A clear vision, not cross-eyed compromise, is what we need

I have been writing for so long now on the subject of the NHS – and what to do with it – that I often despair of anyone with power ever seeing the various lights that are there to be seen. After years – since 1995 to be precise – of collecting data, and logging the experiences of myself and others I know, reliable stories reported in the media, my experiences with my parents in various hospitals, and other horrors, the conclusions I have reached are as follows:

1. The 1949 version of the NHS should be dumped forthwith: it is based on irrelevant principles and far too big

2. GPs have got far too much of the NHS budget, and they’ve lost the plot about what community doctors are for

3. There is still a ridiculous amount of senior management overstaffing at stupidly high salaries in hospitals

4. Both hospitals and local practices have caught all the adverse effects of managementitis, and inherited none of the advantages

5. Despite this, everyday admin staff and ‘real’ medical staff are unfailingly polite, sympathetic and well-organised, although I have no idea why: I certainly wouldn’t be.

My pocket history would be that the original Bevan concept was gobbled up first by trade unions in the 1960s, bloated by Ted Heath in 1973, flooded with Big Hair and meetings bollocks in the 1980s,  and then systematically shafted by a deadly private business in the Nineties and Noughties. Some say you cannot flog a dead horse, but I say that our National Health Service is a gothic monster with five heads, one leg and no brain. It cannot survive, and it must go.

The way for it to go is more localised, away from government, and socially mutual: but I don’t want to get into another 5,000 word essay… this is the wrong medium for it, and it isn’t the point of this post. My task today is to illustrate by example. This morning, I attended my fifth UK hospital in a year. There’s nothing really wrong with me or my wife, we’re just getting on a bit. Some of this has involved pain management, and thus requires a lot of visits to our local GP joint practice as well. There follow a few bullet points for the embattled Minister to think about. They may sound picky, but I do point out the broader ramifications.

a. Ring the GP up for an appointment at the moment, and you won’t be seen for at least a week. This has nothing to do with cuts, and everything to do with a commercial row going on there about who gets what….in the midst of which the key member of ‘management’ at the Practice has been fired, and has taken all the admin software passwords with him. He is now about to sue the Practice, and vice versa. This is what I would call an idiot’s idea of progress.

b. Turning up at Exeter hospital this morning, the most noticeable thing was a series of queues at the various pay and display machines. These have just been upgraded by senior management, and their main drawback is that one needs an IQ over 130 to use them successfully. It was a senior management decision. I can’t see the benefit in commercial terms of the additional complication. This is what I would call a cockeyed idea of what ‘investment’ means.

c. Management by Notices. “This is a Smoke-Free Zone!” proclaims the banner at the main entrance. Underneath it were various clutches of patients smoking fags. Another notice says this: “Every patient contact needs clean hands!” The hand-cleaning facilities at all entrances were invisible. Nobody took any notice of any of them. I just used the search engine on my site to reveal that I have blogged on this subject 11 times since the start of 2010. This is what I would call the senior management belief that notices solve problems, and it is a very Soviet syndrome: it has nothing to do with real management in the private sector sense of the term.

d. ‘All treatment free at the point of purchase’ was a fine principle in its time, but it was of its time. As I sat in X-Ray’s reception waiting room, I was shocked to read this notice: ‘Number of X-Ray patients who didn’t turn up for their appointments, January 2012: 185’. And that’s just one department. Six no-shows a day in one small area. Nye Bevan was a top bloke, but he didn’t foresee either credit cards….or a culture dominated by dickhead misbehaviour. Simple suggestion: make every no-shower without notice pay the market rate for their next appointment. The no-show rate will be 0% within months. This is what I would call a no-brainer.

e. Myself, my wife, and most of the folks in X-Ray were over 55. OK, a fair proportion were downmarket, but the majority were a long way from the soup-kitchen. My age group takes up an unfair slice of the medication/day-treatment budget in 2012, and as more of us survive thanks to braindead social nannying, that proportion will increase in the future. Simple suggestion: everyone with a private pension plan aged over 60 must now pay for their prescriptions. This is what I would call real fairness in action.

Mr Lansley has – in his disastrous ideas for the NHS – fallen between two stools: he has tried to appease the ‘Hands off our NHS’ Left, while at the same time slavishly trotting out potty Thatcherite drivel about everyone wanting to be the next Alan Sugar. Use The Slog’s search engine, and you will see that the prediction of failure and mayhem was first made here in June 2010…..and regularly threafter. All these expectations have been entirely fulfilled – to everyone’s cost.

Localism, mutualism, more money for hospitals, redirecting GPs to the plot, and banishing senior management’s self-indulgent bollocks: these should’ve been the Health Secretary’s guiding lights. Instead, Andrew Lansley’s narrow dilettante approach has spontaneously immolated to produce an approaching systemic breakdown in the UK’s public health provision. He should be fired, and replaced by somebody with a radical realist vision.