On the 28th January, Professor Mark Exworthy gave his inaugural lecture at the University of Birmingham.
When he chose the name of this lecture back in September, he had little idea that the NHS was about to go through what has been called the ‘worst A&E crisis ever’. His talk could not have come at a more critical time.
‘15% drop in social care funding in the last 5 years.’
Professor Exworthy started his lecture with an overview of the current state of the NHS. Since the beginning of Conservative – Lib Dem coalition, government funding to the NHS has stalled, and there has been a 15% drop in social care funding in the last 5 years.
Despite these adversities, the majority of patients still receive excellent care from the NHS. However, the Stafford Hospital scandal and the problems faced by Britain’s A&E departments this winter has called into question the state of the NHS as a whole. Is the NHS in crisis?
‘The NHS is in a critical state.’
Possibly, according to Exworthy. It is not a simple yes or no answer. What is certain though is that the NHS is in a critical state, and it is very possible that the situation will get worse before it gets better.
Exworthy stated that, this ‘crisis’, is part of the management of the NHS – and it is not just a temporary state. Management of the NHS has been increasing since the 1980s. The public response to this increasing managerialism has not been especially positive, with the image of men in grey suits disturbing medical practices being promulgated by the media.
‘35% decrease in the number of managers.’
The NHS managers also tend to be used as scapegoats – having the blame piled on when things go wrong. A common worry about the ‘over-management’ of the NHS is how much it costs. However, there has been a 35% decrease in the number of managers between 2010 and 2014, and they now make up just 3.5% of the NHS workforce, with management costs taking up just 3% of the NHS budget.
If management of the NHS is part of the ‘crisis’, then surely it must also be part of the solution. During his lecture, Exworthy spoke of the rise of the doctor-manager hybrid, and how these professionals could be very beneficial to the NHS. There is evidence that organisations run by clinical leaders perform better, as they are able to see where change is needed better than a non-clinical manager, and are more able to implement change. At the moment, there are 2,700 people working in this type of role within the NHS.
“These hybrids”, enthused Exworthy, “are going to be really important in the next few years”. Indeed the key to making sure the NHS continues to perform as well as it is and even improve, is maintaining a dialogue between doctors, nurses and mangers.
So what does the future hold for our NHS?
Exworthy believes that managerial decisions need to be informed by three core values: expectations of the public, experience, and research based evidence. There have been many NHS reforms over the last decade and these are showing little signs of stopping.
The public can be disturbed by such reforms, but Exworthy thinks the public will probably retain faith in the NHS for the foreseeable future, although this is not guaranteed forever.
By the year 2020, there will be a £30billion deficit in NHS funding. Exworthy stated that the NHS almost certainly will not be able to balance the rising demands of an ageing population with the very minimal increases in funding the NHS is currently receiving. Exworthy said a “new settlement” needs to be found for the NHS, and this needs to come through public and political debate on the options available to the NHS, particularly with regard to funding and spending.
‘Making sure the NHS is fit for the 21st century’
We need strong political leadership, and support for NHS managers. As it stands, the gap between the public’s expectations of the NHS and their experiences is unfortunately likely to get worse. To deal with and counteract this, we need to revisit the role of the NHS, and its doctors and managers, to make sure the NHS is fit for the 21st century.
A recording of the full lecture is available to watch here.
Photo Credits: ALAMY