Changing a culture of fear, bullying and gagging…… Start again with local pride….

NHSreality feels that the culture in Westminster reflects the culture in the nationalised industries as a whole, and the health service being the biggest. It is also the biggest bully, with most fearful staff, and who feel most gagged… Starting again using local pride may help, but some areas may fail to recruit… Perhaps these should be the first to be released from the shackles of Political Interference. Co-payments should be allowed.

Image result for culture of fear cartoon

We cannot address the culture of fear without better management and it cannot come from inside. Even if the skills were there, which they are not, the staff would not trust them. We need an outside provided HR company to do “Exit interviews” on all staff and board members, and to report dispassionately and in a depersonalised way, at regular intervals. Somehow this needs to be amalgamated into an annual public report for localities, and regionally, and nationally. We need to hear the views of all staff who leave a job, move departments, or retire, or emigrate.

But then, you and I know what the result will be….

So at the same time, because we know the outcome, we need to be planning the changes necessary to reverse the decline. I admit that I cannot see the way forward, especially when the official line is “everything for everyone for ever” and no overt rationing applies. We are creating a dependency culture. We are discouraging autonomy. In work with the GIG economy we are creating a slave culture. I see several “Spartacus” like revolts ahead, and the destruction of the whole state health and social care empire unless we have much more honesty and much better leadership.

If we apply zero budgeting and allow local trusts to run themselves without any government interference, restraints, or banal performance indicators, we will get large differentials in health care, but morale will rise. Staff can feel involved and “begin to enjoy themselves”.  After a time best practices will emerge, and convergence of standards, but this will take a decade(s). Meanwhile we need to lift the restriction on medical school and nursing training places, so that we have an excess of staff, even allowing for the dropout rate. We need to acknowledge that no state cannot keep up with the advances in medical science, (see The NHS is being impeded by greedy drug companies ) and therefore we need to ration health care. Cradle to grave, without reference to means,……? The drug companies are out to make a profit, and it is not drugs which improve the health of populations. (See the USA) They do improve the outcome for individuals, but that is different. 

How we do this is the big debate which has not even started. NHSreality suggests means related co-payments, both for health and social care. Then there is the litigation…. without no fault compensation, the combination of reduced resources, short termism and declining standards (see baby death rate) will ensure more and more opportunities for citizens to litigate. Reducing tax relief on pension contributions is another tempting short term fix…  

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Frances Gibb in the Times 15th October reports: NHS payouts to disabled children reach £100m in a day

Sofia Lind in Pulse 20th September reports: GPs should expect to be sued every 10 years, says defence organisation.

Tim Ship man reports in The Times 14th October 2018: Budget pensions threat to raise £20bn for NHS

Chris Smyth on October 15th reports in the Times: Baby death rate could soon be double that of western nations



This entry was posted in A Personal View, Gagging, Medical Education, 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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