Peter Reynolds

The life and times of Peter Reynolds

Back To The Future Of The NHS

with 12 comments

I have grave concerns about the government’s NHS reforms.  I feel like it’s Groundhog  Day.

I was deeply involved in the last major health service reforms back in the 1990s.  I am hearing exactly the same ideas, phrases and promises as we heard then.  Haven’t we done this all before?

When the “internal market” was introduced and the first NHS Trusts were “founded”, the idea of  marketing was introduced to the NHS for the first time.  I saw the opportunity, organised a conference at the QEII conference centre and built a nice business, thank you very much, for several years as an expert in the field.    I was an advisor to several health authorities and a number of the new NHS trusts.  I undertook marketing and communications audits, ran training courses and I made something of a specialty of designing, writing and producing annual reports.   I learned a lot and I felt I contributed a lot.  Why is it all being done again?

Marketing is a perfect description of the way the health service should work.  It is the management process responsible for anticipating, identifying and satisfying customer needs efficiently.  The 1990s NHS model was that  “purchasers”, health authorities and GP fundholders, would buy services from “providers”, hospitals and community health services.  “Purchasing” was later renamed “commissioning” to reflect how complex the task is. It’s about understanding what services are required and making complex choices as well as actually contracting for them.

Strategic Health Authorities (SHAs) were always a redundant tier of bureaucracy in my view.  District Health Authorities (DHAs) were to be the principal commissioners but the plan was that GP fundholders would eventually take over most of it with DHAs becoming centres of expertise rather than administration.  Then there was a rather messy fudge between GPs and community health services and we ended up with Primary Care Trusts (PCTs).

There is a huge amount of expertise required in commissioning.  The complexity of the tasks involved – understanding, assessing, testing, planning, choosing, contracting and much more, is enormous.  GPs will have to buy in that expertise which will build a bureaucracy which we will call – what?  We will have gone round in a circle.

One of the biggest mistakes made about the NHS is the endless stream of attacks on managers.  Almost all the problems that the NHS has and that people complain about are management problems.  NHS managers have a hugely demanding and thankless task for which they are regularly pilloried and censured.  They are, actually, crucial to an effective NHS, just as much as the clinicians.

So now we are to have “Foundation Trusts” and GP commissioning.  It is the same thing, yet again, under a slightly different name.  The NHS is not broken. It is, in fact, greatly improved.  It doesn’t need fixing.

We do not need more reform.  We need some adjustments.  There have been great achievements on waiting times.   Now, we need to shift the emphasis towards outcomes.  We need targets on quality rather than quantity.  It’s a tweak rather than a revolution.

12 Responses

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  1. Back To The Future Of The NHS « Peter Reynolds…

    Here at World Spinner we are debating the same thing……

    World Spinner

    January 21, 2011 at 1:45 am

  2. I disagree the NHS is bloated with too many overpriced temp staff, management and such, we import immigrant workers while we put nothing into training our own people to be nurses etc.

    The death rate and incompetence rate in our hospitals with no coincidence has gone up alongside it as has the sexual harrasment, rape and other crimes if you care to look at the GMC files.


    January 21, 2011 at 9:17 am

  3. Like yourself Peter, I was involved with the NHS reforms of the 1990’s.

    I was seconded to deal with the accounting issues in the Private Patients sector. This was to do with the insurance companies (such as PPP and BUPA) “buying beds” from the NHS to admit their patients. The services being provided to those patients were provided by NHS Staff, from cleaner to Anaethetist.

    The reason I was enganged by NHS Trust London, was to re-bill 6 acute Cancer Care Patients to the insurer PPP. The Hospital UCH, had billed the insurer the costs of the drugs (some class A – so that will appeal to you Peter) and extremely expensive, and at the time “break-through” medicines, at the cost to the hospital.

    PPP disagreed with the pricing and told the hospital to re-bill at the price which the insurer dicatate. Theses were considerably discounted prices to the insurer, and yet the NHS was purchasing these drugs and medications on behalf of PPP.

    I wrote off £50 000 (in 1991) worth of drugs and dresseings. This loss could not be billed to the patient, so the NHS (i.e. the tax payer) had to swallow the loss.

    The other issue raised in your commentary in the use of overseas staff. I would suggest even at that time 1:5 persons working at auxilary and Janoitorial level were immigrant workers on short term contracts. This has nothing to do with the assertion of the Govenrment of the day (Conservative) that this was as a resul of UK native workers refusing to take these posts. No, it was because it was cheaper for the NHS to employ external staff.

    20 years later, things have got worse. 1:4 staff in NHS Hospitals and advministration are not UK born and engaged on Work Permits. The NHS is an Immigrants Playground. This is not xenophobia but one of fact.

    Interesting the management persons to whom I reported where not of English orgination and also on contract. The line Mamager was Austrailian who hadn’t a clue of the issues raised by the domination of the Private Health Companies and the cost to the NHS. No, she was more interested in her back pockets and doubtless sending the money back to Austrailia.

    My co-operative and I found we were have meetings about reports , and writing reports about meetings as opposed to being allowed to get on with the job.

    If the NHS want to make a few cuts; send these immigrants and imported management home. We have more than adequately trained, willing, staff in the UK to deal with the alleged shortage. All they are asking for is descent salaries.

    Get rid of senior Management and so called advisors and use the money to engage properly trained Surgeons and nurses, as the cost of these so managers would employ 3 nurses or one surgeon.

    In fact in 15 years nothing has changed. The NHS like the Governments over that periond are inheritnly corrupt and need to be fired. Until that happens 1991 will still exist in hospitals.

    And Peter R. I trust that you do not see this as “verbal diahoreah” and actually go and see how a hospital works. Sometimes your arrogance and mis-infotamtion is a little worrying or are some of your responses as a result of drafting too much of that weed. Cannibis is a drug: with any decscent luck it will kill you.

    And for the record, as far as Cancer is concerned, more people die as a result of renal failure caused by the drugs than cancer. Most Death Certificates state cause of death to be cancer, or pneumonia: it is actually the drugs that killed that person.

    The Debt Collector

    January 21, 2011 at 10:51 pm

    • Well “Debt”, I was reading that with great interest until first the snide remarks about cannabis and then the blatant condemnation of my entire existence with yet more spurious slander about God’s herb! Really! I’m just grateful that despite my inadequacies, “arrogance and mis-infotamtion” (sic), you keep on coming back.

      Actually, I’ve spent many days and weeks understanding how hospitals, health authorities, GPs and community health servcie providers work. I’ve never experienced the sort of financial corruption you allege but then I’ve never had anything to do with the accounting side so you give me new information.

      Yes a very interesting tale you tell. Thank you for your contribution and I love you too!

      Peter Reynolds

      January 21, 2011 at 11:14 pm

      • Keep up the spelling errors Peter, your making me look good !! 😉


        January 22, 2011 at 11:21 am

      • Which spelling errors David?

        Peter Reynolds

        January 22, 2011 at 12:06 pm

      • “servcie”

        Chuckle. Glass houses 😉


        January 22, 2011 at 1:14 pm

      • Peter,

        Probably the reason why you have never come across the corruption that I found, was because you were not admitted to the Private Wing, nor witnessed the accounting, which I am pleased you have not.

        Actually, the point I am making is that the Private Health Insurers are taking the mickey out of the NHS, whilst people like you and I are paying our National Insurance. I have no issues with the quality of care which our Doctors, Nurses and other Medical support staff; but I do take exception with the way that the Insurance Companies are taking unfair advantage of the NHS.

        The Debt Collector

        January 22, 2011 at 11:47 am

      • Insurance is legalised fraud. The industry is every bit as corrupt and destructive as banking.

        Peter Reynolds

        January 22, 2011 at 12:08 pm

      • “Cannibis is a drug: with any decscent luck it will kill you.”

        Ooohh, that’s Cold dude!


        January 22, 2011 at 1:21 pm

    • All I can say is I am glad I lost my Kidney, crushed my spine, had my stomach torn into my nuts, broke my collarbone, shattered my wrist, cracked a rib, got shot in the arse and a few other things BEFORE the NHS become the death dealer it is today.


      January 22, 2011 at 11:25 am

    • “20 years later, things have got worse. 1:4 staff in NHS Hospitals and advministration are not UK born and engaged on Work Permits. The NHS is an Immigrants Playground. This is not xenophobia but one of fact.”

      Could not agree more as with most other industries now too.


      January 22, 2011 at 1:18 pm

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