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‘Beyond the glittering surface of modern technology,’ begins an article co-authored by the former chief executive of the NHS in England Lord Crisp, ‘the core space of any health care system is occupied by the unique encounter between one set of people who need the services and another who have been entrusted to deliver them.’
But the NHS staff who are delivering the services feel neither consulted nor valued. Low morale continues. Bullying and harassment is at record levels. As Lord Willis of Knaresborough put it in a House of Lords debate earlier this year: ‘All too often, those who deliver the services, the workforce, are treated as a commodity rather than as a precious resource.’
The healthcare entrepreneur Lord Carter of Coles, in his report on productivity in hospitals published six years later, commented that ‘the workforce is regarded as a cost to be controlled rather than a creative and productive asset to be harnessed’.
All too often, management are seen to be secretive and not accountable.
The way patients are moved from ward to ward in a single admission and the discharge experiences of people indicate the lack of patient-centred service. This is also reflected by the current practice of reducing local services thereby causing considerable hardship to patients and their families, who have to travel miles to another hospital.
Decisions are not made quickly and although the slow process is acknowledged by all, no effort has been made to make the system efficient, demonstrating the unwillingness of management to change. The culture at the top of management is quickly understood and feared by all.
Whilst the NHS does need more money, the culture of the NHS must change quickly if we really wish to have a sustainable patient- and staff-centred service.
The most certain way to ensure this change in ethos is to start from the bottom of the service; make the board of every NHS organisation such as trusts and clinical commissioning groups subject to regular election.
Under our plan, all members – executives and non-executives, should be elected for a period of three years. Anyone who worked for the appropriate board would be able to vote. The public would be represented by means of an agreed number of individuals nominated by the local council, serving as non-executive members.
An NHS staff member wanting to be nominated would need to be supported by an agreed number of NHS staff. It is recognised that certain qualifications would be required for those nominated for the executive posts; this would require nationally agreed criteria.
No candidate may represent a political party nor a trade union. No restriction should be applied on the number of times an individual is nominated, although no individual could stand for election to more than one post.
A non-executive member of the board should be appointed as the independent member to respond to concerns of staff or complaints. The existence and functions of such an individual should be widely advertised, and preferably be appointed from outside the organisation. This would greatly facilitate trust and confidence, as is not the case currently.
Elections would be conducted by an independent electoral body.
The proposals made in this paper differ significantly from the elected boards piloted in Scotland. There, the public were asked to vote for candidates for non-executive posts only. Despite widespread advertisements the turnout at the elections consistently remained low, and the pilot studies were abandoned.
Hence, we propose that the electorate should be only those who work within the appropriate organisation rather than the public. Involving the public in this electoral process may well increase the chances of political pressures. Most of the people who work in the NHS are passionate supporters of the NHS and are devoted to their service. In electing officers of the board, they would not be motivated by political issues but by who would best safeguard services for the community.
Canvassing would be according to an agreed standard ensuring that no political party would be involved, and the exposure times of candidates was equal. Given the relevance of the social media, its use in canvassing must be discussed. Each candidate’s CV would be distributed to all those entitled to vote and posted on the appropriate website.
The chair of the board would have direct access to the Department of Health.
We believe that overall this change would be an immediate corrective to the flaws in NHS management and staff engagement that we noted. Management excesses would be curtailed leading to prevention of waste. Accountability would be ensured. It would oblige management to explain why they made changes to the structure of the system, a practice that is often devoid of logic.
Line managers would be enabled to act for the benefit of patient care and to address the concerns of staff rather than act merely as conduits of management decisions. Harassment and bullying would be reduced.
It would enable boards to resist pressures exerted by the centre. Non-executive members would be more questioning of management decisions and become more assertive.
In conclusion, the immediate benefit of this intervention would be a palpable change in the ethos of the NHS. It would lead to the development of leaders capable of delivering a sustainable patient- and staff-centred NHS.
Arun Baksi is an emeritus consultant physician in the Isle of Wight. Parag Singhal is a consultant physician in Weston Super Mare. They are, respectively, honorary secretary and chair of the campaigning organisation Our NHS, Our Concern
This makes sense and I wonder what stopped it to happen so far.
Is this an aspiration or reality? Parag, we have discussed this at lengths and am really proud of you for having brought it out to light.
Leicester Royal Infirmary has blood tainted hands and minds and the managers survive and thrive. Only Patients die and doctors careers get blighted..
I do not know if you are aware of another Down syndrome child’s death a few years after Hadiza debacle under uncannily similar circumstances. This is after supposedly implementing innumerable patient safety and risk management recommendations published by the management. Isn’t it a joke??
This is being written to start a debate and get to a system which will bring accountability. In the first instance NEDs should be elected. They should represent the staff and local population and start standing up for pt safety and staff. Report card concept could be added. Parag
Hats off to your persistence and hope that eventually many of these suggestions will be implemented.I now feel that increasingly the medical staff is less productive probably as their morale is low.
This looks to be a good idea, but it still does not deal with the problem of the Purchaser/Provider split and the problems this has produced. The complete loss of the consultant/ GP relationship must operate against good patient care.
I notice that all comments are anonymous. Is this due to fear?
Dr R D Hill FRCP Consultant emeritus Poole Hospital