Robert Madelin’s Post

*** NHS – Classic business case study in the outcome of breaking the links between control, consequence and accountability *** Lots of debate and discussions today on the NHS but what cannot be ignored, and should be a classic case study for business schools and boards, is the impact of breaking the link between control, consequence and accountability. Gordon Brown, through PFI deals, made sure all new NHS hospitals had to be built and owned by developers. Effectively leaving the NHS to rent buildings, built on the land they owned! They lost control of where the NHS operates. And therefore so did the Government. Andrew Lansley in 2012 brought in reforms so that decision-making was given to NHS England and regional Clinical Commissioning Groups CCGs. In plain English, control for delivery was devolved completely to highly paid (with great pensions too) NHS managers and structures. It means there was no longer an accountability chain. It was broken and severed. There is no link therefore between those who use and pay for the NHS (the public/taxpayers) and the politicians/ministers who are therefore democratically responsible – with – those who have the responsibility for the actual delivery. Therefore the public and ministers have no control, and, therefore there is no consequence or accountability to them for delivery failure. Ministers of all parties get it in the neck for problems in the NHS but it is something they have no control over. Albeit...they created the model. I used to see it in Parliament all the time. A MP would ask the health minister about a NHS problem in their constituency and all they said “I will ask NHS England to fix it”, it was never “I will instruct them to fix it”... because they couldn’t. It’s current core operating model was clearly never going to work properly. Because there is no control, consequence or accountability – between those who “own it” and those who run it. https://lnkd.in/exWqzXkv

NHS leaders facing “drastic measures” to make ends meet as NHS responds to tightest financial settlement in years. Responding to the NHS Confederation’s survey of NHS leaders across trusts, integrated care boards (ICBs) and primary care in England, there was a clear call on the next government to protect local NHS organisations from having to further cut staffing levels. Matthew Taylor, chief executive of the NHS Confederation said: “The NHS is operating under immense financial strain, with some local services already cutting or freezing clinical and managerial posts, as well as cutting some patient services. They are facing up to some drastic measures to balance their books this year. “While NHS leaders know they must continue to run their services as efficiently as possible, this is the tightest financial position the NHS has faced in years”. Read the full survey 👇👇👇 https://lnkd.in/eHDnp6TJ

There is so much effort put into changing and improving the UK NHS. These resources have funded for years, and there has been initiative after initiative applied to the NHS, from well meaning experts. There is one aspect of this change that is clear from evidence from many such situations, that the environment that the organisations resides has to be conducive to change. - The funding has to be there. - Crisis need to be calmed. - Leadership need to have the space to do this. - There needs to be space made for this to occur. - Employees need to be engaged. - The organisation has to be able to shift its fundamental ways of working. - They need expertise to support them to do this. - Ideology needs to be banished, replaced by systemic change expertise. In the NHS, with the ICB's and other changes. The list above has not only not been available, the short term pressures contributing to NOT achieving any meaningful change have actually increased??! So, we continue to wast huge amounts of money. We continue to provide poor healthcare. We continue to overwork employees. We continue with a system design that is broken. We continue with approaches that we already know, before they begin, that they will not work! We continue to be attracted to short term quick fix solutions (often digital). Please! What's going on?

📣 OUT TODAY Bright Blue's new report on reforming the NHS by empowering Integrated Care Boards (ICBs). It is authored by Bright Blue Associate Fellow Conrad Bannister. The NHS in England is in trouble. It is underperforming, both historically and internationally. But the government needs to prioritise more reform, not more money, to improve the performance and efficiency of the NHS. ICBs have an opportunity to improve the way the NHS in England operates, if they are given the finances, outcomes and governance changes to realise their transformative potential: to build an NHS in England that is more local and long-term, focussed on prevention and patients and care closer to home. This report offers 12 policies that would support ICB reform in this country, as well as enable the NHS to alleviate the problems it faces. The report’s recommendations flow from four key principles: 🔴 Prioritisation of the long-term. The report seeks to avoid short-termism. The following policies are not designed to fix immediate problems, but making the NHS sustainable and efficient in the long-term. 🔴 Fiscal responsibility. The report recognises the tight fiscal constraints the current Labour Government is under. Current public expenditure in the NHS is significant and England is currently not receiving good enough healthcare provision for the money that is spent. Therefore, the policy ideas in the report will not generally be to spend significantly more public money. 🔴 No top-down structural reform. The current Secretary of State for Health said that “[Labour’s plan] isn’t about changing structures.” There is a huge amount of goodwill towards ICBs: they are supported across the political spectrum. The policy recommendations fit within this spirit. 🔴 Greater autonomy and accountability. The spirit of these policy recommendations mirrors principles which underlaid the successful academisation of state schools in England since the 2000s: autonomy twinned with high accountability over outcomes. 🗞 The report was covered in the Health Service Journal: https://lnkd.in/eEm59G6M 📘 Read the report here: https://lnkd.in/ecrnuqZF

The latest report highlights the financial landscape of NHS organisations in 2024/25. Balancing books while safeguarding patient safety remains a critical challenge for NHS leaders and staff. The survey by the NHS Confederation reveals that many organisations are striving to achieve efficiency savings, with targets ranging from 5% to 11%. This underscores the unprecedented financial pressures faced by NHS providers. My sense is this also underscores the need for value based procurement and value based prescribing, where medication choices and treatment plans are made based on the overall value they provide to the patient and the healthcare system. #NHS #Healthcare #Finance https://lnkd.in/emZDbX9T

Privatising the NHS is broadly considered an absolute no-go by the public in the UK, and rightly so. It's a national institution and one of the key pillars of British society. However (and I know this is controversial), there's got to be an argument to keep funding public but made the actual organisation of the NHS independent from the government? 🤔 Hear me out... The Bank of England are independent from the UK government. They set interest rates based on what’s best for the economy, not political gain. So, even if rates are high, we can at least be assured there's good reason for it. Why can’t the NHS operate similarly? Right now, governments rarely make decisions with a long-term positive impact. They’re more focused on the next election, quick wins, and sometimes even leaving a mess for the next party in power (as it seems at the moment). They use the NHS as a political weapon for their own gain or to detriment other parties. Take staffing as a prime example. It takes 15 years to train a Consultant doctor, and we need thousands of them. This has been an issue for as long as I’ve been in this sector (14 years now!) and I'm sure there isn't a single colleague in any department of any Trust that hasn't faced issues staffing Consultant gaps at some point in that period. Yet successive governments haven’t significantly increased university places, invested in training incentives, or made decisions to future-proof NHS staffing levels?! If they had done this 14 years ago, Trusts wouldn't be struggling with huge staff shortages and massive locum spend 🏥 I'm absolutely not suggesting that the public pay for their own healthcare, but why not allow the NHS to be publicly funded and run independently from government? This would let it make its own decisions within a framework of clinician-led targets that reflect the best interests of healthcare outcomes. It would also encourage the NHS to invest in it's own future for the long term and not just a short term political cycle 🌟

THE NHS; WHAT ON EARTH DOES LABOUR DO ABOUT IT The challenges facing the new government in relation to the NHS seem immense. The issue of lack of staff capacity may be soluble through making use of the private health sector but there is still the issue of financing those actions. Although the government will want to put “new money” into the NHS, the fiscal cage they have put themselves in would seem to constrain how much money they can find. Another major challenge is that of reducing waiting lists for services. Increasing the supply of services and investment in technology would seem to prime candidates to reduce waiting times but these will of course require time and additional funding. Many of the other proposals for managing waiting lists seem to come down to a series of organisational, cultural and environmental changes. While these are eminently sensible approaches they do, of course, require effective change management in order to be delivered. They don’t happen by accident. However, these tasks need to be performed at a time when NHS managers are managing day to day problems and are constantly being told that there are too many NHS managers. The reality, I think, is that the NHS does need significant system reform not tinkering from Whitehall. I think there are five key issues: 1.     Getting NHS funding on a sustainable basis using a hypothecated tax like the Germans use 2.      Integrating primary care into the NHS rather than having it delivered through thousands of small businesses 3.     Finding ways of better integrating health and social care. Policy statements, directives etc from the Centre won't cut it 4.     Finding a way of protecting funding for prevention and ensuring that only proven interventions are applied 5.     Decentralisation and letting local NHS managers manage the service without constant interventions I outline these in more detail in the attached paper

Key facts and figures about the NHS (Kings Fund 24th June 2024) 👉🏾👉🏾 🏥 The NHS is one of the world’s largest employers, with around 1.34 million full-time equivalent staff in England, as of February 2024 🏥 In 2022/23, the total cost of employing the staff in the NHS was £71.1 billion – 45.6% of the NHS budget. These statistics don’t include salaries for GPs (who are not directly employed by the NHS) or employees in the Department of Health and Social Care and other national bodies, such as NHS England. GPs and GP practice staff are indirectly funded by the NHS. 🏥Cost going to urgent care centre and receiving the lowest level of investigation and treatment, the average cost in 2024/25 is £91. 🏥 For an individual at a major A&E department who receives more complex investigation and treatment, the costs range on average from £137 to £445. 🏥 In 2024/25 an emergency appendix removal operation for a child without complications costs, on average, £3,603, and the average cost of an emergency coronary artery bypass graft without complications is £14,547. 🏥 A recent study estimated that in 2022/23 the average 10-minute face-to-face GP consultation costs £56. Information from article below 👇🏾 https://lnkd.in/d6GhSvue

Since past year most of us working in UK healthcare are talking about the future of agency locums, here is a detailed report of survey done by NHS Confederation about the Financial state of NHS. https://lnkd.in/dvi4u2Kw Also my views on what agencies can do in these difficult times. Despite the financial challenges facing NHS trusts and the potential impact on agency locums, there are several positive developments on the horizon. The NHS's commitment to innovation and efficiency, coupled with its strategic focus on workforce planning, presents opportunities for growth and improvement in the healthcare sector. Opportunities for Agencies: Innovation and Flexibility: Agencies that embrace innovation and demonstrate flexibility in their offerings are well-positioned to thrive. The ability to adapt to the NHS's evolving needs can lead to new opportunities for collaboration and success. Enhanced Role in Workforce Strategy: Agencies can play a crucial role in helping NHS trusts navigate staffing challenges. By offering solutions that align with strategic workforce planning and contributing to the development of effective staffing models, agencies can strengthen their partnerships with NHS trusts. Professional Development and Quality: The emphasis on high standards and professional development presents a chance for agencies to differentiate themselves. Investing in the continuous improvement of locums can enhance their value to the NHS and secure more long-term assignments. Technology and Efficiency: The increased focus on technology and efficiency may open doors for agencies that are adept at integrating new solutions and improving operational processes. This can lead to more streamlined workflows and better outcomes for both NHS trusts and locums. In summary, while the NHS faces financial constraints and agencies may encounter new challenges, these circumstances also create opportunities for growth and positive change. Agencies that are proactive, adaptable, and focused on quality will be well-equipped to navigate the evolving landscape and continue to support the NHS effectively. By embracing these opportunities, agencies can contribute to a stronger, more resilient healthcare system and foster successful, long-term partnerships with NHS trusts. #NHS #NHSFinance #NHSChallenges #LocumDoctors #WorkforcePlanning #NHSTrusts #AgencyLocums

Do you want to increase the productivity of your services without pouring millions into the NHS? With the very real possibility that you may, in fact, save money, improve workforce well-being, and improve patient care. I can hear some people now: Don't be so naive, we can't do that. Well, I believe we can. In fact, I know we can, and I can prove it. Darzi, as well as the new Institute for Economic Affairs, both discuss how more money has not led to greater productivity, although they have differences of opinion when it comes to the solutions. The IEA advocates for a more market-driven, competitive healthcare model (not quite the abolition of the NHS, but close). Darzi, on the other hand, offers more inward-focused solutions: digital technology, empowering frontline staff, better leadership, prevention, public health, and simplifying bureaucracy. You can, depending on which side of the fence you land on, see merit in both approaches. However, I do not see much merit in either. Let me rephrase: I do not see either solution actually being viable for numerous reasons. I also do not hold out much hope for the "no more money before reform' line either...Firstly reform costs money and secondly it masks a fundamental problem. I believe we should be focusing on our greatest asset in the NHS: its staff. The NHS roughly spends half of its £200 billion budget on human resources. But, and here is the kicker, it does not understand how they operate, what they do, or how they can be productive. In some cases, it does not even know who they are. I am not calling for time and motion studies—something much simpler than that. Let's start by knowing who our staff are, what they can deliver, and how to best deploy them. Where to invest, where to save. If you believe this already happens, I am afraid you may be sadly mistaken. I have yet to talk to a trust that has this down. It was the same when I worked as a senior manager in the NHS some 13 years ago. Money is not the issue, or at least it should not be the issue until you understand your workforce, its capacity, and how that capacity can satisfy demand. Spending money wisely, based on evidence, is the way to go. Think for a minute: if I gave you another £100 million to spend in your trust today, where would you put it, and how would you know it was in the right place? This is first principles stuff. The NHS cannot operate without people—it ceases to exist. So know your people before trying to tackle any other major issue. I know this may sound a little impassioned, and you would be right—I am passionate about this. Passionate about making things better. The fix I am suggesting will increase engagement, oversight, consistency, efficiency, and sustainability. I know this isn't the only answer, but it is a massive one, tackling a root cause issue that impacts every aspect of the NHS. Want to know more? Give me a shout. I would love to hear your take on this. #nhs #workforce #darzi #IEA #change SARD JV