07/01/2009

UK doctors urged to challenge 'aberrant corporate cultures'

Private management consultants should be 'ditched' from the NHS

Dr Jonathan Fielden, Chairman of the Consultants Committee of the British Medical Association (BMA), has called for private management consultants to be "ditched" from the UK's National Health Service (NHS).

During a powerful speech in early June,  commenting on a Health Select Committee report that called on the government to gather central information on the cost to the NHS of private management consultants: the NHS English sector alone paid an estimated £350 million to independent management consultants in 2008.
Hundreds of millions of pounds of taxpayers’ money is yet to be shown to have benefited patient care, Dr Fielden pointed out. Whilst NHS staff already has widespread expertise and knowledge, ‘…the benefit of management consultants, steeped in the ethos of the private sector, must be questioned and needs to be justified.’
Whilst accepting that there have been clear NHS improvements – waiting times at an all time low, increased survival rates, cleaner, safer and better hospitals, etc – Dr Fielden condemned the effects of corporate type management in some hospitals. These, he said, had led to failings in which patients had not received the high quality care they deserved, ‘…where the processes, systems and sometimes individuals have let them down. Painful, dreadful blots on the NHS landscape, where patient care has suffered. In each of these there is a common theme: targets being put in front of quality, staff not being listened to, aberrant corporate cultures suppressing concerns and disregarding safety. Doctors must challenge this culture of denial and lead a better way forward.’ NHS doctors are motivated by different incentives, he pointed out: ‘Let more money remain in the NHS - hard-earned taxpayers’ money going where they want it - into patient care, not the pockets of shareholders. It is the ethos, the faith that is at the heart of the Health Service that drives us. One that management consultants, brought up in the tarnished world of finance fail to understand.’
Dr Fielden announced the results of a BMA survey indicating that three quarters (74%) of hospital doctors had had concerns about issues relating to patient safety, malpractice or bullying, during their careers. Seven in ten said they had raised the issues at their Trusts, but often were unaware that anything had been done about them (46%) or, even worse, their Trusts had indicated that, by speaking up, their employment could be negatively affected (15.5%).
“For the first time in working memory, we may see real cuts in health spending. This will provoke some stark choices: what is kept, what is cut, what can the NHS afford? Let’s ensure that it’s doctors making those difficult decisions in partnership with our patients and healthcare colleagues, not faceless bureaucrats, accountants, and those out to fleece the taxpayer.”
Independent Sector Treatment Centres also came under attack. Dr Fielden criticised the amount paid to them for work that was not carried out – up to £927 million in England according to an estimate in a recent study.


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