Now I know why NHS is ‘not fit for purpose’

They employ Management Consultants to guide every new ‘plan’ 

Management Consultants such as KPMG, McKinsey, etc. are excellent at advising companies what needs go be done – but not so good at dealing with human problems, as I found out when I entered the NHS minefield.                                            It’s no use moaning at bad NHS service – it’s up to us to TELL the NHS what WE want. Because instead of reading a selection of letters of complaint from patients, the Dept. Health has the habit of employing management consultants, whose solutions often overturning what already works fairly well, but just needed tweeking.

Four years ago I thought I should stop moaning, and volunteer for a local NHS committee as a ‘Patient Representative’.

I found myself on two committees.  Running concurently, for the first few meetings I could never work out which one I was attending.  Both were run by hired-in ‘Management Consultants’ , appointed by the NHS – at taxpayers’ expense.  And talking incomprehensible jargon I couldn’t undestand.  Maybe that was the idea, so I didn’t come up with any revolutionary ideas that changed their systems.

Until I got my feet under the table and felt confident to ask for explanations, I hadn’t a clue what we were talking about!

Thanks to a wonderful book called ‘NHS for Sale‘ – and their explanations of NHS jargon – all became clearer, and gave me courage to question.  The book explained that, in their eyes, CCG  (the consortium of doctors and ‘professional’ patient reps that now commissions our treatment) stood for CYNICAL Commissioning Group. I got the giggles and didn’t care whom I interrupted to ask for explanations of other Acronyms bandied about. (CCG means Clinical Commission Group – but I prefer the NHS for Sale version).

And boy, were these committees eye-openers.  I learnt that

  • when it comes to new initiatives, the NHS can find unlimited funds
  • And often doctors don’t know what patients really want.

Good and Bad

Surrounded by GPs, I felt intimidated;  until I found out often they had no idea what patients actually wanted – and I, being a patient – DID.  After one day when I have voiced my opinion about what patients wanted rather loudly, I even got an email from McKinsey thanking me for my contribution, and saying how valuable they found my insight !!!

Other consultants  went their merry way, committing every sin in the Presentation Book, from mis-using Power Point, showing over-crowded screena, reading from the screen as though we were illiterate, flashing through screens at the rate of knots, and scowling if we asked a question.  They forgot to supply tent cards so we couldn’t write our names and place in front of us; it took ages before we remembered each others’ names, and even longer to identify which organisation we represented.

Their Proposals

We were meeting to devise a new system for looking after over 65s.  First idea we shot down was their four-page letter, detailing (in NHS words) what this was about,  It was to be sent out to local OAPs, instructing them they had to attend an appointment at a certain time and date.

The arrogance appalled and we said

  • “two pages ONLY  – no more (I wanted one but lost out to bureaucracy!)
  • Make it an INVITATION for an appointment at Patients’ convenience – to sound like a benefit, rather than a COMMAND
  • Patients should be told approximately how long their appointment will take – they do have other things to do
  • Designs for the new Centre showed patients came into a Reception area;  if they wanted a cup of tea they had to walk down a long corridor to a ‘quiet room’  well away from the noise and action.  We explained some elderly people had difficulty walking;  once off transport and in to Reception, they would want to sit and recover!  And, this might be only time they had left their home that week, so they wouldn’t want to be shut away from life in a quiet room away from the action.

Fight Goes on

At the beginning, there was the usual expensive survey, which threw up that Patients wanted a social meeting place, with tea and coffee, and a chance to discuss their care in a holistic way.  Half way through the planning stage, strong letters went out to big-wigs saying patient Reps were unhappy at the way the ‘holistic care pattern’ was developing with too much emphasis on clinical outcomes, and holistic care had disappeared,

Patient Reps suggested Specialist Nurses should be involved, available for consultation by Patients and Carers (Admiral Nurses, staff from Heart and Polio Foundations, Macmillan, Age UK. ROS, etc).  Patients could be told which day a Specialist Nurse was present, and book accordingly.   But surprise – surprise – this idea got ‘LOST’ .  Seems some Management Consultants didn’t know much about Specialist Nurses.- or perhaps they can’t charge a management fee if used?

It had been interesting seeing how to play the system, what goes on behind the scenes, and how Patients can sometimes make a difference.

Sometimes a quiet question makes medics see what WE need – and not just what officialdom thinks is needed. It’s in my interest – like everyone I am getting older, and want better care !


Wherever you live, if you are worried about what your care will be like as you get older – GET JOINING.  Your local Healthwatch is probably a good place to start, or if you have a good relationship with your GP ask them.

There are too many ‘Professional Patients’ on NHS committees;  so when the NHS needs Patient Reps, it is easier for them to send for someone already in the system.  But many of these have begun to start think like the NHS, rather than stand up for what patients want. Se genuine patients are really needed.

Good luck, and Go For It!  It’s your future care you will be working on!

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