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In defence of constructive criticism of the National Health Service

Roger Kline, 11 March 2013

Frank Dobson was always a decent and serious Health Secretary. It was no surprise to me that he failed to join Alan Milburn, Patricia Hewitt, Alan Johnson and Andy Burnham is their recent defence of David Nicholson, the beleaguered head of the NHS.

Dobson campaigned against the early attempts at privatisation more than two decades ago, long before he became Tony Blair’s first Health Secretary, from 1997-99.

Now he has said what no other senior Labour figure has said, that the ‘mad rush’ by his successors to bring in more competition and targets was reckless. 

"I told Blair that reckless changes could undermine patient care, but he didn’t want to listen," Dobson told the Mail on Sunday (10 March 2013), going on to criticise his successors Alan Milburn and Patricia Hewitt.

"They became obsessed with wanting to break up the NHS into individual units. I made my views known to them but was ignored. They preferred to take the advice of management consultants to medical consultants. Huge sums were diverted away from nurses, doctors and patients to lawyers, accountants and PR men."

I have argued previously that without criticism and analysis of what caused Mid Staffordshire we risk a repetition and we risk discrediting the NHS. That’s why the failure of Andy Burnham so far to address issues of culture and bullying is a serious mistake.

So is his failure to understand that retaining David Nicholson as NHS chief executive will ensure that the culture that created Mid Staffs and which treats staff as a cost not an asset, and which seeks comfort in denial and secrecy, remains disastrous for health care.

If we do not have open discussion, transparency and real change in how the NHS is managed we will not be able to learn the lessons and improve the NHS. And if we don’t do that the NHS will indeed become vulnerable to those who wish to utterly undermine it.

Frank Dobson understands that. Critics of the current culture like Julie Bailey, Kim Holt and Brian Jarman understand that. They care about the NHS but understand that the management mumbo jumbo, culture and policies of the last decade have to change.

Just as I was writing this I read this very poignant response to an article in Health Service Journal speculating on who might replace David Nicholson. Dr Peter Brambleby, a doctor, has himself suffered for speaking out on public interest issues on the NHS. Between Frank Dobson and Dr Brambleby we can discern what sort of leadership the NHS really needs. As Peter Brambleby puts it:

“A plea to any involved with recruitment and appointment of deputy leader and/or leader:-

  • Can we have leadership that understands "Health" and "Service" (as in National Health Service)?
  • Can we have someone who understands that at the heart of medicine and nursing is a gift relationship not a financial motive?
  • Can we have someone who trusts and respects the workforce, letting them set their targets and priorities rather than imposing them from above, and in return ask them to demonstrate local involvement, evidence of progress and financial probity?
  • Can we have someone who understands narrative as well as numbers - who listens to what patients and staff have to say, and doesn’t just scan the spread sheets on activity and finance?
  • Can we have someone who measures efficiency in outcomes, not outputs?
  • Can we have someone who will clarify the "mission" in "commissioning" so we return to a sense of common purpose?
  • Can we have someone who welcomes comment, concern and constructive criticism?
  • Can we have a coordinator of a network rather than an autocrat of a hierarchy?
  • Can we have someone who values collaboration higher than competition?
  • Can we have a conductor of an orchestra, not a principal violin?
  • Can we have a horse-whisperer rather than a lion tamer?
  • Can we have a leader, not a driver?”
  • Thank you.”

Hear hear!. Thank you, Peter, and thank you, Frank.

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