Corporate governance in the private sector is being worshipped with religious abandon. The private sector has never been more efficient than the public sector where good leadership is present in either. Scale. For as long as corporate structures and price competition are in place, the idea that it's not for profit is an illusion.
The 'Monitor' is failing in one of his responsibilities? he is failing to have any mechanism in place in engaging the Public in the debate of 'Health & Social Care' why is he NOT aware patients 'Health & Social Care' needs are NOT improving, brought about to some extent to NHS Trusts having to sign up to 'efficiency' savings, while experiencing a 'deficit'.
The 'MONITOR' is NOT truly independent.
The role of Governors? for the most is status, my colleague is a Governor, thirty years experience, however others within this TRUST have absolutely no idea what the CEO is talking about, the same goes for elected Councillors in LA positions.
My final comment is this, why are standards falling for the Mentally ill? many are 'invisible' to the system, while at the same time the 'MONITOR' will write another report on his 'personal' views regarding 'integration'. it's getting better!
'Vanguards' who are they? they are supposed to be an elite group of individuals acting as a 'steering' group' for others. Hampshire have such a group, however a Carer sought my help for her son, the Health & Social Care was practically 'non existent' this individuals was previously on a CTO, where does the 'MONITOR' 'fit into this' and how would he know about the ' practically non existent 'Health and Social Care' shown to this individual and many others,
The 'MONITOR' must raise his profile to the General Public, then his Report may contain the 'TRUTH'.
The 'MONITOR' is 'not fit for purpose' his only interest is money, and nothing else, because that is his MAIN 'JOB'
If ever there was a need to place a large magnifying glass over their powers, duties and delivery it is now.
To have their Chair the same person as the Chair of the Trust is beyond belief ...'independence', 'holding them to account' ...really, doesn't LOOK good.
No one is saying that there is malpractice but what a recipe for potential disaster. Openness, fairness etc etc - how do you convince anyone that this is going on?
Little is heard of their demands, desires or otherwise to expose when problems are finally aired nationwide. How many sit there hood winked through presentations by Trusts and nod pleasantly in the Trusts direction having first put on their rose coloured specs?
Well meaning people I have no doubt but they are our direct representatives.... what of reality?
Yet another example of how top-down reforms have had a malign effect and wasted billions of pounds. See Lale & Temple J. Roy. Soc. Med. 2016 109(1), 18-26.
I agree with N Goodwin that the trusts may have planted the seeds of their destruction through timidity. But Milburn's original Spainish insight was transformed into a pale model of independence. Elsewhere, Canada's hospitals, while creatures of provincial legislature, broadly enjoy high levels of independence despite a monopsony payer; Germany has successful hospitals as does France and the Netherlands; Malaysia is the home to IHH, the world's second largest hospital chain; do we need to mention the US? And so it goes. All operate within both public and private healthcare systems. If I were looking around for world-class hospitals, there are higher performing models in other countries, what lessons would I gather from the NHS?
Having in the past taught hospital management, and conducted hospital performance reviews, I would say there is still a lack in the UK high level hospital / healthcare management degrees and suitable career paths for high performing individuals to move into executive roles. It sometimes seems amateurish.
The current state of affairs may be more a pecularity to how the NHS mandarins worry about their own response to crises. Fear drives actions such as we're seeing and the consequence is to constrain managerial freedoms to innovate, which in the end provides the evidence that state intervention was needed in the first place.
Even the most ambitious organisations eventually learn to stop struggling when the regulatory and bureaucratic chains become too heavy.
All I can reflect back is that if freedoms are good for prison or school governors, what is the problem with hospitals. Such policy incoherence is breathtaking.
The current situation is compounded by at least two interrelated factors alluded to in the blog. First, the failure of the majority of FTs to realise the benefits from their greater freedoms in the early days of the FT movement. And second, the lack of a coherent approach to the development of corporate management within FTs, particularly at board level.
Although Monitor did more than any other national body to develop boards, this was - with hindsight - not followed through with a robust programme of corporate development within each organisation. One of the consequences of that we are likely to see develop in the current climate is the differential impact of boards across the NHS and the development of stronger, direct executive links between CEOs and national regulators. In summary, the develop of a corporate management approach will rapidly emerge as an increasingly significant challenge for the NHS.