I just recently became aware of a deep connection between Countess of Chester hospital and radical restructuring of the NHS in the early 90’s, which brought in new layers of bureaucracy and internal competition. Don’t coordinate and distribute. Instead, let hospitals compete, survival of the fittest, dynamic leadership,and innovation! We’ll end up with better health care for less money.
The connection is Sir Duncan Nichol, former chairman of the Countess of Chester hospital trust. That’s a higher management level than the hospital executive board. Side effect of the innovations was more managers with even bigger top salaries. But Nichol is not just any manager. He’s a former NHS chief-executive, “part tycoon, part mandarin”. Read all about Sir Duncan’s innovations here: https://www.managementtoday.co.uk/uk-profile-sir-duncan-nichol-nhs-chief-executive/article/409550
Source of the table: https://www.coch.nhs.uk/media/204393/BOD-March-2015.pdf, https://www.coch.nhs.uk/corporate-information/board-of-directors/board-of-directors-meeting-packs/archive.aspx. Sorry for all the misprints. CoCH management and more generally NHS management produced expensive glossy annual reports and other publicity material but it seems nobody ever bothered to check the text for spelling errors.
Here are some more quotes from Management Today, emphasis added by myself.
“Nichol helped oversee the greatest shake-up in the health service since the war. Out went the old-style consensus management where low-grade administrators charged round trying to keep high-grade doctors happy; in came a whole raft of modern business nostrums: greater pressure on cost-efficiency and customer satisfaction, the introduction of ‘internal markets’, the separation of key functions like purchasing and service provision, and, of course, the increasing use of snappy titles like chief executive and general manager.”
“Some, still seething at the enforced changes, argue that you cannot apply market doctrines to the basic tenets of caring and curing. Others, especially those working in conventional businesses, remain unconvinced that any amount of fancy tinkering will change the nature of the beast. The last few years, they note, have still been dotted with high profile examples of cash squandering on a massive scale.”
Ah yes, I remember it well. I wept. It started in the 1980s, I had friends who moved to other countries, though similar difficulties everywhere now it seems. It was the start of the infantilization of medical front-line workers. Now everyone has to take a Statin, and negative effects of vaccines are defined to be extremely rare. There are lots of good people but they know to keep in the box.
I saw this first hand from the 90s onwards. Managers brought in to close down units. A big hospital in Manchester closed and the land sold for great profit as it had easy access to Manchester Airport for business purposes.
I remember quite clearly having to go begging to other wards to borrow bandages and dressing packs. No bread available to make a piece of toast for a person who had had surgery earlier in the day either. Wrapping a sheet around a poorly man because the laundry was not done as often, and we had no pyjamas.This was because the budget had been used up for that time period. And this was happening all the time.
I must point out though, I never saw a shortage of drugs or medicine. That is a story for another day.
I saw cash squandering a lot in many areas. A building painted and decorated even though the building was pulled down months later. I asked why? And was told the money in that pot had to be used up.
We Nurses would talk about Managers being paid a big cash bonus to cut costs. And all the time we were struggling to provide basic care.
Whistleblowers were not looked upon kindly.
This is my personal memory and opinions. And it is what first springs to mind Richard when reading the above. There is lots more. You are uncovering the deep, deep seated truth.
I am so pleased to see and hear that more academics like you Richard are coming out and doubting the way Lucy Letby was tried in court… I hold my hands up and say I am not an expert on law, statistics or even medicine.I am long retired from the Nursing profession. However, from my NHS and general life Experience I felt from day one, something was not sitting right.
I believe this was a huge miscarriage of justice. And there are massive reasons for this. I would be frightened to say more.
And of course, I could be wrong as Lucy might well be guilty. But, I have studied and followed this for a long time now and nothing whatsoever tells, or shows me that …
The NHS internal market was introduced in the late 1990’s following, I believe , a funding crisis in the service. It ‘s aims were to improve services for patients whilst improving efficiency by introducing competition between hospitals ( service Providers ) and creating Purchasing Authorities with whom service providers would negotiate contracts for health services based on Service Specifications and Patient Activity levels.
Service providers aimed to achieve as much activity as possible covered by their negotiated contracts in order to achieve maximum funding.
In my experience of other organisations the event of a budget shortfall ” budget savings ” might be required. Certain funds might escape the exercise ( possibly security, safety, hygiene for example) but the effect of this would be to increase the necessary savings from other service areas. If repeated year on year there would be a risk of there being no more “fat” to remove and , in these circumstances. it could be necessary to look at previously protected elements of the budget .
I recall two old sayings :- (1) You cannot make omelettes without breaking eggs; (2) You cannot make a silk purse out of a sow’s ear.
Correction – the NHS Internal Market was introduced in the late 80’s/ early 90’s.
Thanks! That’s an important correction.
An anonymous correspondent sent me this: The NHS internal market was introduced in the late 1990’s following, I believe, a funding crisis in the service. Its aims were to improve services for patients whilst improving efficiency by introducing competition between hospitals (service Providers) and creating Purchasing Authorities with whom service providers would negotiate contracts for health services based on Service Specifications and Patient Activity levels.
Service providers aimed to achieve as much activity as possible covered by their negotiated contracts in order to achieve maximum funding.
In my experience of other organisations, in the event of a budget shortfall “budget savings” might be required. Certain funds might escape the exercise (possibly security, safety, hygiene for example) but the effect of this would be to increase the necessary savings from other service areas. If repeated year on year there would be a risk of there being no more “fat” to remove and, in these circumstances, it could be necessary to look at previously protected elements of the budget.
I recall two old sayings:- (1) You cannot make omelettes without breaking eggs; (2) You cannot make a silk purse out of a sow’s ear.
I don’t know what to make of all this… I worked in a number of hospitals including in an icu. I feel sick reading this and especially when thinking about the life sentences suffered by the nurse and all the parents who lost their precious babies. And most sickening of all is the thought of all those involved who know the truth and who get to sleep peacefully at night, free to carry on their lives as if none of this had happened.