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Rene Kinzett

Four health managers good, two managers better

July 13th, 2010 by René Kinzett

I am wondering if the current dynamic between Government and Opposition is a welcome return to an ideological, or at least an aggressively partisan, struggle in British politics. From schools shake up to plans to scrap a whole tier of bureaucracy in the NHS, the Coalition is set on a course of much needed reform, whilst the Labour Party seek to defend provider interest and the protection of managerial posts (huge numbers of which were created by the previous government), dressed up as concern for patients, pupils and parents.

Whilst Tony Blair sought to reform the public sector and try to embed the “what works, works” mantra across government between 1997 and 2007, it is now received wisdom that Brown was conducting a stalwart defence of the old bureaucratic top-down, provider-knows-best model of delivery. After two and half years of Brown at the helm of Downing Street, the effects of his ideological position on both the state of public services and the health of the Labour Party have now become clearly apparent.

The “shadow cabinet” (the sad and sorry looking bunch of failed secretaries of state who were given the Order of the Boot by the electorate in May, serving out this interregnum until Labour can chose its new leader in the autumn) have had nothing positive to offer in terms of policies and seek to oppose the coalition from a position of moral indignation, a healthy dollop of collective amnesia and good old fashioned socialist concern for Labour Party Members working in the public sector. The shadows forget, or try to forget, the two and a bit years of Brown in residence at Number 10 and seek to blame the rest of the world for Britain’s fiscal crisis. When Burnham says that plans to cut NHS bureaucracy make him want to “weep”, frankly it makes me want to vomit when I think about the profligate and selfish nature of a government headed by a PM who once revelled in the “Iron Chancellor” myth.

The NHS reforms outlined by Andew Lansley yesterday are an excellent case in point. The health budget is a “ring-fenced” area as agreed by the Coalition, but that is not to say that savings can be found in the hugely bureacratic delivery model, savings which can then be poured back into frontline services. For me, that is the essence of the White Paper – doing more for less. Indeed, this is the same motto used by the Minister for Health in the Welsh Assembly Government in a newspaper article for the Western Mail yesterday.

However, as in the rest of the country, the NHS in Wales is bloated, cumbersome and unresponsive to the needs of its patients. That is not to say that the care offered by nursing staff, doctors and consultants is not in most cases exemplary, rather it is the model of delivery and the explosion in managers at every grade which is at fault. The Royal College of Nursing has identified that NHS Wales currently spends more than £65 million on management across bands 8 and 9, but just £31 million is spent on nursing staff in the same band. To spend £34 million more on managers than on nurses by a health service provider is obviously unsustainable.

The plans to allow by 2013 500 GP consortia to spend £80 billion on the NHS across England and scrapping the Strategic Health Authorities and Primary Care Trusts all seem an excellent idea to create a modern and responsive health care service, free from the worst aspects of the monolithic NHS. When Labour ideologues proclaim that they “Love the NHS”, they are really saying that they are wedded to the organisation, not to what it delivers. I am comfortable in allowing doctors, nurses, consultants and surgeons to get together and plan the healthcare services for their communities. I am happy to see hospitals set up as independent corporations, in the same way that universities are run, free and independent from political interference and stultifying bureaucracy.

The proposals from the coalition on the future of health care in England show an inspired plan for excellence and localism. The huge disappointment for me is that it will not be introduced in Wales for so long as we have a Labour Government in power at Cardiff Bay more interested in jobs for the boyos than the health care of the nation.

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Categories [ NHS, Politics ]

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