Rather strangely, neither the Telegraph nor the Guardian appear to have covered a story made a big impact in both the Mail and the Express this week. It is not a trivial, celebrity story but one that goes to the heart of one of the big issues of the time: whether the NHS model of healthcare can ever deliver a first class service.
A consultant surgeon, Mike Lavelle, has resigned from the NHS and leaked a letter in which he made a powerful attack on the way the NHS works.
"The delays in operating theatres are quite frankly scandalous" he says.
"I have no doubt that the service is grossly overmanaged now.. there has been an almost unbelievable increase in NHS employees who contribute nothing to the treatment of patients. But if you go onto my ward the nurses are struggling to look after the patients..."
"For years now, I have been stopped from doing my job in the NHS by the lack of facilities, but in public, the politicians (in particular Alan Milburn and John Reid) have blamed the consultants for the waiting lists. This is extremely demotivating and demoralising", Mr Lavelle wrote."It seems the Government thinks that if only they could get the consultants in the NHS to work harder, then waiting lists would be a thing of the past.
"You may not believe this but I have found in the past 10 years or so that the harder I work in the NHS the gloomier managers get because I am spending the limited resources. The delays in operating theatres are quite frankly scandalous. I have complained about this for years, yet nothing has been done.
"In the end, the taxpayer is paying twice for the operation; once when I am sitting around doing nothing, either because of delays in getting patients to theatres or because of lack of beds, and then again when the operation is farmed out to the private sector."
The above quotes are taken from the limited version of the story on the Daily Mail website.
From the printed version, I would add that Mr Lavelle also criticised the employment of a 'Service Improvement Facilitator' who visited the the endoscopy unit to inquire about the number of endoscopes (in instrument for internal examinations).
"Everybody knows that to improve the service we need a second room up and running and some new endoscopes, but instead of that we employ these people to go around interfering and collecting inaccurate data."
"A year's salary for this person would probably but a new colonoscope and we could have a new scope every year for the next five years!"
"It is my impression at the moment that there always seems to be money available to appoint new managers, but if you go on to my ward the nurses are struggling to look after patients because the establishment is inadequate."
The criticisms of Mr Lavelle indicate some of the answers to the question which we can expect people to be asking more and more in the next few years: 'why has the NHS improved so little when so much has been spent?'
1. Waste of money when operating theatres are not used and highly qualified staff (not to mention the patient) are left hanging around
2. Waste of money on administrative staff which could be better spent on frontline staff.
Some politicians might respond, "Right-o, we will demand that operating theatres are used more efficiently and we will cut back on admin staff". They will imagine that yet another diktat from the centre will solve everything. How many times has this naive idea got to be tried out before it is understood that it will not work?
The problems identified result from a systemic problem. State monopolies tend to be extremely wasteful. They do not have the same incentives simultaneously to save money and serve the customer very well. Their 'customer' is the central government. Their employees' jobs depend on doing what central government demands. So they do what central governments demand. They fill in forms. They report back on how they have carried out instructions. They need more staff to do this. This is the priority and never mind the patients, the waste or all common sense. The NHS is an inherently bad system because it is a government monopoly. Only when the NHS is reformed in a way that it ceases to be a government monopoly - in other words completely breaks with the Bevan model - will it have the remotest chance of being good.
Incidentally, I would be interested to know what Mr Lavelle is going to do next. Neither the Express nor the Mail reveals that. Will he work in private practice, retire or work abroad?
Posted by James Bartholomew • Indexed in NHS • Waste in public services
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After watching 2 TV programmes recently chronicling the demise of MG Rover it was evident that the total disarray and incompetent management of this company was as bad as anything I’ve ever come across in the NHS.
This made me realise that any large organisation, state or private, is prone to descending into a shambles, presumably because human beings tend not to function very well in these environments.
It therefore follows that no amount of tinkering, new initiatives or ever growing funding can change this natural human behaviour. I can think of only one tried and tested solution, privatisation and exposure to market forces.
One would have thought that intelligently applied targets in a state organisation could have performed the role of market forces in a private company, but we see all around us examples of bureaucracies performing worse with targets than they ever did without them. I suspect that this is another example of immutable human nature.
Posted by: John East at June 18, 2005 03:25 PM
How well did centrally-controlled units 'perform' in the old Communist days? Complete with targets & all? Why should a tax-funded NHS do otherwise?
Posted by: Sudha Shenoy at June 19, 2005 04:07 AM
Rover is not free enterprise. It was tinkering.
It's a typical example of what continually happens when ignorant public sector people play god with our money, and work out "deals" with private business.
Basically, because they are incompetent they get shafted (see *every* PFI) and there's nothing that they can do because they signed a dumb contract.
And, of course, they never take any responsibility for their mess, they just take the money out of our pockets.
The NHS will not deliver because it is not in its interest to do so.
If they actually did a good competent job, then they wouldn't be able to plead poverty, claim how things would be sooooo much better if only they had this.
It's amazing (and I speak from experience) if you actually say to people who come to you demanding £xxx "get stuffed, work it out with what you've got" how quickly you can come to a workable solution.
Lazy incompetent managers *always* blame lack of funds.
The basic problem is not to do with public/private sector. It is to do with responsibility for the money.
If it's your money or you are directly responsible for it you do elementary things like count it and check what you are spending it on, and check it isn't being wasted on (say) glossy magazines that no-one actually wants or burnt in inept failed PFI deals.
If it's not your money, then you just waste it and whinge more from the poor tax payers.
Even if you are taking tax money the problem can still be circumnavigated by the concept of responsibility.
In a private company you waste £ 2 million you are likely to be fired. In a public company the *worst* that will happen is you will be pensioned off, and that's in extremis. Normally *nothing* happens at all.
An example of the waste of the public sector.
Norfolk (where I live) Social Services overspent by £4m in 2002-3 (!), and claimed not to be aware of this till the end of year accounts (!!)
To solve this problem, they hired three accountants (at our expense) so they could track the money (it's not that difficult !)
In 2003-4 the overspend was £8m.
Posted by: Paul at June 19, 2005 01:17 PM
Targets never ever work, done this way anyway, because they are simply fiddled.
The waiting list targets are a lie. The crime statistics are a lie. The exam results are lies.
It is Blairism, the epitomy of media management over actual achievement.
It doesn't matter how rubbish you are at something, providing you can convince the press otherwise.
Posted by: Paul at June 19, 2005 01:18 PM
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Having worked at the same hospital as Mike Lavelle & seen the same things happening that he describes I agree with everything he writes.
Mike Lavelle is a very committed & experienced surgeon &, whilst I was working there, it was clear that he was becoming very disillusioned. Things obviously have only got worse since I have left.
I suspect that he has a reasonable private practice that will support him for some time - he practices in a high area of privately insured patients.
Posted by: Thersites at June 18, 2005 12:49 PM