There are a couple of matters which have surfaced in the recent past including the unspeakable behaviour of most Republican Party representatives in the United States Congress and some rather unfortunate problems faced by management of NHS England. As to that, The Chief Executive of said department, Amanda Pritchard, appeared before the health and social care committee. As reported in the Guardian, just hours before she had appeared before the committee, the House of Commons public accounts committee, or PAC, published a report which accused leaders of the NHS and the Department of Health and Social Care of lacking “drive” and “ideas”. In addition, after Ms Pritchard gave evidence, the health committee issued a statement, which said, Ms Pritchard and her team lacked “drive” and “dynamism”. Their quotation marks, not mine.
I had posted a blog on Wednesday the 5th July 2023 (to be found at https://fbuffnstuff.blogspot.com/2023/07/managing-nhs.html) concerning an interview on the Today Program with Amanda Pritchard. During that interview, Ms Pritchard was asked to comment on a joint statement made by the three main health think tanks in the UK, the King’s Fund, the Nuffield Trust and The Health Foundation, which said that the health service suffered from “insufficient resources to do its job, fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT”.
I was rather critical of Ms Pritchard’s answers to questions, or rather non-answers. I commented that when it was suggested that she could put pressure on the politicians to resolve some of the issues causing the current difficult and possibly damaging industrial action, she again shied away from an answer. She stated during the interview “I’m not a politician, wages and funding is down to the politicians, I’m only the Chief Executive”. In the event she came across as Ms Pollyanna, speaking joyfully of planning for more trained staff in the future and generally looking forward. It sounded all very positive but was, in my view, merely a classic ministerial projection of neverland. She made no mention of the outdated equipment and dilapidated buildings and other basics which make it impossible for the staff to do their job. This was of course at the start of the Conservative Government’s last year in office.
My own view, a the time, was that what she should be doing is taking up the report from the King’s Fund, Nuffield Trust and Health Foundation and battering the Minister and government to deal with the failing infrastructure. Hospitals need urgent repair and maintenance. Hospitals need functioning and up-to-date equipment. Hospitals need the latest technology. Hospitals need the best and most efficient IT. Hospitals need staff trained to deal with the latest and best kit available. To train staff in, and with, crap facilities and equipment is counterproductive as they will have to be trained all over again. What reduces waiting and mistakes is effective efficiency. What makes efficiency effective is knowledge and training with the right tools. With effective efficiency you get savings and with savings you get more productivity. To get productivity you need the best staff, and to get the best staff you need to pay them accordingly. Corporations have been going on about this for years (The BBC is an instance in point – they claim they must pay high wages to keep the best talent).
Now, under Labour, the Guardian reports (full report can be found at https://www.theguardian.com/commentisfree/2025/feb/11/the-guardian-view-on-the-health-service-the-problems-go-deeper-than-the-boss), “The frustration of MPs on the health committee at what they regarded as long-winded answers was obvious to anyone watching. But Ms Pritchard is not a politician, and one reason for a lack of clarity in her answers was that the publication of crucial guidance, including updated targets, had been postponed by ministers”
Effectively, poor Ms Pritchard is in the unenviable position of being caught between two stools or rather regimes, neither of which is providing the actual resources required to provide the NHS with the fundamental equipment, buildings and medical personnel needed to make it progressive and efficient. So, having a go at management is all very well, but if there is no real added value to manage, what’s the difference? The Guardian article added, inter alia:
“While MPs, like voters, are understandably impatient for improvement, the expectations of the people with operational responsibility for the health service should be realistic. Given funding constraints, and the fact that NHS England’s structure (with its 42 integrated care boards) is still bedding in, it is unclear what demands for transformation really mean – beyond a wish that things were better than they are. Julian Kelly, Ms Pritchard’s deputy, explained that most of the £10.6bn increase to the organisation’s budget in 2025-26 will be absorbed by salary and national insurance rises, inflation and the £3.5bn allowed for rising costs caused by an ageing population and new treatments…..
Sorting out the confusion should be a priority for the new permanent secretary of Mr Streeting’s department, who is due to be appointed shortly, along with a new chair of NHS England. The filling of these two vacant posts means Ms Pritchard is likely to find she has less room to manoeuvre; the high level of autonomy granted to NHS England by the Conservatives is in the process of being reduced.”
So, in reality we are no further along than tinkering with changes of management as opposed to actually dealing with the nuts and bolts of the service which are necessary for management to be able to do their job; therefore, what was the change of government about?
I have, recently, become one of the more active patients of NHS England and can only speak glowingly of the treatment that I have received. Whilst there have been minor hiccups, the overall dealings I have had with Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts is superb. To allow it to deteriorate would be an abomination. There are of course glaring abnormalities to be found and which make very distressing headlines, but given the numbers being cared for and the size of the organisation these anomalies are a small percentage of the overall performance. Nonetheless it is extremely disturbing such problems exist at all given the tragedies that can result. Striving for 100% efficiency and effectiveness in the NHS is to be lauded. It is hoped it can and will be achieved, but it will be at some cost.
Another matter involves the lies being told to courts by the security services. This is mainly done in order to maintain the standard response by security personnel “I can neither deny nor confirm whatever it is you want to know”. Legal actions involving the security service are often, and usually are, conducted in secret hearings behind closed doors, with the participants having been granted security clearance. More often than not, plaintiffs, witnesses and sometimes their lawyers are not admitted to such courts, nor can they be told how or what led to a court’s decision. Given the rarity of such cases it has always been assumed by the Judiciary that public government servants (which is what security agents are) do not lie. That is a fiction which has been debunked, or rather a fiction that has finally caught up with what we all already knew. Spies tell lies. It is what they do because they are trained to do so. It is the nature of the beast. The current revelations and admissions by MI5 that its agents had told lies in court is not new or shocking. What is shocking is that justices and concerned persons profess to be shocked, which I find just as mendacious.
As to other matters arising in the United States, there are too many to mention. Elon Musk giving a press conference in the Oval Office, with Trump sitting like some side-line observer, whilst Elon held forth with his small son on his shoulders as if he were in complete control, and wasn’t it cute and fun to have the kid there, by the way. He did not seem to defer to, or acknowledge that Trump was even there, or even had any part in His Department of Government Efficiency. He was being transparent. Everything he was doing was out in the open. That no such Government Department is actually authorised by Congress or the Judiciary is, to him, of no consequence. The only thing that was open was that he was acting without any proper legal authority. How he was going about it was not at all transparent. Only his outrageous decisions were out in the open. Since when does he have the power to delve into personnel files, hire and fire and close down government activity?
There are also various congressional oversight committees to question heads of, and permanent staff of, various legal government departments and to approve the various presidential nominees to run some of those government departments. To watch and listen to those hearings is a never-ending state of disbelief. The divisions on display are deep and run along the slimmest of margins. That Trumps Republican Party can claim a mandate through some sort of maniacal allegiance to Trump claiming adherence to the constitution and the democratic process is horrifying. The giving in to executive orders and unconditionally appalling acolytes as his cabinet, is beyond comprehension. The complete absence of so called checks and balances no longer exists. Unless Congress reasserts itself as an equal branch of government, American Democracy is no more and the Empire, that is the United States, will expire. Its disintegration is already apparent in the ludicrous fantasy of the new middle eastern riviera on the Mediterranean. You can already see a new Trump Tower with Casino, spa, boutiques and west facing balconies to watch the sunset, all funded by his crypto currencies. Bye Bye American pie.
No comments:
Post a Comment