NHS business model has failed
Dear Editor, Two major problems in the NHS need to be corrected. First the “business” approach has been an abject failure. Secondly, general practitioners should not be in charge of determining how the majority of NHS money is spent.
There should be no such thing as a “collapsed NHS Trust” (Post, April 18). The hospital was said to be overspending by around one million pounds a week – on too many doctors and nurses?
Rather the reverse. It has fallen into “administration” because a succession of administrators cannot manage. Such events were absent until 20 years ago: at that time Kenneth Clarke introduced the business approach to hospitals: they were progressively reliant on earning their funding by providing paid services to patients of general practitioners.
The changes progressed over the next five years or so, and then from 2000 to 2010 the Labour Government, though doubling expenditure on the NHS, wasted many billions by increasing the number of administrators by 104,000 – largely to cope with the financial interchanges involved – but effectively on occupational therapy for administrators, not on patient care.
Andrew Lansley might have thought he was improving the situation by putting much of the NHS budget into the hands of doctors, in the form of GPs as “commissioners” or purchasers of health care.
As a generalisation, in any cohort of, say 100 medical students the majority of the most academic and forceful personalities in the top 50 will become consultants.
Future GPs are more likely to feature in the lower 50; they perform an important service on the community and some may consider they are more often people – friendly individuals. Female medical students now outnumber male students and more will become GPs and more will choose, for family reasons, to work part-time. Most GPs now opt out of night and weekend duties – hospitals cannot.
In any area, individual hospitals and their consultant staff have been the major force behind any development including intensive, coronary and cancer care and day hospitals. Hospitals have developed at different rates but in cooperation not competition with neighbouring hospitals.
Prior to 20 years ago they were allocated a budget centrally, and they operated within this budget without major overspends. The consultant body elected its leaders democratically; they had a long term commitment and pride in improving their hospital and usually stayed for at least 25 years. Manager and administrators acted in a supporting role rather than in the dominant bleak “target-driven” role they now occupy.
Dr Barrie Smith
Management to blame at Stafford Hospital
Dear Editor, As someone who lives in Stafford, the crisis at Stafford Hospital is a sign of something badly wrong beyond one particular institution.
I can only hope that the magnificent demonstration last Saturday will jolt the policy makers into action on fundamentals, as the bad news was known in the town for a long time – but it was swept under the carpet.
The politicians have to accept responsibility, and this they are not doing. It is futile to bring in more training for starter nurses.
The problems in the Trust were at management level. They were driven by politician actions notably the drive for Trust status.
Blaming nurses is odious. It is even more so when we learn that nurses now have so much paperwork they are diverted from their real job, looking after the sick.
Add to this the news of fat cat managers making money when nurses have had their pay frozen under government austerity for two years and we can see how the priorities are totally wrong. The aim of the politicians running the system are to cut costs to make money, and one step to this is sacking clerical staff and making nurses fill in forms.
This is not just a problem for the NHS, but also for education. It is bizarrely logical that Michael Gove, having induced the Pay Review board to abolish the teacher pay scales, then attempts to have the Review board abolish the regulations which limit teachers to working only with children. The aim is to force them to take on 21 administrative tasks.
The government’s priorities for both nurses and teachers are clear. They will do more and more work on non-essential tasks to cut the pay bill even though this means they cannot do the jobs the public expect them to do.
If the lessons of Stafford Hospital are ever to be learned, they must be extended across both Health and Education to remove the political interference which prevents teachers and nurses focussing on the work the public expects them to do.
Political structure of city needs overhaul
Dear Editor, In spite of the appalling weather, our industrious Town Council referendum group, the main Sutton Forums, Resident Associations, Community Groups, and indeed all of our residents, are now closing in on achieving the number of petitions needed for our joint aim of a referendum for greater autonomy for Sutton, possibly in the form of a Town Council.
When submitted, Birmingham Council will undertake a governance review to place proposals before residents leading to a referendum.
A properly constituted autonomous body could even provide the basis for the return of our historic Royal Town.
Our petitioning has indicated a wish for complete independence, but an element of legalised autonomy now would be acceptable as a step in the right direction.
Although we are taking this action under current localism legislation, we believe that another Cadbury Commission is urgently required to review the structure of the whole of Birmingham, and although they originally looked at breaking this place into a small number of Unitary Authorities, the politics of both parties at that time, killed the radical change really needed.
I have already called upon Sir Albert Bore to stretch to the limit on what can legally be offered to Sutton during the full council session last Tuesday, and our group were pleased with his response which was very positive.
We would, however like his team to also see this as a precursor to what can take place in wider Birmingham.
The largest local authority in Europe cannot continue in its current form, and its structure requires significant change. I appeal to all of our Birmingham constituencies to follow the Sutton lead, and place our joint democratic aim for Birmingham on a level with the rest of the UK and Europe.
Ken Rushton, Chairman Vesey North Neighbourhood Forum,
Chairman Sutton Town
Council Referendum Group
Sympathies with those not on benefits
Dear Editor, The article by Jonathan Walker (Post, April 18) about the “devastating impact of benefit cuts” makes me wonder what is so devastating about them.
The measure is being brought into force to make sure people who are on benefits do not receive more than the median gross salary.
Surely that is fair.
What about the many families who work for less than £25,148 a year and do not receive benefits.
That’s where my sympathies lie.
Tessa Miller, Sutton Coldfield
Fire service cut backs puts lives at risk
Dear Editor, A fatal fire in Tyseley, thousands of tonnes of paper alight in Nechells, and what do we see?
More cutbacks and our fire bosses nodding their heads in political cohesion. This isn’t making our fire service better, we’ve seen the same by our chiefs of police and by the bosses of the ambulance services.
So just when are our emergency service top brass going to stop making excuses and toeing the official line and tell the truth – cutting back on jobs to appease the bean counters isn’t improving efficiency or creating better working practices, it’s compromising security and putting lives at risk.
We expect our leaders in the emergency services to be putting the public at the top of their agenda and not complicity to save the faces of their political masters.