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What is Going to Happen to the National Health Service Now?

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Author: Peter Hunter

Sir Nigel Crisp, the head of the NHS who has just been persuaded to leave said, "we need leaders who can facilitate, motivate, and engage clinical staff and who can create an environment in which practitioners have the freedom to improve services for their patients and communities."

He failed to make this happen and is therefore being blamed for the failure of the people who should ...

Now that Sir Nigel Crisp has been assisted to leave the NHS most of us are left wondering what he will do with his enormous golden handshake.

Perhaps more importantly, there are also some who are wondering what on earth is going to happen to the National Health Service now.

In living memory every election promise ever made contained the phrase, "An increase in spending in real terms on the NHS" and the sum of all those promises is a National Health Service in which more authorities than ever before have run into debt, debt that can only be supported by cutting the services the extra spending was meant to maintain.

Sir Nigel Crisp was a man with a vision for the NHS that did not involve simply spraying it with more money in the naïve hope that the problem would go away.

Sir Nigel Crisp had a vision of a health service transformed from an unwieldy and inefficient hierarchy into a flexible dynamic organisation run by the frontline staff in response to the needs of their customers, the patients.

Sir Nigel said "we need leaders who can facilitate, motivate, and engage clinical staff and who can create an environment in which practitioners have the freedom to improve services for their patients and communities."

His belief in the power of the individual when given the right tools to do their job was typified by a story from a Scottish Hospital in which one of the nursing staff, a Staff Nurse, expressed her frustration at having to look after people who were not sick when she knew that there was a queue of sick people waiting for the bed. This phenomenon is commonplace in the NHS and is known as "Bed Blocking."

She explained that if a patient was well enough to be transferred home after midday on Friday then if they required an ambulance they had to remain in the hospital until Tuesday, at a cost of £2,000 or £500 per night.

This was due to the fact that the ambulance station closed at midday on Friday and an ambulance could not therefore be requested until Monday, Since all ambulance requests had to be made 24hrs in advance the request on Monday had to be for an ambulance to come on Tuesday.

This was not a new cause of frustration, it was a situation that had existed since she had qualified at the hospital and it was not until she was the senior nurse on the ward, the ward sister was on holiday, that she felt that she was able to ask why this situation existed.

She telephoned the ambulance station, a 10 minute drive from the hospital, and asked to speak to one of the ambulance drivers. The first question she asked was why there were no ambulances available after midday on Friday.

The driver replied that in a cost cutting exercise many years ago the receptionist at the ambulance station, who was classed as non essential, had been asked to reduce her working hours. As a result her working week finished at midday on Friday while the essential staff, the ambulance drivers, sat in the ready room playing cards until five o'clock when they went home because nobody ever called for an ambulance on Friday afternoons.

The Staff nurse, sensing that this was a situation the ambulance driver felt was slightly ludicrous, asked whether it would be possible for the receptionist to transfer the telephone through to the ready room before she left at midday. This seemed not to have occurred to the ambulance driver who had always accepted the situation as "The way we do things around here." He agreed that there did not appear to be any reason why this could not happen and the ambulance service on Friday afternoons was immediately restored, at no cost.

Having made such easy headway the Staff Nurse pressed on and asked her second question. Why, when the ambulance station was only ten minutes from the hospital, was it necessary to order an ambulance twenty four hours in advance.

The driver explained that in the same set of negotiations that had resulted in the reduction of hours for non essential staff, performance targets had been set for the ambulance crews.

One of these targets was that all requests for ambulances that came from the hospital had to be met within 24hrs.

In order to ensure that this target was met the hospital had been told that in future they must give 24hrs notice when requesting an ambulance.

The Staff Nurses next question was, If I asked for an ambulance now how long would it take to get here.

"Ten minutes", the driver replied "and even when we are really busy it would be unlikely to be more than an hour.

In one phone call the Staff Nurse had got rid of a problem that had been frustrating her ability to give the patient care that she had been trained to deliver.

It had taken years of built up frustration before she felt confident enough to make the call that ended the frustration for herself and the many other members of the care staff in that hospital.

The Staff Nurse that made the call did so not because she had any special skill or was a high priced consultant trouble shooter.

She made that call because she cared about her patients but was prevented from giving them the care they needed.

If the environment had been created that allowed her and other members of staff the freedom to improve services in the way they knew would best serve their patients then that call would have been made years earlier or perhaps this ridiculous situation would never have been allowed to occur in the first place.

Sir Nigel knew exactly what was required to transform the NHS but as the lone voice on top of an entrenched oligarchy he had neither the support nor the tools to make that transformation happen.

The sad thing is that the people who currently control the spending in that hospital have no idea that this saving has been made, or what happened to make it.

The powers that be believe they are in control. But they are still worried about the estimated 4,000 beds per year in this one hospital that are being blocked by healthy patients who cannot go home.

They still do not understand that the solution to this and a host of other expensive problems already exist within their workforce.

Will the new head of the NHS throw more money at the problem and spend time putting on spin to disguise the real state of affairs or will we find a leader who can release the potential that already exists in every individual in the huge NHS workforce.