Postman Prat Speaks.

Our new SS for Health yesterday sent out a letter to all NHS staff providing initial details of the latest review of NHS Services, the first of many no doubt.

Slightly edited for reasons of space.


Dear colleague,

Next year marks the 60th anniversary of the National Health Service.
While the challenges our service faces today may be radically different
to those it faced in 1948, the fundamental principles that underpin the
NHS has remained constant throughout the last six decades.

G – Hurrah!

The service has seen many changes over the last 59 years, but, arguably,
the last five years have been among the most testing for NHS staff as we
have faced the dual challenge of using unprecedented investment to
deliver increased capacity while driving through radical and bold reforms.

G - That would be ‘expenditure’, not ‘investment’ unless invoking the military terminology that suggests ‘laying siege to’, which seems strangely apposite. Bold and radical reform probably refers to the constant reorgansation, the greatest beneficiaries of which are the printers of letterheads! And an accountancy system that doubly punishes indebted organizations. And an addiction to the use of consultants. The overspend in the NHS was about 1bn last year – guess how much was spent on management consultants during the same period? (hint: the answer’s in the question). So bold, so radical….shame you didn’t trust us to come up with the ideas ourselves!

Any objective assessment shows that the NHS is performing better than
ever, with more than one million operations taking place each year, waiting
lists down and patient satisfaction rates up. Yet subjectively and anecdotally, there has been confusion and frustration across the NHS with many staff suffering from reform fatigue.

G – If you going to spend that much more there is bound to be a statistical improvement but £ for £ productivity has decreased. That’s the problem with chucking money at an unreformed system. Didn’t they teach you that at the sorting office? The paragraphs accuracy would also benefit from changing the words subjectively and anecdotally to objectively and demonstrably!

This lack of confidence and strained morale matters, not only because it has an impact on our ability to deliver patient care, but because it suggests that our most important asset – you, our staff – have not always been as involved in the changes that have been made to the NHS as you should have been.

G – Really? I’m impressed that you’ve worked that one out. When was the epiphany? I know it’s easy to miss the blindingly obvious sometimes but surely someone could have figured this out before now?

So, to ensure that we move forward together in a more cohesive way, we are today announcing a wide ranging review of the NHS, which will be led by Professor Sir Ara Darzi – one of the world’s leading surgeons and a newly-appointed Minister who will continue to practice medicine.

G –Moving forward together in a cohesive way led by a part time minister or a part time surgeon, you decide.

The review, which has the full backing of the Prime Minister, Gordon Brown, will consider the case for a constitution of the NHS as the basis of a sustainable and lasting settlement that meets these challenges, enhances local accountability, secures value for money and protects the fundamental values that the NHS embodies.

G – So this is going to be a constitution rather than an amending instrument or a tidying up exercise? Can we have a referendum please? It would almost seem credible if this wasn’t the same Gordon Brown who is cutting the capital allocations for England to protect the celtic fringe and building up a mountain of off balance sheet PFI debt. Or is this his idea of a sustainable and lasting settlement?

We have a once in a generation opportunity to ensure that a properly resourced NHS is patient-centred, clinically-led and locally accountable.

G – I thought we had a once in a generation chance to save the NHS in 1997. Surely this doesn’t mean that the service has been mismanaged since then? Heaven forefend! Local accountability again? Why not have local people voting for the board members of their local Acute Trust / PCT and give them the ability to set policy that suits local needs? No? I thought not!

Professor Darzi will engage directly with frontline staff, not just the great and good of the health world. Over the coming weeks everyone who is part of the NHS will have opportunities to take part.

G – If my experience of some consultants is anything to go by Prof. Darzi’s conversations with ordinary frontline staff should be fascinating.

You can contribute any initial thoughts to our mailbox, nextstage@dh.gsi.gov.uk.

G – I would invite all (2) readers of the Grendel blog to forward their opinions too. I assume that the locally led changes will see wholesale closure programmes halted….No? I didn’t think so!

Your views matter: we can only develop a robust social partnership between patients, practitioners and policy makers that is truly underpinned by trust, honesty and respect, with your involvement.

G – Blah, blah, blah ad infinitum. You really want to know what would help? Would you? Then fuck off and leave us alone to get on with the job. I don’t want to talk to you or your acolytes I want to be left alone to do my job, which is to support the clinical guys in doing theirs. I don’t want another ‘big conversation’, I don’t want to have to wade through reams of turgid government propaganda masquerading as information. I don’t want to read about robust social partnerships, patient-centred, clinically-led services, stakeholders and forward facing strategies. It means nothing, It’s the use of hyperbolic verbiage to cover up a void of talent and original thought. Until you figure out that you are the problem, you, Patsy, Milburn et al then how can anything get better, You have wasted billions on pointless computer systems, reorganizations and initiatives but now the money and your political credibility has run out you are turning to us to save you.

Maybe if you had asked our opinions in the first place then this wouldn’t be perceived as the shallow political exercise that it so obviously is!

And if you had asked our opinions in the first place then we probably wouldn’t be in this mess now!

Alan Johnson

G – Love, hugs and kisses xxx