Patrick Barbour: Political management has failed the victims of C-Diff

Patrick Barbour was chairman of two public companies, is a trustee of Civitas, and was one of the three founders of Reform.  The author of the position paper for the TaxPayers’ Alliance Better Government Campaign, he argues that the NHS won't improve whilst it's managed by politicians.

The smoke is now clearing, just over a week after the Healthcare Commission released the results of its investigation on the scandal at the Maidstone & Tunbridge Wells NHS Trust where C. difficile infections have killed dozens of people and contributed to the deaths of hundreds.  The chairman and chief executive of the Trust have both resigned, Alan Johnson has set up inquiries to look into everything except how government policy contributed to the crisis and the Nurse of the Year has quit “in disgust at the pen pushers running the NHS”.

However, there is already a new crisis on the horizon.  Just a week after Johnson told the Today programme that the scandal at Maidstone and Tunbridge Wells was an isolated incident a new scandal has emerged in Lancashire.  Before we go on to consider fresh scandals though, it is worth taking a little time to consider just why things have gone so wrong in Maidstone & Tunbridge Wells NHS Trust and whether there is a connection to broader problems in the health service.

The right place to start is the original Healthcare Commission report that said:

"The lack of organisational stability with numerous structural changes over the last three to four years, meant managers could not settle into roles and focus on the key issues. The high turnover of executive directors and senior managers caused instability and left gaps in leadership as the trust grappled with its very busy agenda. Many staff felt the degree of change had been damaging and had contributed to the lack of clarity on accountability."

Did Rose Gibb, earning around £150,000 pa as Chief Executive of the Maidstone and Tunbridge Wells Trust, really have the management skills to run an organisation with a budget of £243 million and 4,527 staff?

Apparently not.  Personal hygiene and cleanliness are management problems which could be righted in days not months.  The Healthcare Commission described an autocratic senior management that failed to build managerial and leadership capacity throughout the organisation, with little delegation.  In addition, Mrs Gibb is described as difficult to challenge.  All it would have taken was one effective challenge to her repeated assurances that the infection problem was under control.  If the Directors had ever walked round the hospital they would have seen for themselves that this was not so. 

To add insult to injury the Board had apparently agreed to pay this failed manager £250,000, and gave her a glowing reference.

If the Maidstone and Tunbridge Wells tragedy (and there are twenty even worse hospitals in the Country) had happened outside of a government-run service politicians would be demanding major change.  Imagine if a care home in the private sector had over 90 deaths due to negligence.  But will anything happen here, where the NHS is run by ever-changing politicians, who lack management experience and knowledge of healthcare?

The Secretary of State, the three Ministers and two Parliamentary Undersecretaries have made up the top three levels of the NHS over the last 10 years.  Yet they have virtually no management experience, no in-depth knowledge of the NHS and they frequently change their jobs.

Alan Johnson, the current Secretary of State for Health, is typical.  Before becoming an MP he worked in the Communication Workers Union, a position for which no healthcare expertise was needed.  Since he was first appointed to a ministerial position eight years ago he has been a minister at the DTI and at the DfES and a Secretary of State for Work and Pensions, the DTI and the DfES before moving to the Department of Health.  That’s more than six jobs in eight years, in four very different departments.  How does any of this equip him to run one of the largest and most complex organisations in the Western world?  It doesn’t.

We will continue to have a Health Service which is ranked as 18th out of 19 developed countries by the British Medical Journal as long as politicians continue to manage the Health Service.

Comments

[Les]

///That’s more than six jobs in eight years, in four very different departments. How does any of this equip him to run one of the largest and most complex organisations in the Western world? It doesn’t///

An excellent article which really goes straight to the heart of the NHS problem--political managers with no relevant experience in the areas for which they are responsible.

The comment above would surely apply equally to sombody like Boris Johnson (for example) holding the office of London Mayor or George Osbourne managing the nation's finances.

[Tony Makara]

One of the greatest problems with the political system is that we have people put into ministerial positions and they have no expertise in the area they are to cover. Gordon Brown himself became chancellor yet had no academic training in economics and no experience in the world of business or finance.

The way the Labour party plays ministerial musical chairs is a disgrace. The NHS can never be put right until we listen to and take on board the experts in the field. People go into hospital to get well, not to die from Labour's killer superbugs.

[Father Brian]

This article sums up what I've thought for years - the underlying problem of the NHS is that it is run by the government.

The last Conservative administration swept away the notion that industries and services are best run by government departments. The principle spread far and wide, contributing to the collapse of the Soviet Union. Even Labour wouldn't renationalise, as the Wilson government planned to do with steel in 1964.

But two bastions of 1940s thinking survive, propped up and defended by unions motivated by self-interest - Royal Mail and the NHS. It's no coincidence that they are both in terminal decline.

Les is right - there's no evidence that things would be any better under Conservative ministers. The problem lies in the near-total isolation of politicians of all parties from the everyday realities of commerce and industry.

Politicians who have never done anything else have no qualification for managing the country. When candidates next come knocking at your door, seeking your vote, ask them for their trade or profession. If the answer is "politics", send them away.

[Tony Makara]

Father Brian, I think we have to find the right balance. The old nationalized industries were trying to be run as a business whereas the NHS is not a business but a service. The political imput into the NHS has to go and health care professionals with experience in the field have to be given a free hand to right the wrongs brought about by political interference. Labour politicans have used the NHS while in opposition and while in power as a political dartboard. Scoring points out of the NHS rather than seriously trying to find solutions to the problems of the health service. Targets and deadlines may be very useful tools of delivery when running a business but when running a service like the NHS they clearly upset the applecart.

[Les]

Tony Makara says:

///Targets and deadlines may be very useful tools of delivery when running a business but when running a service like the NHS they clearly upset the applecart///

Actually, targets and deadlines have pretty-much the same response in a commercial business environment--i.e. the 'subjects' of said targets immediately go into 'cooking the books' mode and concentrate on massaging figures to the detriment of getting the job done.

In my opinion, any distinction beetween running a 'service' and a 'business' is irrelevant to the issues of day-to-day management.

Such distinctions relate to the alleged 'profit motive' of commercial business though managers earning £150,000 in the NHS cannot really be said to lack financial incentives.

Sensible targets and budgets are simply administrative tools and not a substitute for competent management as tends to be the case with government-run organisations.

[Richard Tracey]

There is some confusion here in the distinction between democratically elected politicians and professional managers. Politicians and ministers should never try to micro-manage, but should scrutinise and hold the managers to account . And the political appointees to NHS Trusts and the like should remember this too.

[Father Brian]

Tony, I agree with most of what you say. However, the old nationalised industries were run primarily to support a payroll vote, guaranteed to vote Labour in defence of their employment. The same applies to the BBC, Royal Mail and NHS. It's no coincidence that overmanning features so prominently in the so-called public sector.

I'm surprised that the Europhile leaders of our main parties don't advocate the health insurance systems commonly found in our neighbour countries. None of them would dream of adopting a system that sets unrealistic expectations and tries to be all things to all people, with incongruities such as fertility treatment and contraception at public expense. Austria and Sweden, two countries that have had socialist governments for most of recent times, expect citizens to make direct payments for their treatment.

The NHS was planned in an age of meatball surgery, plant-extract drugs and bed rest. We must beware of assuming that it is the only health care model for the future. Those who can afford to are already making the choice.