SOME readers may recognise that the title of this article is cribbed from Florence Nightingale’s famous little book – and I couldn’t improve on it as a heading to my thoughts below about the NHS and the health of the nation right now.
Many good men and women, from both the private and public sectors, have been broken on the wheel of the NHS in attempts to reform it, or make it more efficient.
They seem always to get lost in the Kafkaesque, intangible vastness of a behemoth that sucks more and more money into itself without any measurable improvement to its output. Its bigness is its problem.
I have no issue with the ‘free-for-everyone-at-point-of-need’ concept behind its foundation. It was a wonderful, enviable idea which, like all original creations, got subsumed into a vampiric bureaucracy.
The plot has long been lost, along with the passion and, indeed, the compassion (apart, that is, from the vacuous mantra exuded regularly from politicians’ lips about their ‘passion for our wonderful NHS’).
Bureaucracy prefers to call itself administration, because it sounds more respectable and conveys the impression of usefulness. But it is largely the product of its own invention.
Bureaucrats lurk in the swamp like leeches, waiting to attach themselves to a new creation. As it continues, certain tasks are deemed necessary – treasurer, secretary, chairman – hey-ho, we have a committee. The tasks seem to grow, and with it their perceived importance. Crucially, they become TERRITORY. Eventually they are the dominant force, with the creatives subservient to it.
We are led to believe that when an organisation expands it needs administrators in their own right, full-time managers to run things, disconnected from the creative or productive drive. This is when, in universities for example, senior academics are set punitive targets by junior managers (see Dark Academia – How Universities Die, by Peter Fleming https://www.amazon.co.uk/Dark-Academia-How-Universities-Die/dp/0745341063, for a graphic description of this abomination).
The NHS surrendered long ago to it. The monster grows inexorably, rabidly feeding itself with more of its own while the front line staff, who are meant to provide the care, respond to target-setting piled on by the centralised machinery of administration with their own restrictive practices and part-time demands, and become intrinsic to the ‘producer capture’ process.
No tinkering round the edges, or a campaign of small changes over an extended period to ‘avoid rocking the boat’, will cure the NHS. It needs a major procedure. It needs anaesthetising, cutting out the cancers, and stitching back together. Below is an agenda for the operation:
1. First, on opening up the body, the hospital trusts need to go. A whole layer of unnecessary blubber. Instead, revert to the simpler concept of every hospital running as a stand-alone entity, under the eagle, tyrannical eye of its own matron.
2. Cut just a little deeper and we arrive at the huge cancer of administration, including, for example, CEOs, Diversity Managers, Target Setters, Progress Monitors and Quality Managers, with innumerable support staff, all reporting to each other. Would their severance lead to utter confusion? Undoubtedly, we’d be told that it would. Time to return to the stand-alone hospital Almoner? Plus the right level of sophisticated technology to run an administrative system just requiring nurses’ real-time input?
3. Pay nurses a lot more money (with the vast savings from a removed administration), and return to the original concept of nursing. In a sense, it goes right back to Florence Nightingale, who said that the mark of a good nurse is character, not qualifications.
A good nurse will learn on the job. A good nurse does everything. A good nurse comes from all strata of society, with or without qualifications. Specialisation of labour is counter-productive in an holistic environment, and highly-paid, all-round nurses would do shifts across the spectrum – ward work, reception, cleaning, pharmacy, theatre, etc.
So-called ‘medical professionals’ who balk at ‘cleaning shift’ should reflect on who cleaned up after Florence Nightingale. Nurses should be the very fabric of a hospital and therefore responsible for its fabric.
There is no better way to understand the significance of cleanliness and hygiene than to do it yourself, rather than delegate it to contract or even employed cleaners. The worst kind of nurse, in my view, is one who believes that having a degree means they’re above personal care and cleaning the ward.
4. Tuition fees are another cancer to be removed – is it not scandalous that they have to pay to learn for a vocation?
5. Redundant administrators should be offered the opportunity to retrain as nurses. Hospital-proud, ‘holistic’ nurses are tomorrow’s matrons.
6. Weed out part-time work practices that are also at the root of NHS inefficiency.
If all hospitals were to be run as self-operating entities, fronted by matron and the nurses, is there still a ‘National’ in the NHS? Yes. It clears the NHS for what it should be:
- A central purchaser, for economies of scale.
- A state-of-the-art laboratory for research, development and production of medicines and drugs as a non-profit alternative to Big Pharma.
- A formal training centre for nurses when not learning on the job.
Four final tips for our future PM to win the hearts and minds of the populace:
1. Proclaim that there will never be another mandatory lockdown for any reason.
2. Proclaim that no medical procedure will ever be mandated, and that it is a criminal offence to discriminate against someone on the basis of their vaccine status.
3. Instruct GPs to restore full-time, face-to-face patient consultation, as a condition of their licence to continue in practice.
4. Require five years’ full-time NHS service as a condition of training to be a doctor before eligibility for part-time work.