NHS needs managed change not headline grabbing

The general election debate on the NHS is shabby. It is all about money – “our lollipop is bigger than theirs”.

Headlines are offering us a choice between David Cameron and Ed Milliband as Prime Minister, with NHS policy coloured in some way by a minority party or parties. On the one hand there will be poorly managed NHS decline, on the other repeated crisis interventions attempting to maintain a failing status quo.

The contrast between the standards which NICE and CQC demand and the ability of many hospitals to deliver them will become striking. ‘Failing’ hospitals will become common. One party will bring in the private sector, even though the Hinchingbroke experiment failed dismally. Standards may rise but services will disappear to provide the funding to do that. The other party will achieve similar results through rationalisation.

In 2007 Sir Gerry Robinson, the former CEO and Chairman of companies such as Granada TV and Compass Group, spent six months in Rotherham Hospital trying to help it become more efficient. It was covered as an Open University TV production. The experience was enlightening. Creating change was difficult, hindered by long-standing practices which benefited staff but neither patients nor the financial management of the hospital.

Patients all know about the Friday wind-down. From midday onwards hospitals prepare for the weekend. Consultants disappear. Anything which is categorised as URGENT gets left for Monday. On Friday night it goes quiet until Monday morning. Weekend ward rounds are conducted by a consultant you meet for the first time, has no idea of your condition (he doesn’t have time to read the notes), relies totally on the senior nurse accompanying him and in the hackneyed stereotype is due at the golf club before lunch. The nurses and other staff have a proper shift system.

Consultants are at the heart of patient care. The purpose of the NHS could not be met without them. They underpin everything that a hospital does but pursuit of their agendas can cause problems. Our recent experience shows that an individual consultant can distort, I would even say corrupt, effective complaint handling. They gave Gerry Robinson some tough problems. Their collective influence, left unchallenged, can create the defensive culture that Sir Robert Francis described in the Stafford report. It is insidious and unspoken. It is not even in the consciousness of the consultants themselves. Poor management cannot handle it and by being unable to challenge it, follows the path to failure

I will never deny that many (most) NHS consultants work extremely hard and the responsibility they take can be awesome. But they will each be able to identify what would make them work more effectively and in a more involving manner. They need to be engaged in change not in defending a status quo. We need to be able to tap their ability to innovate. Doing that is going to take a cohort of exceptional managers.

Gerry Robinson was interviewed after his series went out. He said “I think what the NHS needs to learn is that actually you don’t solve problems by throwing money at it, and not every problem actually needs money to solve it. That’s the first lesson. Secondly, to get out of their heads the idea that things have to take three years to do and get into the idea that there is a series of objectives that we need to do now, and that we’ve got months, not years to do it. Those two things, I think, would have the biggest single impact on the way that the Health Service is managed.

He wasn’t wrong in 2007 and he would not be wrong now. Politicians should take note. The trouble is it does not grab headlines.

How does the NHS do it? It needs to identify and recruit exceptional managers to join the NHS. That is where the private sector comes in – providing talented people who can foster and manage change. It does have some already and NHS England is headed by such a person in Simon Stephens.

Politicians should stop inventing new headlines, identify the real opportunity and foster constructive, well-managed change.