The Management of the NHS

The announcement of a record payout and damages to Dr Eva Michalak will surprise no-one who is close to the management of NHS hospitals. The NHS (National Health Service) management is guilty of poor practices that are almost breathtaking in the twenty first century.

Perhaps the worst managerial practices are those that impinge directly on patients. The worst of all is the way that junior doctors are universally forced to sign a "voluntary" opt out from the European Working Time Directive. I am generally against European regulations but in this case patients must have some form of legal protection against being treated by junior doctors who have already been working 70 hours in a week. The junior doctors are also used as a buffer between the patient and the consultant so that if the consultant makes a mistake the junior doctor will be blamed and disposed of. If there is a mistake all the registrars and consultants team up to find a junior scapegoat, there is no concept of good management where staff are developed and protected in the early years.

Another practice that endangers patients is the empowerment of nurses. Nurses should be the human face of the medical machine but the management, in their wisdom, have created a weird medical role for nurses. Lets be clear about this role, if nurses were good enough to be doctors then they would have gone to medical school. What is happening is that the nurses are being used as cheap labour in roles where they are unsuitable and are failing to fulfill their true purpose which is nursing. The real nursing is being done by nursing auxillaries who can often barely speak english and the nurses are used as unqualified doctors. It might be imagined that when a nurse countermands the treatment specified by a junior doctor the nurse would be investigated but if you imagined that you would be mistaken, in many hospitals the junior doctors are "rated" by the nursing staff and can be disciplined if the nurses dislike the doctor for interfering. Patients may not realise it but this Soviet style of management means that they are often being treated by people with a couple of dubious A Levels who have done a couple of years of human physiology.

The wholesale employment of cheap and underqualified foreigners also endangers patients. There truly are doctors from overseas who do not know enough medicine or english to be working with patients. Ask any hospital doctor. The government should not be employing foreigners anyway - the NHS is a direct method by which the government can alleviate domestic unemployment. It is crazy to be giving government money as unemployment benefits to people who could be working for government money.

Another problem with the NHS is that the management are cheats. A medical worker's contract might say that they have parking or accommodation for night shifts but the management will not actually provide these facilities. When the government inspectors arrive they can show them the contracts with the wonderful facilities they offer the staff and when a junior doctor complains about sleeping on the floor and asks for the facilities in their contract the management inform her that she cannot expect to work in the NHS if she is a troublemaker. The management also cheat the patients, queues are managed by cancelling or "losing" records of appointments at the last minute or using a junior to fill in so that a further appointment is required.

The management's trump card is a vast number of foreign staff who only care about keeping their jobs: patients and working conditions do not matter to these foreigners. If the staff complain or show concern for the patients there is always an Indian or Filipino who doesn't care and will take their place. The management also divide and rule with a policy of continually moving young doctors from shift to shift and place to place so that by the time they have developed any solidarity they are broken up.

The para-medical staff are also heavily unionised and play the game to their own advantage so that if you sneak in to a "busy" ultrasound suite you will find the radiographer doing her knitting. The consultants are largely self interested money grubbing types who have been brutalised by years in the system. Their greatest pleasure is to make their juniors suffer as they suffered and to afford another villa on the Mediterranean. They are so self-centered that they do not realise that the modern junior doctor is treated far worse than they could ever imagine. They used to have accommodation for being on call at night, a doctors club, perhaps even sports facilities and parking - these have all gone and being "on call" is now simply working non-stop.

Of course, the problem with the NHS is that it is a mega-corporation and near monopoly. If a junior doctor refuses to sign their voluntary exception from working hours regulations they will be unable to get a job anywhere in the UK. The nursing unions have tremendous power that management dare not cross. Patients must tolerate foreign doctors and nurses because there is no alternative. Anyone who can tell you about the appalling management of the NHS is gagged by contract and would never get a job in the NHS again (I transferred to private industry years ago). The mega-corporation must be broken up and the patients allowed to go to private providers who are paid by the GPs. The NHS should be free to use but the services offered must be diverse and competitive.

The government can break up the NHS using the existing rules (patient's Choose and Book etc). Just get on with it, kick these evil apparatchiks who dominate the NHS up the backside!

See

Indian Doctors and Immigration Exemptions