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Leader: we need to be brave


22 April 2016

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The chair of The Commissioning Review wants leaders to be brave and make changes to the NHS before it is to late

The chair of The Commissioning Review wants leaders to be brave and make changes to the NHS before it is to late

In the book Direct Democracy: An agenda for a New Model Party that listed Jeremy Hunt, secretary of state for health, as one of the authors it called for patient power to change the way the health service works, by giving them the funding to buy healthcare from the provider of their choice. This was either through the tax system or universal insurance. It said: “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain, so extending to all the choices currently available only to the minority who opt for private provision.”
Sadly, I have read through the book as I wanted to understand why the NHS seems to be in such turmoil at present. To cheer myself up I watched the BBC sitcom, Yes Minister’s episode called The Compassionate Society and finally understand how we have got into the state of distress that pervades the NHS – the NHS is not sustainable in its present form because it is set up for the system and not the patient.
I have had a conspiracy theory about why the system needs changing. In the not too distant future the country won’t be able to afford the pensions of the NHS workers. If the monopoly of the NHS was broken up and the workers moved to private pension schemes the treasury would be happy. And you have to keep the treasury happy to get your funding.
With junior doctors already striking and GPs being balloted to sign undated
resignations from the NHS in July unless a rescue package is agreed, I fear hugely for the NHS. Our pharmacist colleagues are not exempt with £170 million coming out of their contract by October.
The devolution of health money to councils to spend came with pump-priming money to smooth the transition; will that be available for all devolution sites? What happens when the rubber hits the road and the sums don’t add up? Health has always been bailed out and councils are not allowed to overspend. I predict that there will have to be a local health and care tax to fund the shortfall payable in a council tax. It will then be the responsibility for local politicians to explain why there are cuts to the social care system and even worse, explain why health has to be rationed in their area.  
Dame Julie Moore chief executive of University Hospitals Birmingham, has suggested the NHS is failing because of “gross incompetence” among hospital executives and poor leadership at every level. She blames a “culture of indecision” in which managers made their way up the hierarchy by avoiding responsibility.
Darwin’s survival of the fittest was not survival of the strongest but those most willing to change. Is the NHS a health service determined to improve quality by learning from mistakes or is it an employment service so transfixed by risk of failure that no change is permitted. You can only have a market if there are losers as well as winners. Simon Stevens’, chief executive of NHS England, Stalinesque five-year plan will only work if everyone is willing to risk some failure.
What is now needed is to have everyone associated with the NHS to take personal responsibility for their individual delivery and back the system before it is too late.

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