Monday, 3 May 2010

The Circle of Life.

For anyone who has worked in the NHS for longer than any reforming politician’s mayfly like lifetime involvement with the NHS you start to see what we at the ND Central term the “cycle of life” otherwise known as idiots effing up (sorry about the grunt word) the health service.

What is this?

It is where a politician decides that something that works does not work and therefore needs reform.

Therefore a politician reforms it (because they have power but not necessarily the ability or more importantly the knowledge) and creates subdivisions to manage the same problems more “efficiently”.

For example: we have an inefficient large local Health Authorities “unresponsive to local needs” and a “drain on resources” so we will create “more locally responsive” and “efficient and accountable” Primary Care Group(s) to “improve patient care”.

So in an area with one health authority you might get 2 (or more) Primary Care groups each of which needs its own and new Chief Executive, Secretary etc.

Result a growth in front line healthcare professionals called managers. Work is duplicated to achieve the same or less and no doubt “efficiency savings” result. Wages do not go down for individuals but the wage bill increases as you have 2 or more parallel organizations working side by side instead of one before. They do the same jobs albeit with new and often more important sounding titles.

This is not like opening a new hospital in an area where the extra beds and doctors and nurses employed could treat extra patients it is doing the same job as before but creating more managers to do so.

These don’t work so now the Politicians will now create more efficient “Primary Care Trusts”. In doing so we will re employ all the former Health Authority and Primary Care Group employees (as redundancy payments cost too much) and so save the Public millions by increasing management costs to do the same job as the original Health Authority but with more people than before.

This process seems to occur in 10-20 year, or 2-4 Parliament, cycles, costs millions, does not improve healthcare but does increase bureaucracy.

Another example is we shall abolish the district general hospitals (run by the former health authorities). We shall create NHS Trusts (lots of them) and after a few years merge them into the same hospital units that were the former district general hospitals but with new names e.g. NHS “Foundation” Trusts.

More managers, lots of work for printers, sign painters and web page designers all on the front line treating patients but bugger all improvement for patients as there is zero extra healthcare provided via reforms.

Praise be to the Party for supporting the Circle of Life or is it actually an ever widening spiral of increasing management with each change in Party? And so the cycle continues ever downwards, more inefficiency, less front line care and there is an election coming.

Joy unconfined.

1 comment:

Prisoner of Hope said...

The behaviour you describe has been termed "skilled incompetence" by Chris Argyris in the Harvard Business Review as long ago as 1986. It occurs in many organisations but is particularly rife when politicians are allowed to micromanage. For a restatement of the symptoms here is a link to
a more recent article on the subject by Argyris.