’ll pay us for doing it (I was at the provider end not with the commissioners). Now everything is set out in a legally binding contract, which can be hundreds of pages long.
As an example of the changes, several years ago I had to write a proposal for a new development at my hospital. I talked to the clinicians who would be involved, wrote it up on 10 sides of A4 and Region agreed to provide £3 million to build it. The Trust then decided it wanted to build something a bit bigger and needed more money, but by then the rules had changed and a “full business case” was required. A Project Team (not involving me, thank God) was set up under a full time lead and met weekly while the new details were drafted, consulted upon, redrafted, reconsulted, etc, until finally two lever-arch files of detailed information could be submitted. Two years after the creation of the Project Team the funds were made available and the unit was then built. The full business case was much more impressive than my 10 sides of A4 and everyone could now be sure that the money would be well spent; but I dread to think of the true cost of creating that business case – and that was a small development of a few beds in one hospital.
I want to write a lot more, especially about PFI, but this is already well into TLDR territory.
Richard, you’re right in principle, but the reality is complicated. You need to shoot the biggest of the alligators before you can drain the swamp – or they’ll bite you in the arse.
Very interesting insight – thanks.
So what is your job?
Gaxvil, I took voluntary redundancy when there was one reorganisation too many – and my face no longer fitted. I peaked at Assistant Director of Clinical Services.
Inevitably, bureaucracy, like Topsy, just grows and grows.
Just another attempt by a liberal media outlet to stoke the flames of resentment towards the government to distract from the real causes of strain on the NHS, which were caused and exacerbated mostly by the Labour party.
I love our NHS and want to protect it, but lying like this is not the way.
The NHS worked better some 40 years ago and that was without computers. A large/medium sized hospital trained their own Nurses like apprentices, had on Matron in charge whose rule was law. A Hospital secretary + half dozen administration staff. Now after years of liberal/left rules and directives they have completely changed the simple management structure and workforce and complicated it dramatically. They have many foreign nurses some with dubious qualifications and credentials that don’t have a full command of English, they have layers of highly paid managers and under managers, hundreds of Admin staff, a lack of leadership, cleanliness, direction and seem to be failing at every level. So what is their answer. Throw more money at it so they can employ more expensive managers to make an even worse job of a system that use to run like clockwork.
I promise I’ll keep this one short.
John, the politicians decided that the system you describe was run by the doctors for the doctors and so had to be changed. The priority was to break the power of the doctors, and the means was the introduction of “general management”. There was a lot wrong with the old system, but there was no effort to keep the best bits. Then as flaws were found in the new system it was changed, and changed again, until every new Health Secretary produced a new master plan. The guiding principle for the Conservatives in the 1990s was “the purchaser/provider split” to introduce the “discipline of the market”, with the complication of GP Fundholders and Super-Fundholders. This, of course, was hated by Labour, so they re-disorganised everything by collectivising Fundholders into Primary Care Groups, which had to be small and local (and therefore expensive because of duplication of management). These were then restructured to Primary Care Trusts, which were leter amalgamated to give economies of scale. Meanwhile the “discipline of the market” morphed into “patient choice”, where hospital had to compete with each other – co-operation was officially abandoned, but managers still talked to each other because we had a common enemy in the Department of Health. In essence, managers take the flak but the problem is the politicians.
One other point – we need lots of nurses whose first language isn’t English so that we can communicate with all the patients who can’t speak English. When the staffing mix goes wrong we provide a veterinary service. You can blame the bloody politicians for this one as well.
Apologies – not quite as short as I’d intended.
I joined the NHS 39 years and it was as you say. The spiral of decline came with the formation of Trusts with the added boost of EU regulation.
Thing is admin staff have to have something to do and that obviously impacts on the core workers who just want and need to get on with the job.
In my hospital which replaced two others, less beds, less frontline staff we did have a Personnel Department consisting of 2 Officers, one Admin Assistant and one Typist. There is now an HR Department with, Director, Deputy Director, Assistant Director, Assistant Deputy Director, Manager, Deputy Manager and on and on. At the same time there’s a desperate shortage of Nurses and Doctors – make sense?
And therein lies the real problem. What the politicians sell to the public as Economies of Scale when they lump together a number of small, efficient units into one large conglomerate is really nothing of the sort. In reality it has nothing to do with making economies and neither has it anything to do with creating efficiency.
The claim which is usually made is that by bringing everything under one set of management costs and duplication can be reduced. That is a complete deception which never actually happens.
What does happen is that the larger single unit, because of it’s increased size, automatically creates far more layer of management with far more levels of administration with far more levels of decision making leading to a bureaucratic nightmare. Even the simplest decisions have to be passed to and fro around the system to make certain all the hierarchy feel they, and their departments, have been able to be a part of the decision making.
When it comes to major decisions or where the outcome cannot be fully predicted the system not only means decisions can be put off or avoided altogether but when one does happen to be made it enables those involved to duck, dive and deflect responsibility meaning the blame for any failure can be spread around, deflected and hidden until those responsible can avoid blame or censure.
That is why there is always such an explosion of managers, deputies, assistants and underlings. it also explains why there is always a tendency to use advisors, committees, steering groups and all the various other useless talking shops management love to invent. It distances them for whatever happens if things go wrong whilst still allowing them to claim all the glory when things actually manage to turn into one of their rare successes.
The days are gone when the person at the top automatically assumed responsibility for the failures in their departments by those under their management, now it is all about the cowardly act of protecting themselves from blame and keeping well away from any repercussions resulting from incompetence and failures.
BBC = National Stealth-Edit Service
To those of us who are familiar with their trick of stealth-editing articles
Materially changing content after publication.
Lord Hall presides over hundreds of charter breaches everyday.
Hold him to account.
Also you could call it the National Stealth Brainwashing Service
with it’s Info-Wall which stops anything other than LeftMob views getting out to the public
Ha when I posted I was unaware of Guido pointing out a major stealth-edit today ..in the headline of the FakeBrexit story.
Notwithstanding the generally honest and balanced comment by Chris Ham, would that be the ‘left leaning’ organisation, the King’s Fund?
I remember when Lord Hall was interviewed in Parliament on the many BBC financial irregularities in the BBC Charter negotiations. Lord Hall remarked that the BBC was as ‘vital’ as the NHS! We also know that there are many reported financial abuses in the NHS that go unreported and ‘covered-up’.
Lord Hall is so impressed with the NHS that his entire cohort and salaried staff enjoy the privileges of being seen immediately by BUPA (not NHS) that they want you to believe is the ‘best in the world’ (it isn’t) and the BBC cannot claim that either. It survives, that’s all.
When Lord Hall was offered the ‘top’ BBC job by Chris Patten (then a BBC Trustee) it was over a cosy chat in a top London restaurant. Now James Purnell (current Director of Strategy) is being proposed for the next BBC Director General (after Lord Hall quits with his BBC ‘handshake’ which (like Mark Byford before him will be (not less than) a million pounds + a years BBC salary. To succeed in the BBC top brass you need to be an acquisitive ‘Trotskyite’ alongside the likes of Alan Yentob (and his wife, both being exposed by Jeremy Clarkson (Top Gear) in his The Times serialised memoirs as (self confessed) ‘TROTS’. The BBC has a (70%) stranglehold on the UK news and pursues its own political ‘group-think’ agenda. The BBC take your (TV) public funds and call it ‘independent’ broadcasting. But from who (or what) do they claim to be ‘independent’ from? It’s not independent from the TV license but it is totally independent from those that ‘object’ to the BBC/Labour alliance.
http://heatst.com/world/bbc-covers-up-james-purnells-links-to-the-labour-party/
The Media was not always been like this. The BBC has been radically ‘taken over’ by this small Labour elite who acquired the sole abusive ‘rights’ to run the old UK ‘nationalised’ coal/media industries based on a list of political ‘favors’. Its the old (cosy) British Rail cooperative again that we cannot ever ‘vote’ out. The ten year BBC charter is full of ‘favors’ to this elite bunch.
https://www.theguardian.com/media/2016/aug/23/michael-grade-defends-bbc-role-james-purnell-tory-labour
I with most of what you say and add, successive governments have screwed up the NHS. I am sorry to say that private hospitals are better run with less staff and run and controlled by doctors, however the advantage they have over the NHS is to pick and choose their patients and there is no accident and emergency or major incidents.
John, one story about “less staff”. When I was involved in the contracts for forensic psychiatry there was an absolute staffing standard for the ratio of consultant psychiatrists to patients. NHS providers were required to meet this ratio, with no exceptions. One private provider chose not to meet the standard. At every commissioning meeting this “failure” was raised with them. They explained that it was too expensive to comply and if the commissioners insisted on it being met prices would have to be increased. The meeting then moved on. The sequence was repeated at every meeting I attended.
I make no comment on whether the staffing standard was too high or the private sector’s quality of service was too low, but the NHS service ended up as more expensive.
I agree with you RJ. Perhaps they need to start again from scratch. I worked in the NHS many years ago and still have former colleagues who are employed there, so I get plenty of feedback. Its far too top heavy and no government seems to be seriously prepared to tackle this problem. Departments are all pulling against each other for monies in short supply without any proper overall control. Plus they waste huge amounts of money through bad management and negligence. I have a friend who is a senior accountant with a greater London hospital and he spends most of his time checking invoices that have been paid to companies(by junior staff) who have invoiced the NHS for work that has not even been carried out or ever likely to be. The NHS is a soft touch for such criminals. Some staff are not doing their job properly. Apparently this criminal act is widespread within the NHS, but they keeping the lid on it, like they do with most other things..
Exactly John, we both know what’s going on in the NHS. I jumped in with both feet on this thread because I didn’t want it to degenerate into a simplistic “doctors and nurses are good, managers are bad”. There are far too many managers, but the current system demands that they be there – the NHS has been made so complex that without them it would collapse. The short term answer is to leave clinical services alone and simplify the structure to strip out layers of management, but there are too many vested interests for that.
The original NHS staff structure was like most businesses or companies that had to make a profit, or in the NHS case not waste any money, a structure like a pyramid, with one boss at the top spreading underneath. Now the structure at the NHS and most other nationalised companies,central government or local government or Defra are heading towards becoming inverted pyramids. For instance at Defra there are more staff than there are farmers in the country. Every now and again governments come with the same message we need to bring back the Matrons. I couldn’t agree more, but it never happens in the true sense, because they still keep all the existing managers and under managers, principals etc etc. So nothing changes other than things get worse.
Whatever the study might recommend it will only tinker around the edges and will not address the fact that the sacred cow operating model of being totally taxpayer-funded and ‘free’ at the point of delivery is not working and must be radically reformed.
There are umpteen countries across the globe providing better health care more efficiently and it is absolutely gobsmacking that their hybrid models are never looked at let alone given serious consideration because this is ‘our’ NHS, ‘we’ own it and the ‘private sector’ must never ever be allowed to get involved to any great extent if at all in the minds of pressure groups like self-interested public sector unions and 38 degrees – political zealots who detest the private sector out of principle despite proof that they have in many instances delivered a more efficient, better quality service when contracted to do so. They do not give a FF for the wellbeing of patients. The hypocrisy of the junior doctors who wanted to ‘save our NHS’ yet were threatening to go and work in Australia which runs a hybrid health service funded through a combination of tax and private medical insurance was breathtaking.
You can bet your life that if the government were to double the budget of the NHS it would only take 5 years for it to be running a deficit again.
The BBC is complicit in this unholy mess as it will never, ever give us an honest debate. It would be the easiest thing in the world for them to do a Panorama ‘special’ and show Joe Public how other countries do it better and ask the honest question ‘Why can’t we do the same?’ As with ‘climate change’ and many other issues they keep their viewing/listening public in the dark to maintain a defined narrative driven by socialist ideology. They truly are devious bastards.
The High Court, yes the same institution that subverted the will of the British people over Brexit, has recently told the NHS that it will have to make pre-exposure prophylactic drugs available to those at risk of contracting AIDS, ie taxpayers money is to be used to supply drugs to people that don’t have anything wrong with them. We all appreciate the principle of preventing greater costs down the line for those who do become ill, but in this case there are obvious alternative means of preventing infection.
Meantime, the parents of children who have lost limbs to meningitis have to fund-raise to provide replacement prosthetics as current ones are outgrown. Was this really Bevan’s vision when the NHS was set up in 1948?
Am I right in thinking that the NHS in its present form is so envied by the rest of the world that no other country has copied it?
Lobster. Well written. An extremely obvious point yet one I have rarely seen in print.
It’s been the ‘envy of the world’ for nearly 70 years, yet is still unique. Wallop.
Should be the default first response to any of the vested interests that claim foul when anyone criticises the/their sainted institution.
The doctors’ trade union, the BMA does not want the profession to check entitlement to treatment because ‘ we should not be doing the work of the border agency’
I have a simple answer. If they want to be trained by the state and employed by the state, they should be carrying out work assessed as important by the state.
In Italy, we had to go to A and E. We had to show our passports. How hard was that?
In France we needed to see a GP after a skiing incident. The doctor had a credit card machine ON HIS DESK. We paid Eu 75. How hard was that?
With such prehistoric attitudes and intransigence and pissing on the taxpayer shown by the vested interets within the NHS, no wonder it is in such a state.
This is a most interesting discussion. Especial thanks due to those who know what they are talking about – I’m sure nobody reading this blog minds reading informed comment whatever the length.
Lefty friends spit with hatred as they opine fiercely that everything wrong with the NHS is the sole fault of this and previous Tory governments. That this infantile view cannot possibly be true does not seem to matter at all to them.
They are determined to believe socialism only ever leads to good, and private only ever leads to evil. A view shared and advanced constantly by the pathetic BBC.