NHS reform offers hope to our demoralised doctors and nurses14 July 2010
The news that nurses are so swamped with form filling that they spend less than half their time caring for patients should come as a shock, but it won't.
Cambridge University NHS Trust, which includes Addenbrooke's Hospital, estimates that nurses spend only 44 per cent of their time looking after patients.
The trouble is that so many of us have become so familiar with the idea of groaning bureaucracy in the NHS that the news will be greeted with nothing more than a shrug. Few will be particularly surprised.
We have a new Government pledged to tackle such scandals but expectations will be low that there will be much improvement. The prevailing mood is that such problems are inevitable, inherent in the system.
But are they? The Health Secretary Andrew Lansley wants to keep the NHS but reduce the bureaucracy. 'The NHS remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff,' he told the House of Commons on Monday when he was introducing the NHS White Paper.
'For too long, processes have come before outcomes as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year,' he added.
'We will remove unjustified targets and the bureaucracy that sustains them. In their place, we will introduce an outcomes framework setting out what the service should achieve, leaving the professionals to develop how.'
At least a third of NHS-related quangos are to be abolished, releasing billions of extra money for patient care. Last year the Primary Care Trusts and Strategic Health Authorities increased their management costs by 23 per cent and spent £261 million on management consultants.
Now these PCTS and the SHAs will go. The money and the power will be taken from them and given to GPs - and GPs will commission the services their patients need.
Instead of just being able to make requests, the GPs will make the decisions.
For some that extra responsibility may take some getting used to. So, of course, they may recruit some staff to administer the arrangements. But GPs will not have to spend as much time navigating through PCT and NHS bureaucracy on behalf of their patients.
Freedom can take some adjusting to. It is a cultural shift, a bit like de-institionalisation. But for most GPs, and more to the point their patients, it will far less frustrating and far more effective in getting the treatment required.
The plan to hand an extra £80 billion to GPs is certainly bold. It should be judged not by whether it works perfectly but by whether it provides an improvement on the existing shambles.
The ambition is to drive up our health standards to those of the other western countries where we are lagging behind.
Of course the NHS will continue to see spending increases. And ultimately I suspect it will fail because we need to move to an insurance-based system.
As Nick Seddon of the Reform think tank has said: 'According to the OECD, the fairest systems are the insurance schemes of the Netherlands, Germany and Switzerland; that is, the countries where the poorest get the most similar standards of care to the richest. Insurance can deliver higher quality and greater equality in outcomes.'
So although the Government's plans are bold they are still constrained by the idea that the NHS can provide us with world class health care.
But if the Government doesn't manage that, the plans will at least offer hope for some improvement on the mess our demoralised doctors and nurses are trapped in at present.