Guest post: There has to be some slack in the system

Guest post by Maureen Brian, originally a comment on a Guardian piece about National Health Service funding problems.

First a bit from the Guardian piece by Bob Kerslake, for context:

I have this weekend decided to stand down from my role as chair of King’s College hospital, London.

This was not a decision that I took lightly. I love King’s and have the highest regard for the people who work there. But in the end I have concluded that the government and its regulator, NHS Improvement, are simply not facing up to the enormous challenges that the NHS is currently facing. This is especially true in London where the demands of a rapidly growing population are not being matched by the extra resources we need.

King’s is a big teaching hospital that serves a population of more than one million people in south-east London. It provides world-class services such as neurosciences, haematology, liver, diabetes and cardiovascular, where it is a centre of excellence. King’s is also one of four major trauma centres and played a key role in the response to the Westminster and London Bridge attacks and the fire at Grenfell Tower. But most of all, it is the local hospital to a diverse and often deprived community.

Maureen’s informed and informative comment:
No-one seems able to persuade politicians that all change costs money. Properly planned and researched change costs money – collecting data, planning the process, retraining staff, extra management time, etc – before it starts to happen. However good the idea was it is going to take time to implement and even more time to bed in and all that is costing all the time. As any fule no.

With something as vast and complex as the NHS we should be thinking of the whole process taking something like 10 years for a major change in management structures and lines of accountability. We are just about to move onto major change number 4 since the Tories came back in 2010! Drawn up by politicians, of course, on the back of the proverbial fag packet and with little or no consultation with the people doing the actual work.

Those people know that you cannot plan to the date and the hour when there will be black ice on a ten-mile stretch of motorway or a small outbreak of measles in Cardiff. There has to be some slack in the system. There has to be a system which allows the local hospital to call in a recently retired orthopaedic surgeon or to open up an extra ward and staff it within 24 hours.

Don’t get me wrong. I still believe the NHS is among the best in the world but it could be better if the medically qualified people did not spend half their lives pushing water up hill against the massed ranks of politicians and accountants.

Bob Kerslake is a good man. He did not do this lightly.

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