Having spent most of my career in NHS management roles before becoming an MP, I often reflect on my own motivation for choosing two such unpopular careers—ones that, like the England manager job, virtually everyone can do better. One of our colleagues said recently that NHS managers are utterly useless and overpaid, which is what many of our constituents might say about us. As someone who has always been a manager and active in the Labour party, I was often told rather gently by my colleagues that I was too political to be a manager in the NHS, and my colleagues in the party often say that I am a bit too managerial to be an MP, so I think I am somewhere just about right.
The truth is that the NHS is an intensely political construct. NHS managers do not have the neutrality cloak of civil servants or the freedom of many business leaders. The lack of clarity around the role of NHS management is, I think, problematic, and it often leaves managers isolated and less able to do the job that we crucially need them to do. The Secretary of State’s pledge to cull managers yet again comes at a time when the challenges faced by the system are the greatest that we have ever seen, even without taking the pandemic into account. Industrial relations are at an all-time low, capacity and demand are massively out of kilter, the physical estate is crumbling, with £10 billion-worth of backlogs, and morale is at dangerously low levels.
We need much better management, but managers need to be clear with us. Ten years on from the Francis report and the introduction of a duty of candour, we—the public, Members of Parliament and patients—have to know where and when our system is and is not safe. We have to be informed about the trade-offs between cost and quality, and we should be active parts of the discussion about the future of technology and big data in healthcare. I am disappointed that the Minister has again trotted out the figures of inputs but has not addressed the crucial issues. We did not do that before the pandemic, and it is quite extraordinary that the Government are still not receiving the messages from the frontline.
The increased recruitment to NHS unions, more support for strikes and the reality of people’s experiences all tell us the same message. The Government’s current response is all about getting rid of the current crisis: the money that they are putting in is too little and too late to be of real value, and instead of collaborating with local authorities, which are now worrying about the pick-up
rates, they are fragmenting many local relationships. The uncertainty about payment by results and the faltering steps towards better collaboration mean that the deckchairs are still moving, and for our constituents, things are not improving.
Our focus in government, of which I am enormously proud to have been a part in an NHS trust and then as a manager, was on patient choice. That was not because we think that the NHS is a market, as is often said, but because we think that the NHS needs a stronger patient voice to co-produce individual care, and because we are asking people to pay more in this age of long-term conditions and co-morbidity, so we have to ensure that they have more local accountability in the system. The system is not accountable locally.
I repeat my comments about Scotland and Wales. The Welsh waiting lists are not acceptable. The Scottish waiting lists are not acceptable. None of this is acceptable. As politicians, we all need to start addressing some of the underlying issues we share and start learning from one another.
I am proud of my time in the NHS and fully aware of the scale of the task ahead, but with good clinicians, good managers and, dare I say it, good politicians, we can develop a longer-term plan and turn this around, should we choose to. The workforce is the right focus to start with, but other improvements in quality of care can happen if we trust the local. Let us build improvements where we can and work with the willing. Let us rejoin the dots destroyed by the disastrous Lansley reforms.
I recently received an updated join strategic needs assessment from my local authority—the plan for my constituency. These are all things I worked on over 10 years ago, and it is utterly heartbreaking to see. Cervical screening coverage for all women in Bristol is lower than average. Bristol is below the national average for HPV vaccination in boys and girls. Breast cancer rates are 16% higher in Bristol than the England average, and the prevalence of osteoporosis is rising much faster in Bristol than in England. One in four attendances at A&E for falls is a resident of my constituency. I remember the old falls service 10 years ago. This is not a new disease to be eradicated; we do not need a new cure. These are all entirely, and fairly cheaply, preventable problems of public health.
The local NHS priorities are now excess weight management, harmful use of alcohol and falls in old age—all public health preventive work—but with child and adult social care taking up more than 60% of local authority revenue budgets, public health has been hollowed out and is entirely reliant on the voluntary sector. People living with profound disability and ill health are dying earlier and in worse condition. The next debate is about employment. Let us get those people back to better health and back to work. Let us help them care for the older people and people with disabilities they need to care for, but crucially, let us give them their life back. The Government need to join the dots. Instead of bad-mouthing and culling more management, let us give local government and the NHS the tools they need to do the job.
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