Monitor is producing reams of consultation documents. If we ignore the fact that they are churning this stuff out during the holiday season (At a rate no one can read; confusing consultation with asking what we think and costing a fortune.) it seems to me 'Off-sick' is setting up a ludicrous bun-fight for lawyers.
The Carbuncle? No better; developing more guidance than a Sat-Nav factory. CCGs? Worse! I have seen draconian agreements binding practices in a way that gives serfdom a good name. Don't Doc's realise that it'll only take a hissy-fit by their CCG board to put them out of business, with no comeback.
Countless new organisations; uncoordinated, developing out of sync with each other, trying to fit, like pieces of a jig-saw and none of them has the picture on the box. Struggling for primacy like piglets on a sow.
Isn't it now beyond argument; the NHS has descended into a comical, cat's cradle of the cockamamie. I know why; the NHS was dropped by clumsy politicians. The Big Beast is trying to glue it back together. What started as a plausible flat structure; 'doc's in the driving seat and a management cost ceiling', has turned into a mountain of laws, assurances, governance, regulation, guidance, control, directives, instructions, commands, rulings and edicts.
We all know it's a mess. More dangerously, it's a mess with no money. What started out as a crusade to break-up the NHS is now a battle to aggregate-up in the desperate pursuit of economies of scale. Trusts are merging, result; all-powerful providers. CCGs corralled into bigger configurations, result; GPs with less power and even less influence. The Carbuncle, seizing more power, result; CCGs with less influence and even less power. Monitor... Hoovering-up everything that's left (Power is intoxicating!).
As the parcel of power is passed up the line the NHS becomes less nimble and more sclerotic. When the music stops and the parcel unwrapped, I fear there will be no savings inside.
I'm convinced, in complex service industries, it is a myth that specialisation and standardisation leads to lower costs and greater productivity. I'm even less convinced savings will be made flogging-off the estate and sacking managers. In truth, this approach is fine if you only want to manage costs. But we need to manage value, don't we?
If the NHS were a factory, concerned with mass production, passing the parcel might be right. However, I thought we were trying to move away from industrialised healthcare? As we add layers of supervision, reporting, and oversight, decisions will be made further and further away from patients - where the actual business of healthcare takes place. In pursuit of economies of scale we have disinvested in 'doing' the business and focussed on 'managing' the business.
For MBA case-studies on 'misunderstanding economies of scale' try the Banks; "Cut the number of buildings, reduce the number of managers, put all the phones in one place, overseas 'it's cheaper' and create call-centres". Result; valuable relationships damaged and failure-demand (increases in demand fuelled by not getting things right-first-time), lead to cock-up rates as high as 80%. You know how it works; ring-up, hang-on, hang-up. Do it again. Speak to a junior, have a row - clog the system, create costs, start again.
Banks made the same mistake with business units; lending decisions taken away from local managers and passed upwards to data processors who have never smelt the oxides from a welding torch or fresh fish on a slab. Result; no lending.
Misguided; moving decision making (creating satisfied customers) away from the customer. Call-handling is not 'back-office' it's front of house. Failure-demand costs. End-of.
Economies of scale change the balance. They reduce the size, power and influence of the customer at the point of service and increase the size, power and influence of the organisation at the point of management. 'No decision about me, without me' becomes impossible.
Realistically; I can't change my GP, my GP can't change their CCG, the CCG is stuck with a CSS. When we should be managing value by looking outwards at the patient, their carers, relatives and friends, we are cutting costs by looking upwards at 'out-posts', Senates, Monitor, NICE, the CQC, competition authorities, the Carbuncle and the latest - score cards...
It's all going horribly wrong.
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