UKC

https://www.theguardian.com/society/2020/jul/10/boris-johnson-plans-radical...

Massive reorganisation of the NHS at a time of great stress, budget pressures and staff shortages, increasing ministers' control, reversing changes made just recently, Boris Johnson incharge, CUmmings' mate on the committee that is to do all this by the later summer. Can't see any problems with this idea. No, none.

Not a fan of the abysmal timing but I do broadly favour the idea of politicians having reasonably direct control of the levers of power within their brief. Otherwise, it lets them off the hook too easily. I don't want Matt Hancock, when he's being grilled about NHS targets on the Today show, to be able to say "yes, terrible isn't it but really nothing to do with me, you'll have to ask the NHS". We elect the politicians to take charge of these things and they should be accountable. An astute politician, of course, would know when to temporarily delegate responsibility and which levers to not touch. And my dislike/distrust of the current mob of incompetents makes me less certain of the principle, but I dislike the previous strategy even more. That is, reorganise so that power is entirely delegated down the chain, then refuse to adequately fund the system and disclaim responsibility on the basis that you're not really in charge any more but you're sure they could make it work if they got their act together.

In 1988 Mrs T set about reforming the  NHS, and  we have had multiple further  reforms down the years since then. If any of them had really worked we wouldn't  be  hearing of further reform now.

In 1988 the cost of  managing the NHS was around 5% of total cost.  I believe it is  now around 25%.  Management consultants have made many millions from the  process. Maybe  that is what they want.

Conflict of interest: I was an NHS hospital consultant from 1987-2016 and lived through lots of  reform. In addition  I read Private Eye. 

The NHS will be gone within a decade, health insurance will become the new norm, chlorine-washed chicken, hormone-injected beef will be for the monied. 

Welcome to the new world GOD bless America

. 

So what are you saying.Further reform and even more spent on management consultants will solve everything this time? 

youtube.com/watch?v=Cz5dl9fhj7o&t=2

This is worth watching. It refers to more recent reforms and is interesting.

The idea that the SoS should have the responsibility is in theory good, but I can imagine under the current administration it will be a way to allow/encourage more involvement of private health care companies and the further watering down of the  NHS.

I’ll take the other side of that bet. No one is going to dismantle the founding principles. But the service must evolve to face changing demands.

I couldn't believe this. The NHS needs professional leadership that the workforce respects, highly technical decision making uninfluenced by short term and ignorant Daily Mail headlines, and long term planning and Strategy.

Hancock?

PS: Just listened to Jeremy Hunt; he is beginning to sound like the voice of sweet reason. 

I'd be delighted to see the end of most of the Lilley reforms. In particular the expensive and highly bureaucratic purchaser provider system that makes NHS provision a distorted market and Public Health England back out of local councils and ring fence funded.

In addition I'd like other changes... especially more formalised NHS links with Social Care as is happening in some UK cities.

Yet the idea Matt Hancock is frustrated with Sir Simon Stevens is great news to me, as this government thinks it's a good idea to appoint the car crash that is Pritti Patel as Home Secretary and to top even that today we hear Chris Grayling is going to chair the (lack of any?)  Intelligence Committee.

https://www.theguardian.com/commentisfree/2020/jul/10/chris-grayling-chair-...

This is well beyond *rse elbow distinction, it's madness.

Jeremy Hunt really knew his brief. He walked the talk where he could have waffled and dodged meeting angry NHS staff who enjoyed cruel rhymes. He ran the department during the foolish fallout of the Landsley reforms in a time of austerity and major industrial action. I think he did well, and for a long time, given that nightmare brief. Outside the tough political fights (which get too partisan to judge the quality of the man) he made some stupid mistakes (Cygnus was buried on his watch) but he was always better than most of the current cabinet put together. He's not the only one... some of the most talented tory MPs were sacrificed on the altar of Brexit.

Another classic announcement earlier this week was Liam Fox is the UK candidate to lead the WTO. The fool who claimed trade deals after Brexit would be quick and easy in the face of any evidence is who we think would be the best person to be run the international trade refereeing body.

Are we still allowed to ask whether Fox still takes his boyfriend with him on trips? Obviously Bojo takes his girlfriend(s).

Hunt battled on for too long over the 7 day NHS, but yes I'd give a lot to see grown-ups like him back in charge.

I don't think we'll ever look back on this lot and sigh, 'If only Hancock was still Health Secretary...'

No, I am suggesting  that  as previous reforms have not improved the NHS , it seems unlikely  more reform will help.

The problem  is  too many of us living too long, and  needing health and social care. 

I think  it is the effect of  the  great reduction in  smoking, but  I  am not going to  suggest  everyone  take it up again. 

That's not the self evident truth you think it is. The need for expensive healthcare kicks in at end of life; as we live longer the requirements kick in later.

Right, understood and makes sense.

I missed that Fox announcement!

I think my response is somewhere between the utterances of John McEnroe and Victor Meldrew.

Dave

Lansley reforms; not on any party manifesto. No one voted for the mess that saw £3 billion of tax payers money go down the drain.

The nhs doesn't need reform. It's outcomes are already considered to be relatively good compared to it's low funding per capita. Ie. It is quite efficient despite being under funded. 

If the population want it to improve they just need to fund it more.

There is zero accountability in British politics at the moment, giving ministers more control won't stop them shirking responsibility and scapegoating.

jk

£3Bn doesn't just go down the drain, it goes to the islands in the pockets of old boys with the right ties.

jk

You're right, the basic problem is twofold; healthcare is getting more expensive and the British public is requiring more of it, the latter of which is driven by the inreasing prevalence of long term conditions.

I'm not actually against further reforms of the NHS; the Lansley reforms of 2012 were damaging, to say the least. The NHS itself has been quietly rolling back the changes for the last 6 years.

But that organic change means we're in a bit of a mess. There's debatably a role for top down re-organisation, I just don't particularly trust politicians to do it.

Declaration of interest: Ex Trust Ops Management, Ex Digital Tech Management, current Population Health Analyst.

To be fair, the current government is doing it's best to address this issue.