Judy Terry is a marketing professional and a former local councillor in Suffolk.
The suffocating public sector bureaucracy we all face every day leaves many of us in despair at the waste of public money. Endless commissions appointed to ‘review’ but without any outcome, or anyone ever held to account for not implementing policies and recommendations. Nobody taking responsibility for failed IT projects. Poor procurement, and over-regulation stifles ingenuity and the ability to welcome change, instead of blocking it.
A case in point is the NHS which has taken bureaucracy to a new level: what’s the difference between NHS England and NHS Providers? How can anyone make sense of the attached Structure Chart? What is the point of Healthwatch, with its regional office network, conducting surveys and writing endless reports?
Talking of reports, at the beginning of December I attended another meeting of the Ipswich and East Suffolk Clinical Commissioning Group (CCG). It is one of two CCGs covering 40 GP practices in the county; together with West Suffolk, they share 271 staff. Having belatedly given up its expensive leased offices at Great Blakenham, since 2017 Ipswich & East Suffolk is based at Suffolk County Council’s HQ in Ipswich, whilst West Suffolk CCG is based at West Suffolk Council’s offices. Established in 2012 to replace Primary Care Trusts, 191 CCGs across England have responsibility for “planning and commissioning healthcare services in their local areas”. Despite complaints of a lack of funding for the NHS, they cost billions, yet mergers are opposed. Is there any evidence that they add value?
Ipswich & East Suffolk has eight GPs on the board, including the Chairman (who is paid £65,000 on top of his GP income; the others receive a more modest £30,000). West Suffolk has six GPs on its main board, all in receipt of the same annual payments, including the Chairman. More GPs are involved in a range of other committees across both CCGs, tying them up for days; is this really the best use of their time, when patients can’t get GP appointments?
Glossy Annual Reports for 2018/19 (here and here) were published last May. Why not a joint report? These are reviews of activities over more than 100 pages – to what purpose, when it is doubtful that anyone, including in Government, will read them? And what was the cost? The two websites are another expense, kept updated for the few who bother to access them – when almost no-one has ever heard of CCGs.
Because of that lack of awareness, the bi-monthly public meetings are poorly attended, and most people will be at work when they are held. As usual, the Ipswich and East Suffolk agenda comprised a dozen or so reports (not available at the meeting in hard copy, to save paper, and difficult to follow, even downloaded to a laptop as board members discussed without inviting comment from the public), together with details of staff consultation and further recruitment, including director posts. Because of election purdah, public questions were restricted.
Being responsible for commissioning the East Anglian Ambulance Service, the board was asked to hold a minute’s silence for the three paramedics who died within 10 days of each other in November, one allegedly confirmed as suicide. An independent investigation is under way by an officer from the Metropolitan police, amid accusations of bullying and ‘a toxic culture’. However, the CQC (Care Quality Commission) had already identified that the Service suffered from poor leadership and requires improvement. At the last count, the Service had 300 vacancies and its difficulties were widely known, not least through extensive media coverage over several years.
The obvious question is why the CCGs are responsible for ambulance services, and how did they hold its leadership to account, when they were aware of deficiencies, as noted in their annual reports?
Just what is the purpose of the Health & Wellbeing Board? It is attended by representatives from both CCGs but it doesn’t address obvious failings. What are they doing to reduce pharmaceuticals waste, dumped whilst still within date, costing millions of pounds annually? Or to improve management of temporary aids like crutches and walking sticks, and even wheelchairs, by encouraging their return and re-use to hospitals, instead of being scrapped, at considerable expense? Are they reviewing annual flu jabs, which seem to make people ill, instead of protecting their health?
Suffolk’s Health & Wellbeing Board has recently refreshed its strategy but appears to avoid detailed scrutiny or engagement with services in crisis. Adding to bureaucracy, Suffolk also has a joint Health Scrutiny Committee with Essex, ‘scrutinising issues relating to the implementation of the NHS Suffolk and NE Essex Sustainability and Transformation Plan. Introduced by NHS England in 2016 to implement its Five Year Forward Plan.
We are constantly reminded that the NHS is “free”. But it is not free. It is funded by taxpayers, and only free at the point of delivery, but increasingly top-down, lacking genuine engagement with highly skilled professionals on the front line who do a remarkable job. Instead of spending their time completing paperwork, struggling with outdated computer systems, they know they could do an even better job if someone listened to them. For example, GPs in France have ultra sound equipment in their surgeries – why not here? It would aid early diagnosis, saving time, when patients can spend weeks or even months going backwards and forwards to GPs and hospital – seeing different consultants – for tests and (usually as a last resort) scans. Co-ordinating appointments to do all this within days would save stress and money.
On January 3rd, BBC Look East investigated a tragic case of a young man, in extreme pain and paralysed for the last four years, following car accidents, taken to hospital in Chelmsford by ambulance more than 100 times in the last two years. Stoke Mandeville Hospital will help with specialist treatment, but the Mid Essex CCG will not commit to funding it.
Meanwhile, why should older people, who worked hard all their lives and paid their National Insurance, have to wait years for a hip or knee replacement, as worsening pain affects both independence and quality of life? Allowing older people to go blind because they can’t get treatment for cataracts is unacceptable and, in the longer term potentially a huge cost for personal care when a simple operation would sustain their independence. Some CCGs reportedly ration cataract treatment to one eye, not both. Consequently, those with savings are forced to spend thousands of pounds on private treatment from their NHS consultants, whose operating theatres are unused.
Having watched a number of programmes about the Air Ambulance and how lives are saved in the most difficult circumstances, it’s evident that the Service should not have to rely on charity for its funding – Government should contribute. When one consultant explained how his experience as an army surgeon was invaluable dealing with emergencies, and some of the helicopters fly from military bases, could there be mutual benefits in closer working with the Armed Services, each learning from the other, boosting expertise? This could include the provision of state of the art prosthetics and rehabilitation for amputees.
The NHS is, rightly, a sacred institution to be proud of. As an emergency medicine consultant, who led responses to the 7/7 bombings, and other major incidents, said in a recent interview:
“When you watch the NHS kick in, the effort that goes into saving people is unbelievable. It’s an amazing statement of how society does care.”
We can all agree that such commitment deserves to be acknowledged, cherished and respected – but that doesn’t mean that it can’t be helped to adapt to fresh challenges and enabled to broaden access to amazing developments in new treatments.
The Prime Minister promised a revolution in Government; he should start with the Health Service. Reducing waste in the system, something we are all guilty of in our own lives, could redirect funds and improve procurement. A review, not via a lengthy commission, or one of the five main accountancy groups, but led by someone beyond Westminster and its somewhat incestuous appointments system.
Someone outside politics and unconnected with the healthcare sector, who understands delivering best value for the wider community, listening and learning from those on the front line, who see problems first hand – and have the solutions.
Ideal candidates would be either of the two founder Chairmen of the New Anglia Local Enterprise Partnership, credited with creating one of the top-performing LEPs in the country. Their strong leadership, insight, aspiration, business acumen and lack of ego, could be just what’s needed to inspire the transformation of our treasured NHS, by reducing interfering management, allowing the focus to return to the patient – and staff.