Nhs performance managementThis governments failure to improve public services is perhaps most obvious in its manybungling ...
marketing directors, strategy directors and communication directors will be gettingsimilar enviably large pay and benefits...
also inspiring: protecting the public through professional standards. The NMC has beenalso been quite generous to itself. ...
At the time of the Mid-Staffordshire scandal, the head of health at Unison commented: Itseems unbelievable now that despit...
than we did twelve years ago, it is far from obvious that the government has delivered onits pre-election promise.http://p...
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Nhs performance management


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Nhs performance management

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Nhs performance management

  1. 1. Nhs performance managementThis governments failure to improve public services is perhaps most obvious in its manybungling attempts to reform our national health service. When looking for evidence ofour leaders catastrophic mismanagement of the NHS, youre spoiled for choices. A recentreport comparing survival rates for conditions like cancer and strokes estimated that if wecould just reach the level of comparable European countries, over 17,000 deaths a year,almost fifty every single day of the year, could be avoided. Then there are about 6,000people a year dying from hospital-acquired infections - the number would be just about120 if we matched the performance of some other advanced European countries. On itswebsite, the NHS admits that around 34,000 people die unnecessarily in our hospitalseach year and an additional 25,000 are unnecessarily disabled. But whatever your choiceof figures, the only conclusion you can reach is that although this government has morethan doubled healthcare spending from about £45 billion to £105 billion a year, deathrates in Britain are still massively above where they should be.One striking feature of this governments approach to reforming the NHS has been theextraordinary amounts of money that have been squandered on building a newmanagerial class, most of whom have absolutely no healthcare training. The number ofmanagers and senior managers in the NHS has shot up from around 20,000 in 1997 toabout 40,000 today. We now have 5,000 more managers than we have medicalconsultants (34,900). Just in the year 2008, when the recession had already started, thenumber of managers in the NHS went up by around ten per cent while the number ofmedical staff only increased by about two per cent. There are various reasons for thisalmost obscene spawning of bureaucrats.One is the governments obsession with poorly-thought-through target-setting,meaningless reports, unnecessary form-filling and unproductive box-ticking. Another isthat managers are often uncomfortable dealing with highly-trained medical staff, so theysurround themselves with other managers and live in their own little world, all holdingimportant meetings with each other where they can speak management gobbledegook andthink up new and exciting initiatives. In most hospitals today youll find directors ofstrategy, of communication, of planning and development, even marketing directors.Naturally, they all feel they need offices full of secretaries and subordinates busilywriting reports and attending meetings and going to training on teamwork and all sorts ofother superfluous rubbish that has nothing to do with improving the quality of caredelivered by the NHS.Not only have the numbers of managers shot up, so have their salaries compared to mostfrontline medical staff like nurses and midwives. The average salary of a NHS trust chiefexecutive is now over £158,000 a year, more than double the 1997 level. Moreover, withthis salary comes early retirement with a tax-free lump sum of up to £240,000 and aninflation-linked pension of over £70,000 a year. All the plethora of finance directors,
  2. 2. marketing directors, strategy directors and communication directors will be gettingsimilar enviably large pay and benefits packages. The increased cost to the NHS of theseextra 20,000 managers is over £3 billion a year and they are a massive and unnecessarydrain on NHS resources. If we could just get back to the level of management of 1997,the NHS would have an extra £10 million every single day to spend on medicines andpatient care.Yet while the managerial population is growing, the number of hospital beds theincreasing army of managers have to manage has been falling - from about 250,000 in1997 to less than 180,000 now. Where we once had 12.5 beds per manager, we now have4.5. Just this statistic alone should make our government hang its head in shame. Butquite the opposite is happening - the numbers of beds keeps on falling while the numberof managers just keeps on growing. Then, of course, we should not forget the £600million a year or so being spent by the NHS on management consultants, a cool £15,000per manager, just to tell all these managers how to do the jobs we already pay them fordoing. This situation is so farcical you almost couldnt make it up.One area where the managerial explosion has been most shocking is in the ever-increasing number of healthcare regulators the government has given us. One of the fewhealthcare regulators that actually predates New Labour is the General Medical Council(GMC). It was founded in 1858. Its motto is the very fine-sounding protecting patients,guiding doctors. As rates of unnecessary deaths in our hospitals have probably more thantripled over New Labours time in power, so have the GMCs budget and the salaries ofits employees - the GMCs costs shot up from just over £20 million in 1997 to £75million by 2009. Yet the rapidly rising numbers of unnecessary deaths in our hospitalssuggest it is not obvious that this eye-watering three hundred per cent increase inbureaucracy has benefited anyone apart from the employees of the GMC. The GMCsbudget increases have been so staggering that even some doctors, who have to fund itthrough their registration fees, are questioning why this bureaucratic monster seems to beafflicted by such morbid obesity.In 2001 the National Patients Safety Agency (NPSA) was established to: improve patientsafety in the NHS and by 2009 it had amassed 292 staff and an annual budget of almost£30 million. The NPSA has destroyed almost Amazonian amounts of trees producingpresumably useful guides about anything they can think of. Unfortunately, after spendingwell over £100 million of our money on paperwork and their own comfort, they still haveno real idea of the number of unnecessary deaths in hospitals each year. One independentstudy even suggested that the NPSA was only picking up about five per cent of incidentswhere avoidable harm was done to patients. The situation was so bad that in 2006 thePublic Accounts Committee PAC) denounced the NPSA as being dysfunctional and notvalue for money because it had no idea how many patients were harmed as a result ofmedical errors. In spite of management changes following the PAC report, it is notobvious that things have got any better.In 2002, the Nursing and Midwifery Council (NMC) was set up in order to protect thepublic by ensuring that nurses and midwives provide high standards of care. Its motto is
  3. 3. also inspiring: protecting the public through professional standards. The NMC has beenalso been quite generous to itself. It has increased its budget from about £14.9 million to£34 million in the first seven years of its existence and it now employs about 220 staff, allpaid for by our nurses registration fees. Perhaps a little worrying for people in hospital isthe fact that the NMC, which is responsible for ensuring we receive quality nursing, takesno disciplinary action against nurses in around ninety per cent of the complaints itreceives - most are rejected as trivial.In 2002 we were also fortunate to be given the NHS Confederation. It calls itself Thevoice of NHS Leadership and its aim is to help members improve health and patientcare. Although this is not really a regulator as it focuses more on the management ofrather than regulating the medical aspects of running the NHS, it still spends our moneyin order to supposedly improve our healthcare and has been a true leader in the way it hasincreased its own budget. This rose by a factor of five from a tiny £5.3 million in its firstyear of operation to a much more impressive £29 million by 2009. It too seems to be inthe business of destroying innumerable forests to produce mountains of reports. Somecould be useful such as Managing Excellence in the NHS and Bringing Leaders into theNHS. Some like Why We Need Fewer Hospital Beds might seem a little worrying tothose of us who know that hospital over-crowding is one of the major causes of hospital-acquired infections.In 2003 we got the Health Protection Agency (HPA) to look after our well-being. Its aimwas to provide an integrated approach to protecting UK public health. The HPA hascertainly been effective at spending taxpayers money. Its total costs increased by fifty percent from £180 million in 2004 to £270 million by 2009 and the number of staff went upfrom 2,518 to 3,160. The HPA produces a vast amount of presumably valuable literatureabout almost any medical topic you could think of including lots of guidance aboutreducing hospital-acquired infections such as MRSA and C Diff. In the meantime, theseinfections have claimed over 20,000 British lives. The death toll would have been lessthan 400 had these victims been living in countries like Holland, Denmark or Sweden. Inthe same year, we also were given the Medicines and Healthcare Products Regulatoryauthority. It has eighty staff and an £80 million annual budget, yet EU regulations shouldmean that medicines tested and approved in one member state should be availablethroughout the whole EU without any need for further approvals.The following year, 2004, was a bit of a bumper year for new healthcare regulators withno fewer than three being established. In January 2004, we were blessed by theappearance of Monitor. Its mission is: To operate a transparent and effective regulatoryframework that incentivises NHS foundation trusts to be professionally managed andfinancially strong and capable of delivering innovative services that respond to patientsand commissioners. Its chairman earned over £215,000 in 2008-09 (almost £20,000 morethan the Prime Minister) and it spends about £12.5 million of our money a yearsupposedly regulating NHS foundation trusts so they provide better healthcare to us. Yetrecent events at the Mid-Staffordshire NHS Trust which was granted trust status in spiteof the unnecessary deaths of possibly more than a thousand patients might make peoplewonder what Monitor is up to.
  4. 4. At the time of the Mid-Staffordshire scandal, the head of health at Unison commented: Itseems unbelievable now that despite a history of clinical and staffing problems andfailures at Mid Staffordshire, the trust was awarded foundation status in February lastyear. It is time Monitor the regulator was held to account. Moreover, there are so manyother examples of other hospitals being given trust status despite serious concerns abouttheir standards of care that with Monitor we probably have a case-book example ofregulatory capture as the regulator is possibly being driven by political pressure toincrease the number of NHS trusts rather than any real concern for patient care. To quotethe head of health at Unison again: Hospitals need to get out of the cycle of trying to winfoundation status and the regulator needs to be more rigorous in granting that status tofailing trusts.2004 also gave us the Healthcare Commission (HC). The HCs motto is Inspecting,improving, informing and it has an inspiring mission statement for its five hundred plusstaff: The Healthcare Commission is committed to driving improvement in the quality ofboth the NHS and independent healthcare services and to making sure that patients are atthe centre of everything we do. The HC has been slightly more prudent than the HPA - itonly increased its spending of our money by about thirty per cent between 2004 and 2009to a mere £70 million. One of the key focuses of the HCs work since its inception hasbeen getting to grips with hospital-acquired infections, whose incidence and mortalityrates have hugely and relentlessly increased since the HC started producing documentsabout how to go about tackling them. MRSA and C Diff have now started to go down,but they only constitute a small proportion of the hospital-acquired infections whichravage the NHS and so we can expect many more excellent reports and guides to beproduced at our expense.Then in the same year, perhaps to score a hat trick, the government dreamt up theCommission for Social Care Inspection which by 2008 grew to 2,335 staff and a budgetof £164 million. This new organisation only lasted about four years as it was rolled intothe Care Quality Commission by 2009.There may have been a couple more new healthcare regulators since 2004, its difficult tokeep track. But now the government has set up the mother of all healthcare regulators -the Care Quality Commission. It will combine several existing regulators such as theHealthcare Commission, the Mental Health Act Commission and the Commission forSocial Care Inspection. Its aim is: To make sure better care is provided for everyone,whether thats in hospital, in care homes, in peoples own homes, or elsewhere. Had anyof the other bureaucracies done their job properly, this new regulator would not havebeen necessary. Moreover there is only one certainty with todays new generation ofexpensive, self-serving, regulatory-captured regulators - this new body will be asludicrously expensive and as laughably ineffectual as all the others.In its 1997 election manifesto New Labour promised to reduce administrative costs in theNHS, The key is to root out unnecessary administrative cost and to spend money on theright things - frontline care. As we now pay over £450 million a year more for regulators
  5. 5. than we did twelve years ago, it is far from obvious that the government has delivered onits pre-election promise.http://performanceappraisalebooks.info/ : Over 200 ebooks, templates, forms forperformance appraisal.