How I'd reform the NHS

How this old geezer would reform the NHS

We need to reform the NHS, email me if you agree or object. If objecting, please say why and what you would do instead.

First of all, there are too many layers of authority between the Government and the surgeries & hospitals at the end of chain.

We need to get back to the “county level” of running things.

Ministry: there should be an NHS Department in charge of all purchasing and payments. Now that the NHS is fully computerised, both sections could be run with no more than a staff of 100 for each section, although this would have to be greatly increased whilst setting up.

Purchasing: senior executives of Amazon should be approached to set up an Amazon style operation. Not to run the supplies department but to advise in setting it up. And to inspect (but not oversee) it on a regular basis. Whether you approve of Amazon or not, there can be no argument about their being ultra efficient and they are used to working on huge scales.

Payments: the department should be responsible for two areas. And two areas only, everything else should be handled at the local level (surgeries and hospitals).

First of all they should be responsible for the payment of all salaries which are paid into the bank, and the issue of all payment instructions to the surgeries and hospitals for weekly cash wages.

Secondly they should be responsible for the payment of all purchasing incoming invoices other than surgery and hospital’s local purchases which should be kept to a minimum.

County Council: There should be no other levels of management until we come to Country Level in the local County Council offices. This is where they decide whether hospitals should work individually or in groups, and the number of surgeries required for the local demographics. Nothing else. The Council themselves can make those decisions, but perhaps a manager (one only) could be based there, using the council’s secretarial services when required?

Surgeries: should be responsible for the running of their surgeries, other than the actual payment of salaries, equipment or medicines. They already have a practice manager so would only need one extra member of support staff.

Hospitals: should be responsible for the running of their hospitals, or hospital groups, other than the actual payment of salaries, equipment or medicines. They already have a managerial staff so would only need to expand their support staff.

Prosecutions: There should be a mandatory sentence of a minimum of five years for any theft of over £100 from one person or one group of persons in any one year. from the NHS. After all, we can't afford to clutter prisons up too much!

NHS Continuation

I received two emails last night asking me about management teams and hospital boards.

I had ideas on this years ago and have researched my notes. It is based on the premise that managers need to have experience in hospital routines and not just in management theory.

Management: Once a qualified nurse or doctor reaches their 45th year, or has at least fifteen years on the job - whichever is sooner, they should be given the option of carrying on until retirement, or move over to management. This way the only managers in the NHS hospitals will be those who have been “at the sharp end” for a decade or two and will have the right qualifications to manage within the hospital complex.

Board of Directors: These should be appointed from hospital nurses or doctors once they reach 60 years of age from those who have proved capable at the required level.

Hospital parking: This was mentioned but it has to be down to each hospital and is not something that comes under the remit I have set myself. But whatever the hospital charges, there must be no exceptions, everyone must pay it including the Chairman and CEO of the Hospital Board and not allowed on expenses. This alone would focus the mind of management!