Wednesday, 18 March 2009

'Individual management failures'

The headlines surrounding Staffordshire General Hospital have been hitting the news in the last few days and it is hard to see how anyone could not be outraged at the appalling standards of care 'provided' there. Gordon Brown was answering questions on the subject at lunchtime today and he kept repeating the words 'individual management failures' while ignoring repeated criticisms of the NHS' dire central management which imposes the market from Whitehall and the top down target based system that is arguably to blame for problems like Staffordshire General's.

Others have covered this story already. Dr C points out that anyone pointing out these kind of glaring failures in care is likely to be labelled mentally ill by the GMC, such is a whistleblower's fate in the NHS. Dr Grumble points out how the idiotic target based system encourages the prioritisation of political imperatives over clinical ones leading to junior doctors being bullied by managers into ignoring the clinical priorities of patients. Dr Rant points out where the blame should lie. The Witch Doctor cleverly points out that the 'leaders' which this government is so keen to marginalise are probably the only people who could dig the NHS out of the deep pit which the politicians have been digging for so many years.

Alan Johnson and Gordon Brown are living in cloud cuckoo land. While some hospitals do manage to provide high standards of care, it is despite the government's central megalomania, not because of it. The problems in Staffordshire General stem from No 10, the DoH and the top. The government's top down control freakery and brutal imposition of various brainless reforms is the cause of problems like this. The management structure of the NHS is centrally driven and top down, there is no room for feedback, no room for local decisions, it is do as the government says or die, quite literally in some cases.

It is no coincidence that patients were killed in both Maidstone and Staffordshire as a result of Trusts prioritising their finances over patient care. Both hospitals were trying to gain Foundation hospital status, hence they wanted to save money and meet targets, whatever the cost in terms of patients being slaughtered. The government has killed these patients with its systemic mismanagement of the NHS. The market has been their top priority and imposing this from the top has come with the obvious costs attached. There is no doubt that the governent has created this environment in which finances are prioritised ahead of patients' lives.

Gordon Brown and Alan Johnson have the blood on their filthy hands. These are not individual management failings, these are systemic failings as a result of a Stalinist system that forces managers to prioritise the government's wishes ahead of patients' clinical needs. The government's explanations for these deaths do not cut the mustard, it is simply not good enough to try to pin the blame on individual managers. The blame lies with a cynical and corrupt system that is set up to meet the short term propaganda gathering needs of politicians, local managers are frequently in a no win situation as they are forced to meet political targets rather than improving the process of clinical care with their hospital.

Gordon Brown's stupid words in defence of his targets sum it all up beautifully, he claimed that no reasonable person would deny that cancer patients should be seen within two weeks and that AE patients should be seen within four hours. Actually Gordon I am reasonable and there are many situations when it is very reasonable for minor injuries to wait many hours for treatment, as if there are moribund patients needing resuscitation in the same AE department they must be the number 1 priority and the sore big toe or the itchy buttock can damn well wait.

Targets do not improve patient care, only extra investment and a consequent increase in capacity can do this, the targets are a bit like robbing Peter to pay Paul, improving care for one condition invariably results in someone with another condition suffering. All the managers in Staffordshire General were doing was responding to the pressures of a system that had been put in place by central government, if they had some local autonomy then it would be fair to blame them, unfortunately they did not. The government has created this dangerous clinical environment, it is they who should be up in court charged with murder.


Anonymous said...

Dear FF,
Ra Ra to your rant. Although the NHS does not need additional funding, its not going to get anyway. What it needs is the money to be directed towards providing clinical care, not job opportunities for wannabe managers. Then of course you appreicate this. Keep up the good work.

Garth Marenghi said...


So much of the extra cash has gone to feeding useless extra layers of bureaucracy such as the PCTs

Look at what the PCT did about Staffordshire General and you can see why this money is basically being pissed down the drain.

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