Doing the business


Artykuł pochodzi z pisma "Guardian"

Doing the business

The government wants NHS managers to be more businesslike but does it know what that means, asks Roy Lilley

Wednesday April 2, 2003

To this former businessman, recruited to chair a trust hospital in the 1990 Tory health reforms, it was clear the NHS needed a dose of the real world.
Nothing was properly accounted for, staff set their own agenda and any mention of the patient as a "customer" would bring the roof down on your head.
Now, Labour is set to have another try at modernising the NHS. It wants services to become, to quote Tony Blair at the last Labour conference, "as good as they are in the private sector".
He means business, but does he really know what a business-like NHS means?
Mrs Thatcher's reforms fizzled out through lack of political will and a constant erosion from within the system. Will it happen to him?
So far the extra millions poured into the NHS have produced almost no lasting improvement. More patients through the system, true, but seen by the same staff, working in the same ways, paid slightly better for doing the same job.
The stunningly good businesses that excite the prime minister are the product of a fanatical obsession with customer needs, ruthless competition, blindingly good information technology (IT) systems, a passion for quality and excellence and flexible staff driven by a carrot and stick - in equal measure.
The NHS has none of this. Patients are kept hanging around in a fragmented system. It loses medical notes in a pencil and paper slum; it ticks over on comfortable collegiate cooperation; unforgivably, it inflicts hospital acquired infections and has a naive quality inspection system based on announced visits by health managers checking each other.
Were the NHS a business, it would be out of business.
The reason for this reality gap? Doctors, nurses and health managers are largely home grown. Few of them have worked outside the NHS and fewer of them have any clue how a modern business is run.
Labour has made a good start by bringing in an outsider, Richard Granger, the tough new IT tsar. He has already upset complacent and sometimes deceitful IT system suppliers. He is set for a row with GPs who will have to dump their investment in toy town practice computing that is, mostly, little more that a diary system with a prescription printer.
And Mr Granger will have a fight on his hands with hospital consultants who are resisting electronic patient booking. It is consultants' secretaries who manage NHS appointments, often juggling them to fit in with commitments in private practice.
IT systems managing patient records, means IT systems that can audit outcomes and clinical performance, holding staff to account. Incontestable electronic appraisal is common in business but rare in the NHS.
The new foundation hospitals, free to borrow and operated in a business-like NHS are a huge test for Labour's resolve. If they are to prosper they can only do so by consuming, merging and taking over other, less efficient hospitals.
And, if the bill is passed, any health provider - public, private or foreign - would be able to apply for foundation status and compete within the NHS. A mixed economy of health companies challenging each other, to look after us. Competition levers up quality, keeps a handle on costs.
Employing staff on local conditions, reflecting vacancy levels and skill shortages is a common solution for business with recruitment problems. Foundation trusts would be able to do this and, in the process, strip health unions of their national pay bargaining role. Another test for labour relations.
A modern, business-like NHS will challenge vested interests, shake up established practice and turn patients into customers. It will be hard labour for the new NHS and even harder for New Labour.
• Roy Lilley is a former health authority vice-chairman, and the chairman of Homewood NHS trust from 1990-95. He now writes and commentates on health policy. He can be contacted at:

appraisal – ocena, oszacowanie
complacent - zadowolony z siebie
fizzle out - spalić na panewce
inflict - wyrządzać
incontestable - niekwestionowalny
juggle - żonglować
merge – to connect, połączyć
NHS – National Healthcare System – panstwowa sluzba zdrowia
ruthless – without mercy, bezwzględny
slum – a dirty place
tsar – an official
vested interest – ulokowany kapitał


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