Cut duplication not services in the NHS

VIEWPOINT Julia Manning Chief executive of independent think tank 2020 Health

Just as Turkeys don't vote for Christmas, mediocre and superfluous managers won't be quick to identify themselves as the part of the efficiency savings equation

The National Health Service is facing a huge budget shortfall after 2011. Former NHS clinician Julia Manning says it is time to look at the duplication of roles in the health service.

The NHS was asked last financial year to start thinking about how to cut £10bn from its costs.

As time has gone by that amount has increased to estimates of £15bn to £20bn required in savings.

This surely has to be one of the most significant motivators for finding efficiency savings in the NHS that the government and NHS management has ever had?

Well, yes and no. That's because efficiency savings not only mean using the material resources you have more carefully, but it also means taking a hard-nosed look at duplication of roles, unproductive processes and to put it bluntly, unproductive people.

Across all government departments there has been a huge increase in the number of civil servants and the Department of Health is no exception.

The single most depressing fact is the waste in the NHS of a huge number of incredibly talented, imaginative, innovative medics and ancillary staff Read your comments

This has helped to keep the unemployment figures down and the tax-take up but it seems to have had zero impact on productivity.

Likewise in the field, there have been huge increases in the number of backroom staff and managers and management consultants - the Independent in August reported an 80% increase in spending by primary care trusts (PCTs) over four years on administrative and clerical staff.

Michael Fallon's piece on the 'bureaucratic monster' in the Telegraph in October articulated the confusion felt by so many about who is actually running their local health services and who is accountable.

Is it the local hospital foundation trust or the community trust or the primary care trust or the social care partnership trust or the strategic health authority?

So not only is there proliferation but confusion too.

'Pool of wisdom'

And as a former NHS clinician I think the single most depressing fact is the waste in the NHS of a huge number of incredibly talented, imaginative, innovative medics and ancillary staff.

Their expertise and experience is a significant pool of wisdom which is frequently ignored or dismissed.

And that's when they feel able to express their opinions; much of the time they keep quiet, not wanting to receive the wrath of their line manager.

There are still stifling hierarchies in the NHS which mitigate against true partnership working and which breed mediocrity instead of excellence

The choice can simply be to choose the limited freedoms that they have to carry on looking after patients over the fight for justice and progress.

I met some superb NHS managers in my 17 years of working in the NHS, and they must feel incredibly annoyed when they are 'lumped' into the general moan about NHS waste and poor management.

And those who have an excellent track record are probably the ones least fearful of the months ahead and most able to harness the wisdom of their clinical peers as they work together as partners.

They've proved their worth and their trust knows it.

'Stifling hierarchies'

For all the talk of 'NHS partnerships' however this is still the greatest paradox.

Partners are equals, able to work together to achieve the best service and outcomes for those they are serving.

There are still stifling hierarchies in the NHS which mitigate against true partnership working and which breed mediocrity instead of excellence.

Until we achieve real independence for the trusts who deliver services for the NHS, there will be little incentive for them to streamline in the way that they should.

But just as turkeys don't vote for Christmas, mediocre and superfluous managers won't be quick to identify themselves as part of the efficiency savings equation.