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Rapid Responses: Rapid Responses published:
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Too Many Chefs........
- Jay Ilangaratne (16 August 2008)
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Free the NHS from political meddling
- Laurence E Wood (18 August 2008)
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Only one credible and strong NHS Board is needed
- Layla Jader (21 August 2008)
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Jay Ilangaratne, Founder www.medical-journals.com
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Having "several NHS boards"[1] could be akin to having Too many Chefs....I think it would lead to greater chaos and inconsistencies with the all-important taxpayer having to foot a higher bill for the management of such multiple NHS boards. Hence,at a time when the NHS is facing unprecedented demands on its resources,it is neither wise nor practical to emabark upon experimenting with yet another management structure. I honestly cannot see that further subdivisions as suggested[1] would reduce inconsistencies,improve credibility, or improve overall efficiency of the NHS.Given Ministers have the ultimate authority as to policy making,it may be that improving ministerial efficiency is more apt than the scholarly suggestions of the authors[1]. References [1] Rhema Vaithianathan and Geraint Lewis Operational independence for the NHS BMJ 2008; 337: a497 Competing interests: None declared |
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Laurence E Wood, Lead Obstetrician University Hospitals Coventry & Warwickshire
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Vaithianathan and Lewis make a compelling plea for independence of the NHS from party politics, but one of their central tenets is fundamentally flawed. They suggest that parliament still drives performance management, both in relation to short term ‘targets’, and long -term ‘outcomes’. Whereas the long term sustainable vision is clearly a matter in which politicians have an important stake, it would be a grave and stifling mistake to look to them for micromanagement. An empowered multi- professional team will design a far more effective performance management framework. High level performance management is to make sure that this happens, rather than to meddle with it. (eg “What are your main problem areas? How will you tackle them? How will you know if you are successful?” etc). Where politicians and clinicians agree on targets, the political input is superfluous. Where they do not, political distractions stifle forward movement. The result is to create demotivated teams who ‘tread water’, and who define success as staying alive – look at any Trust Board agenda. But treading water is exhausting, and eventually you sink. The NHS will only become successful when we unleash a host of clinical teams, and foster constant forward movement, unhindered by irrelevancy. Laurence Wood
Competing interests: None declared |
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Layla Jader, Consultant in Public Health Medicine Wales
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Although I agree with Rhema Vaithianathan and Geraint Lewis notion of an operational independence for the NHS, I disagree with their model and their arguments for multiple Boards dealing with separate NHS issues. Not only these issues are linked with each other and inter-dependent, such a system will lead to chaos and increased bureaucracy. Wales is facing its biggest ever NHS structural re-organisations where by none of the organisations that were controlling (DHSS within Welsh Assembly Government), commissioning or delivering services will be untouched by the change. While England can only dream of such a concept, we can make it a reality in Wales. It is an opportune time for Wales as part of this major re-organisation to go the extra mile and create an a National NHS Board that have members elected from within their organisations that include the main political parties and NHS professional groups such as doctors, nurses, managers and others , , . This is based on the concept that the NHS is such a fundamental pre-requisite to our prosperity that only by working together will we ever succeed in achieving the stability it craves. We have to all acknowledge that we are in this together no matter how hard the decisions are or how unfamiliar and untraditional the concept is. Working in the NHS for 30 years taught me that we mustn’t leave a legitimate stakeholder out in the cold. Not only they have a legitimate stake but leaving them out will create havoc and ensure continued instability. The model I am suggesting is that future health ministers will have the power of deciding the overarching funding and policy framework based on their party(s) manifesto(s). He/she will also have the responsibility for public health and ensuring that various government departments are also working within a public health strategic framework. The minister would have to delegate the day to day running of the NHS to this credible, powerful and respected all parties’ Board. Only such a powerful Board with Assembly Members on board would be protected from ministerial interference, although within the required legislations in the future there will be times under clearly defined few conditions when such ministerial actions will be allowed. As the chances of a Labour government diminishes by the day and possibility of a Conservative government in Westminster becomes even stronger the only chance for a coalition that includes the Labour Party in Wales relies on a major shift in voting at the next election. In my view such a strong altruistic concept will buy them the extra votes they need to stay in power in Wales. Competing interests: None declared |
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