General who led invasion of Iraq to report back on NHS management review

ByAnn Erika

Jun 8, 2022 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,


Within the Government – most markedly from the Treasury – there is clear concern about efficiency and spending on bureaucracy.

Boris Johnson has just ordered a Civil Service cull, with 91,000 jobs due to go in order to cut costs by £3.5 billion.

But some of the questions facing Sir Gordon are rather different.

Merry-go-round of management

The merry-go-round of health service management, with hospital chief executives staying in posts for an average of four years, means failure can be rewarded – or recycled.

It also means there is little appetite, or reward, for those prepared to take on the most intractable problems, and invest the time needed to turn around performance.

Sir Gordon is understood to be concerned that too much NHS management energy is focused on immediate and short-term tasks, with too little attention paid to the long-term agenda; and the need for more fundamental changes in the way care is delivered.

He will also consider the vexed question of money and whether the best deserve more of it.  

The review is being asked “whether the right pay and incentives are in place to foster good and excellent performance and recruit and retain the best leaders from start of career to retirement”.

Latest data shows the number of NHS executives earning at least £250,000 a year rose by more than 50 per cent last year. The official figures reflect more than 1,000 senior NHS managers on at least £130,000 annually, including 150 on more than £200,000.

But attracting the best may mean paying for it, even if the political stomach for such moves is limited.

Highly politicised system

NHS leaders are also working in a highly politicised system. A decade ago, ministers introduced radical changes to the way the NHS is run in an attempt to foster more competition. Many have since been quietly reversed, with efforts to introduce more collaborative working, and ensure different parts of complex health and social care systems work together.

The measures also introduced a new body, NHS England, which was supposed to mean the NHS had some operational independence from the Government.

But during the pandemic it became clear that the number of different organisations responsible for aspects of healthcare could make for a muddled blame game and a lack of accountability.

Sajid Javid, the Health Secretary, has vowed to be “watchful of any waste or wokery” in the way record NHS funding is spent.

He has his own ideas about the way the health service should be run, although most of his public pronouncements have spoken in favour of reform in the broadest terms.

The recent appointment of former TSB executive Richard Meddings as chairman of NHS England reflects Mr Javid’s desire for a “radical shake-up” of the NHS, with an “outsider’s eyes” keeping watch.

‘Super hospitals’ being considered

The Health Secretary is understood to be working on a major NHS Reform White Paper, which aims to turn around failing organisations, and could see the creation of “super hospitals” merging different groups. Ideas under consideration could see some GPs directly employed by hospitals instead of running their own practices.

Most family doctors are effectively self-employed. As a result, ministers and health officials have limited levers when they are dissatisfied with the way surgeries are being run.

Meanwhile, many ideas about how to improve the calibre of leadership and support those in the toughest jobs are familiar to those with experience of the health service, which has previously tried “buddy” schemes to pair up failing hospitals with those which are more successful, and schemes aimed at getting more medics into management positions.

But there has long been concern that there are few repercussions for senior managers who preside over the most grave failings.

Earlier this year, Mr Javid pledged to “go after” those responsible for the maternity failings in the Shrewsbury maternity scandal and make sure they are held to account.

But this is a debate the public has heard before – most notably in the wake of the Mid Staffs scandal, where plans for a register of managers, so they could be “struck off” for the most egregious failings – came to naught.

With record funding being pumped into a most precarious service, the challenge for those running the NHS has never been greater. 


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