Beware of the NHS’s new zero tolerance policy | Letter
Victor Adebowale, the cross-bench peer, raised two concerns about the NHS (report, December 26). Firstly, that the country risks being paralyzed as it waits for Wes Streeting’s 10-year reform plan. Secondly, the long waiting times this year, compared to a similar period in 2009, for diagnostic scans and elective care, and in emergency departments.
My concern is not that the NHS will be paralyzed as it waits for the Ten Year Plan, but that its intentions have been overtaken by the zero tolerance for failure package of NHS reforms announced on 13 November by the Department of Health and Social Care. That package resembles the regimes of the 2000s: firing persistently failing managers, sending turnaround teams to struggling hospitals, rewarding the best performers with autonomy, and striving to reduce waiting times for 18 months to 18 weeks.
A key to the NHS successes of the 2000s was the annual real increase in NHS spending of 5% over a decade. Now the outlook is 3% for three years. Moreover, in July 2024 31 out of 42 of integrated care systems in England showed a deficit (total £2.2 billion). These must be eliminated by March 2025.
The board of Mid Staffordshire NHS Trust gained the deserved autonomy of NHS foundation status in 2008 by eliminating the financial shortfall through draconian cuts to nursing staff. Robert Francis described how the resulting appalling care was hidden in plain sight from “a plethora of agencies, monitoring groups, commissioners, regulators and professional bodies”.
In October the Dash report found “significant deficiencies” in its review of the Care Quality Commission (CQC), resulting in a substantial loss of credibility within the health and social care sectors, and a deterioration in the CQC’s ability to identify poor performance and drive support quality improvement.
Gwyn Bevan
Emeritus professor of policy analysis, London School of Economics; former director of the Office for Information for Healthcare Performance at the Commission for Health Improvement