NHS ‘chaotic and dysfunctional’ says head of NHS England

NHS ‘chaotic and dysfunctional’ says head of NHS England

The Times reports that Lord Prior of Brampton, who chairs NHS England, has described the NHS over which he presides as a dysfunctional system, in an attack on 25 years of ‘flawed health policies’. He said that targets, competition and reliance on inspectors had all led to a disjointed system and demoralised staff, at a conference organised by the think tank, Reform.

The Times wrote that Lord Prior, whose role is guiding the health service’s strategy, said that the main aim of a ten-year plan was to overcome organisational divides that had “riven the NHS over the last 25 years”. He said that chaotic organisation and overuse of targets “led to a disempowered culture, a learned helplessness culture, a top-down looking-upwards culture, a very hierarchical culture”.

He was talking about hospitals, rather than general practice, but many GDPs will agree with his assessment, which could well apply to NHS dentistry. Lord Prior continued by saying that a series of NHS reforms had broken up the health service into autonomous hospitals which “makes driving an integrated strategy across the NHS almost impossible”, he added. “You could not have designed something that had at its heart more dysfunction. It’s truly remarkable.”

Lord Prior, who also headed the CQC, continued: “How we address these cultural issues is fundamental, how we bring back that vocation. I remember talking to many junior doctors who say, ‘At the end of our day when we’re about to go, we’d always walk back to A&E to lend a hand if there was a problem. Now we go home’.

“The number of GPs who want to leave when their pension plan hits their maximum, who historically would have worked for another couple of years; the number of nurses you meet who say, ‘I’m 60, I’m going’, who might have worked for another couple of years in the past. If we just recapture that kind of engaged spirit, that vocational engaged spirit, then I think so many of our other issues would be taken care of.”

Roger Matthews
David Prior
Good comments Tony. I first heard and met Lord Prior when he had just become Chair of CQC in October 2013. He struck me as a frank, honest and determined leader, and opened his speech with: "I am not a natural regulator".

He regretted that regulation was necessary at all, but noted that in an 'imperfect market' where providers had an 'asymmetry of information', it was required.

Prior added that 'regulators don't assure quality - that can only come from front line professionals' and what was needed was evidence-based judgement, not regulatory compliance.

Those were the days immediately after Prior (as Chair) and David Behan (Chief Exec) had just taken over at the CQC. When asked, during Q&A why he thought CQC had lost its way, he replied: "It was put together too quickly, and every strategic decision made in the first three years was wrong".

I thought that extraordinarily frank, like his latest utterance as Chair of NHS England. That is a vastly bigger supertanker though!

Anthony Kilcoyne
NHS is 'chaotic and dysfunctional' says head of NHS England.
Very true especially the more centrally-limited and target-driven any system with the NHS is operated, with NHS Dentistry being a very obvious candidate for a top three prize...... of a wooden spoon :(

Trouble is everytime someone gets knowledgable and honourable enough to admit this publicly, they soon get silenced or moved on - surely the NOLAN PRINCIPLES of public life should dominate and be fully protected (Honesty, Selflessness, Integrity etc.) and not brushed under the carpet, so to speak?

This admission publicly is as exceptional from those in power/knowledge, as it is honourably in the Public Interest to be fully open and transparent, to diagnose the major problems first, to give a chance for some proper Major solutions.

Yours also observationally ,



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