News from nowhere

The more things change, the more they stay the same. Ask the chief executive of the NHS, who puzzles over this conundrum without realising that he is part of the problem, not part of the solution. At a gathering of senior NHS managers held soon after the Parliamentary vote on foundation hospitals he presented an astonishing argument. Those who were against foundation hospitals were against patient choice and against improving services, in his view. This view coincided with the argument of ministers in the Parliamentary debate, which may not surprise you, but it should.

The chief executive of the NHS is a civil servant, and he should not sell government policy, merely consider how to implement it. By adopting the tone of ministerial argument he has abdicated the traditional task of ‘speaking truth to power’. And he has done so in a way picked up directly from New Labour itself, firstly by suggesting that all those who are not with the government are against it, and secondly by using moral blackmail to identify the opponents on one policy as the enemies of all things reasonable.

The senior managers listening to this motivating speech do not much respect their chief executive, who is perhaps too lacking in charisma. This disrespect did not show as questions or challenges to the new orthodoxy, despite the obvious misgivings of experienced trust managers. As one participant put it to a puzzled NfN mole: ‘Why should I commit professional suicide?’ There is of course no possibility of speaking truth to power when no-one dares criticise, or even comment.

But all is not yet lost. One week after the passage of the foundation hospitals bill the government itself had laid down 47 amendments…

An interesting snippet heard at another managers’ meeting led another NfN mole into the vaporous world of anaesthetics. According to insider knowledge most consultant anaesthetists dislike routine anaesthetics (it being boring), so they delegate to juniors and get on with more interesting things like pain clinics. But even with such diversions, much of the work is determined by others (surgeons, mostly) and if there are no operations there is little to do. Some anaesthetists may get a full-time salary of £65K while working a four day week. Our mole’s favourite was the anaesthetist for whom Friday was ‘balance day’.

The departure of Peter Homa from the highest level of the Commission for Health Improvement within a few months of Professor Kennedy’s arrival as director sent ripples through the NHS. Whether it bodes a more confrontational approach for the new Commission for Health Audit and Inspection remains to be seen. But we can be certain that CHI staff do not know if they will be CHAI staff next year, so there is much treading of water. Change sometimes stops things working as well as they might.

How to become a foundation hospital. 1: Reduce A&E waits

Reducing waiting times for punters in A&E is easy. First, make a note of national audit week in your diary. Second, during this week close the hospital to elective admissions, maximising bed availability. Third, send all available staff to A&E to clear queues as fast as possible. Bingo! The sick are speedily processed, the inspectors are impressed and the quality standards are ticked off. The following week, let it all go back to normal.