NHS needs radical surgery

The sad truth is this. If a trust tries to maintain its clinical services and ‘overspends’ as a result, then it is put into special measures and its managers depart.

If it tries to balance its books – and succeeds by reducing staff (75 per cent of the budget and with many fixed costs the only option for major savings) – then it runs the risk of being found wanting in a clinical sense.

So it is put into special measures and its managers depart.

They are in a lose-lose situation.

Clinical adequacy and financial balance are simply incompatible and it’s unfair to blame managers who cannot square circles – not that that is any excuse for bullying behaviour, something my erstwhile failing and now failed trust (I was a hospital consultant for almost 30 years) did with me.

At present over 80 per cent of acute hospital trusts report that they will be in deficit this year.

It is simply incredible to suppose that 80 per cent of hospital managers are incompetent.

Neither can I believe that all of the 13 trusts in special measures deserve to be, not least when they include flagship hospitals such as Addenbrooke’s in Cambridge at St Bartholomew’s Hospital in London.

Most of Kent is in special measures, in fact.

The truth is that the criteria for failure are seriously flawed.

The best managers in the world cannot rescue a bankrupt business; the options in business are merger or closure.

The health think tank, the King’s Fund, has recently published a report concluding that mergers don’t work, and closing 80 per cent of our hospitals is hardly a viable option.

So if hospitals cannot be run as proper businesses because there are no options for failure they should not be run as businesses at all.

I might add that hospitals are paid for their services by the community health trusts, which in some instances are as strapped for cash as the hospitals, so they can’t and don’t pay for work done, or ask the hospitals to delay or cancel planned work.

So we have a system where the provider service is bust, but the purchasers cannot pay, but anyway blame the hospitals for unacceptable waiting times.

If you think this is madness you are right.

What we need to do is wipe the slate clean and start again with an NHS system that is both financially and clinically credible.

If this means there are services that will no longer be supplied, so be it.

It will hurt but the NHS needs radical surgery.

Dr Andrew Bamji

Retired Consultant 
South London 
Healthcare Trust 
West Street

Rye

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