Is the NHS safe in NHS hands?

[Marmora Man]

There are a number of healthcare professionals that take part in the EDF. The above question is not rhetorical - it arises from some recent experience.

I am in the process of changing jobs - my CV, briefly, includes a military career, 5 years in senior NHS management, 7 years in senior private healthcare (managing 17 hospitals) and 6 years in the provision and management of PPP / PFI healthcare projects. I have been a Managing Director and also a Director of a number of companies.

Given the, relatively, buoyant state of the public sector (look in the recruitment pages - 80% of all jobs advertised are for public sector or charities) I applied for some senior roles in the NHS. In every case the response was along the lines of "we are looking for someone with current NHS experience".

QUESTION: Can any organisation that only seeks to recruit internally for its senior management ever succeed and generate new ideas, challenge the status quo or move beyond the accepted cultural mores of group think?

SUPPLEMENTARY: Can the NHS change and become more fit for purpose without new thinking and fresh ideas?

PS: I have now abandoned my search in the public sector for a new role in private healthcare.

[charliecharlie]

Their loss, Marmora Man and sad to see high level expertise being lost to the private sector. Sounds like your broad experience would bring with it the ability to see 'the bigger picture' (hate that expression, but sums up well here), which, I would imagine, would be ideal given the current and future challenges the NHS faces. I suspect budget (or lack of it) will continue to be one of the greatest challenges, especially considering all the quantitive easing that's been goin' on round these parts!

I suspect not....

[buggie]

Sorry to hear that MM, think Kings completely bucks that trend - our new(ish - he's been in post over 6 mths) CEO has come to us from British Telecom!

[Brendan]

"Can any organisation that only seeks to recruit internally for its senior management ever succeed and generate new ideas, challenge the status quo or move beyond the accepted cultural mores of group think?"

What about the military then? If organisations don't promote new management up through the ranks you wouldn't get any new blood coming into upper management. From what I?ve seen it?s easier to make the jump from middle management to director level within the organisation you work for.

But like you say organisations can become stagnant so there does need to be a balance.

Perhaps the NHS is so vast they feel that they generate fresh new ideas just by moving people around. I doubt it though.

Or it could be that due to tight budgets they prefer to get someone who is already working for them somewhere else as it may save them the trouble of having to make a post redundant.

[SteveT]

Hardly safe hands, 10 years from now there will be little to recognise of the remaining NHS.

We have all watched it erode over the last 20 years and observed the rise and rise of the private sector.

I have paid in to this club for 48 years and as one needs grow with age in this direction, it appears barely fit for

purpose inspite of the input of many dedicated staff.

[PeckhamRose]

I am a Member of Kings College Hospital Foundation Trust and am thinking about applying to be a Governor.

Recent meetings have been very interesting in the way they have shown us how forward thinking they (at Kings College Hospital) are. Example: they are excellent in liver transplants because the study and the science and the learning behind it goes on right next to the actual patients needing the help. (Incidentally, this will mean more helicopters rushing people to Kings in the future.)

One of the questions I asked, at the last meeting, of Professor John Moxham, who is the enigmatic and outspoken MEdical Director, was "Do government targets get in the way of your trying to be a good hospital?" And he answered in many cases, yes. And he gave very good examples. He ended by saying that when Kings is allowed to set its own targets, with the medical experience to know what is realistic and SAFE, they can reach them. Despite SteveT's negativity, Kings is a force and the likes of Prof Moxham are part of that force. He and his colleagues and the governors are passionate about it and fiercely protect it. Do go to the Open Day in July.

I am a regular outpatient of Kings and rely on it for my constant wellbeing.

Anyway, to the question of the topic.

I think the NHS can improve and change for the better when the government stops meddling and lets it get on with it. But yes of course it needs outside help in some areas and I am sorry the right job has not come up for you, MM. Have you thought of becoming a Member of Kings and working your way in that way? If you really want to work for the NHS, you really must keep trying and showing them with your considerable skills and experience what you can offer. And often the Person Specification includes things that you may not have, but when they see that what you do have makes up for it, they might realise you may be the best person for the job. How well do you know the NHS? Are you a patient or do you have private healthcare? (Rhetorical questions also!)

[charliecharlie]

Good post PR,

Yes, we are so lucky, Kings in many ways seems to be rather exemplary!

[Marmora Man]

Personally I believe the NHS could be a lot better if given far more freedom from centralised control (as echoed in Peckham Rose's post). At least part of the problem is the number (possibly even a majority) of CEO's and senior staff that look "upwards" to the DoH and SHA rather than inwards (to hospital patients & staff) and outwards (to the community) for direction and strategy. From personal experience in and alongside the NHS there is too much emphasis on committee and consensus and not enough on simple leadership and management. I always mentioned these points in my covering letters which may have been a turn off.

The radical idea that the patient and local community should be the focus of all efforts is not always welcomed in today's NHS. Some, more enlightened staff, do understand and are able to implement this. Many more would wish to but are thwarted by "the system".

[PeckhamRose]

I suggested an idea that would save money at Kings whilst showing it had forward thinking and sideways thinking and upside down thinking philosophy. I suggested that they employ a hypnotist. I had to have a small procedure - a biopsy - a while ago and there was no way I could let them do it just with a local anaesthetic. A hypnotist could have helped. But I had a general anaesthetic instead. Lots of the individual members and governors I've met liked the idea. It JUST needs a little harder push.

But MM I do believe that Kings' individuals - the staff and governors, are chomping at the bit to move forward but the government is that bit that just gets in the way. There were a lot of public meetings over the last few months and they have taken on board quite a few points we made which they had not thought about, and are taking them on. If the Govt lets them. But of course it's not perfect and I do agree a Leader is important. I really was impressed by the Medical Director. He still has his own clinic and yet also was the Dean and now the Medical Director. He lives in Camberwell and is passionate about his hospital.

[SteveT]

I did not mention Kings at all PeckhamRose.

I mentioned something I have observed for many years, the erosion of the NHS. I did not intend a negative post, I only

speak as I find.

[Keef]

I've said this elsewhere, but for me, all public sector services are going to suffer due to government performance indicators. I understand why they have them, but they were badly thought out, and rather than help the failing services, they give them less backing, and reward those who are already doing well.

[PeckhamRose]

So which if any political party is these days the most NHS friendly?

[Marmora Man]

I would say this wouldn't I but - I believe the Conservatives offer a better future for the NHS than the current obsession with target setting and centralisation. The Labour government's experiment of vastly increasing the spend without introducing any significant efficiency improvements or culture change has not worked.

The inheritance for the next government, of whatever political creed, is one which will require very tight control of government spending for the next decade. Every public sector department will have to improve its act without wodges of extra cash - some may even have to do more with less. Properly focussed this can make a difference if everyone recognises that patient care must be the focus of the efficiency drive.

So no "recycling" of old Chief Executives just because they're there, less committees more action, less talk more nurses, less worry about who provides the service(s) more concern about effectiveness of the services. Some proper rules and guidelines might help - for example do away with patient visits at all hours - restrict it to 2 hours afternoon and 2 hours evening, re-introduce proper ward handovers between nurses, get ward sisters out of the office and into the ward, make cleaning staff accountable to ward staff and part of the ward team. Hand responsibility AND authority back to clinical professionals - take the target setting out of A&E. I could go on.

[PeckhamRose]

Just seen the Party Political Broadcast on behalf of the English Democrat party. Wonder what they'd do?