Last week we blogged about the strikes in the health sector. One thing has been obvious over the past few days are the efforts of the Minister for Health to avert the first major crisis in his tenure….Now the strike has been called off.
The Minisiter was hard at work last week…
…negotiating with the NMA as described here
…appearing before the House of Representatives as described here
…and explaining the intricacies as in the press statement below.
The truth is that there are fundamental problems with the way we run our tertiary health institutions. After the 8 wasted years of the Obasanjo regime spent on white elephant projects we now need to really re-evaluate our teaching hospitals. These large institutions, with huge budgets are managed by colleagues with often no managerial experience prior to the appointment. They are managed as huge bureaucracies with no incentives to preform and no consequences for failure. We have refused to do the critical thinking required in order to reform, and we keep throwing more money, more equipment, and more of the same…New MRI machines are not the answer…never have been. You do not need to have an MBA to figure that out.
The Vamed project was the most colossal waste of time, energy and money witnessed by the health sector in my lifetime, and I doubt it has saved a single life.
Several years ago Albert Einstein told us that if you want different results, do not do the same things.
I remember studying the history of the NHS in the UK and the THINKING that has led to the different reforms to maintain the ideals of the founding fathers in 1948 to provide a health service to the citizen – free at the point of care – from the cradle to the gave. It is important to reflect on this as this was the colonial experiment we inherited.
The attempts at reform since 1948 can be summarised as:
1. 1950 – 60: Realisation of finite means despite infinite demands for health careleading to the introduction of a spending ceiling, charges for dental /optical services and prescription charges.
2. 1960 – 62: Introduction of “Hospital Activities Analysis” – to pressure consultants to consider the economics of their practice. The Hospital Plan for England and Wales – first attempt to take comprehensive view introducing national norms for adequate hospital beds e.g. 3.3 acute beds per 1000 population.
3. 1962 – 69: As the NHS is a monopoly supplier of health care for the vast majority of the population, it suffered no consequences of failure and managerial inefficiency was endemic. Management was identified as the fundamental problem for the NHS.
4. 1974: 1st major re-organisation of the NHS. Introduction modern management methods – New layers of management: districts and areas.
5. 1984: The Griffith’s report: The “managerial revolution”. Griffith was Head of “Sainsbury’s”, supermarket chain famed for it’s financial success. A single general manager was introduced at each level of management with real power. A new doctrine of “general management” was introduced using performance indicators. Manager’s salaries were linked to performance.
6. Late 80s: Introduction of the Internal market legitimising seeking value for money within the NHS and introduced accountability for outputs by attempting the introduction of market forces.
7. Early 00s: Collaboration replaces competition. Introduction of targets, performance indicators and league tables.
8. Late 00s: Darzi review leads to the introduction of the “Quality agenda” and polyclinics.
By now you will have noticed my point – every single major reform is around MANAGEMENT.
My thesis – Healths systems are complicated and despite the resources to a country like the UK, they are constantly THINKING about how to make it more efficient. Since we inherited our present system from the British in 1960, nothing has fundamentally changed. The National Health Bill is still stuck at the National Assemble after 5 years. A Tertiary Hospital Commission that could lead to some change in the managerial arrangement of our hospitals is also stuck in the system….
The consequences – Consultants hardly come to work, hospitals hardly generate any income, patients have no confidence in the health services, health care workers are not motivated to provide the service…- A VISCOUS CYCLE
The Honourable Minister has his job cut out for him….and we wish him well. We really do!
Press Statement from the Ministry of Health
hasten to state that given the sensitivity of the issue of health care to our population and citizenry and the negative consequences that would result therefrom, one would expect that this will be the last option that the workers would consider. As it is, lives are being lost right now and the hospitals are left with no choice than to discharge patients, even as new patients are not being attended to. Inevitably, this will affect all and sundry, including the relatives of the striking workers themselves.
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead