Open Hart surgery

"Another re-organisation? Oh, dear..."

THE Welsh NHS will tomorrow undergo a radical makeover which will see competition abolished and 29 organisations replaced with seven new super Boards to provide healthcare across the country.

Health Minister Edwina Hart says she is determined to create a health service for Wales that is entirely focused on patients and not systems. Her vision is simple.  Collaboration and not competition will ease the administrative burden, cutting bureaucracy and improving access to the NHS.

Few lament the demise of Jane Hutt’s 22 Local Health Boards, which promised to bring health and social care closer together. From the outset, the small commissioning bodies struggled to make an impact on the powerful NHS Trusts and failed to develop the relationships with local authorities that ministers had envisaged.  These concerns were expressed in the majority of the 356 consultation responses sent to Jane Hutt in 2001, but went unheeded.

Ms Hutt’s famous ‘cost neutral’ catchphrase was so dubious that the current Health Minister has been careful not to re-use it about her own project. But the botched reorganisation of six years ago is already forgotten amid the optimism – and perhaps desperation – that the new one will be the answer to the NHS‘s problems.

As we speed ahead to October 1, we should remember that there has been no accountability for the failures of the last system, and its cost remains unknown. With public spending cuts imminent, more questions now need to be asked about how this new structure will be funded to ensure that no more taxpayers’ money is wasted on a reorganisation that once again does little to improve patient care.

This time around, the mood is definitely more buoyant. But this time, patients and their doctors won’t tolerate failure. After the last debacle they now want to see a structure that actively addresses their problems and those of the NHS. And there are plenty of them.

In July, hospital waiting times rose significantly in Wales and the ambulance service once again failed to meet its response time targets after a dismal year. Doctor shortages are now “unprecedented” according to the BMA, resulting in increasing pressures to fill ward rotas and keep specialist units open, while the Health Minister and First Minister are seemingly at odds on the best way to recruit more.

Mrs Hart insists that clearer administration will make the practical issues easier to deal with. But will this structure be less bureaucratic and less costly to administer? It certainly has the potential to make savings and improve patient care. This stands to reason when 22 Local Health Boards are being reduced to seven and most of the NHS Trusts are being abolished.  The functions of the specialist commissioning body Health Commission Wales are likely to be given to the LHBs and Public Health Wales will bring together a plethora of smaller bodies under one umbrella.

Plans are also underway to merge Powys LHB with Powys County Council to improve efficiency, which could provide a blueprint for future local authority reorganisation, though ministers will not yet say that publicly.

Some of the hanger-on organisations that claim to improve the workings of the NHS could also be culled, or merged into the structure to provide the same services. Take health quango NLIAH, for example, whose purpose is somewhat vague considering it costs the taxpayer nearly £100m a year.

According to WAG, the National Leadership and Innovation Agency for Healthcare has a “central role in supporting and sharing best practice in the NHS to improve patient care and the working environment for staff”.  Information obtained under the Freedom of Information Act reveals it spent more than £500,000 last year in salaries for its Executive team alone, but analysis of the outcomes is sparse and the benefits of their expenditure still in question.

WAG insists the bulk of its budget – some £88m – is spent on “supporting workforce planning and commissioning non medical professional education”.

Negotiations are ongoing about managers’ status and salaries in the new structure. But despite promises to streamline management, there is little evidence of it. After several recent high profile interventions on neurosurgery services and kidney cancer drugs, it seems the Minister now wants to distance herself from micromanaging the health service.

Mrs Hart says she “doesn’t make statements lightly about money” and in the long term, she hopes the new structure will bring benefits in terms of costs. But she can’t say how many managers her new structure will need as she doesn’t get involved in the “day to day running” of the health service. So it will be up to the new Local Health Boards to deal with any surplus jobs.

This suggests that many of the senior managers in the old structure are being kept on (presumably on protected salaries) under a top tier of even more expensive management in the new system. Two weeks before going live, we should surely know how many and what jobs they will be doing, yet Mrs Hart is unable to tell us.

In true style, the Welsh Health Minister is unrepentant about going her own way and is convinced that her restructuring is the answer to the NHS’s problems. The problem is that her predecessor said the very same thing before “moving immediately to implementation” while concerns about operational matters remained.

In the spirit of openness and accountability that will drive her reforms, and for the sake of any future plans she may be considering, the Minister should be very clear about exactly how this structure will be staffed and paid for at a time when funding is at the forefront of everyone’s minds.

Patients may not want to know about systems, but they do know that we can’t afford yet another failed NHS reorganisation.