The NHS in the age of anxiety: rhetoric and reality—an essay by Rudolf Klein

 I missed this essay from a much rspected elder when  holiday.

Essay: The NHS in the age of anxiety: rhetoric and reality—an essay by Rudolf Klein. BMJ2013;347doi: 21 August 2013)

Cite this as:BMJ2013;347:f5104
“A dangerous gap is opening up between rhetoric and reality as the NHS faces a grim fiscal future, Rudolf Klein argues. High flying ambitions for transforming the NHS are not matched by achievement, and austerity will compel a new agenda of minimising harms rather than maximising benefits

Statistically there does not seem to be much wrong with the National Health Service. At the turn of the year, the Department of Health could report that “key performance standards” had been maintained even as fiscal austerity began to bite.1 Some, such as hospital infection rates, had even continued to improve. Further, the department expected the NHS to have passed the halfway mark towards achieving its £20bn (€23bn; $31bn) savings target by the end of the 2011-12 financial year.2 A more recent sample survey also suggests that there has been no deterioration in performance, bar a marginal increase in the number of patients waiting for more than four hours in emergency departments.3

Organisationally, too, the NHS seems to be a success story. It has successfully implemented the disruptive and distracting Lansley programme of change. This involved closing down 170 organisations, creating 240 new ones, making 10 000 staff redundant, and then re-employing 2200 of them.4 NHS England, as the NHS Commissioning Board has chosen to style itself, is now in charge of the service, churning out instructions, consultations, and exhortations at a manic rate. Yet it would be surprising if the public and patients noticed any difference in the way the NHS operates, so smoothly managed has been the transition; it is those working in the service who have absorbed the shocks and pain of change.

Bad news stories

But, of course, there is another story to be told: that of the NHS stumbling into crisis. The three volumes, 1781 pages, and 290 …

read the whole essay – Klein-bmj.f5104

The deterioration in performance in Wales, with waiting times twice as long as England is significant and serious. Hywel Dda Trust exclusion of Hip/Knees is rationing under any name. But the English NHS is also in trouble as choice is relatively inappropriate for common conditions, and unavailable for those with travel challenges. Klein avoids recommending rationing, which by itself would still not be enough. The  4 organisations have such high overheads in the form of administration, sickness and absence, and litigation etc. that although I hate the idea, I am more and more inclined to make each trust/hospital completely independent so that new cultures and organisations evolve. Some will go bust… and there will be a great deal of short term pain, but it should all be worth it if we can streamline the service and avoid the current “swimming in treacle” as Klein describes it, with morale sinking in many staff. Their career progress was often fossilised in the demise of  “agenda for change” as the only defence for trusts became to renegotiate contracts, and get most people to do the same work at a lower grade,

This entry was posted in A Personal View, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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