NHS-bureaucracy
Health and Social Care

The NHS: The Elastic Band of Bureaucracy

It has become a cliché to say that the COVID crisis has presented the NHS and the state more generally with unprecedented challenges. I would argue it adapted quicker than many small-state Conservatives would have thought possible, as everyone worked together for the common good, writes Councillor Tom Parkhill.

Some of these changes will undoubtedly be in the best interest of patients, for example, it would be no surprise if the incidence of hospital-acquired infections such as MRSA are greatly diminished with the greater focus on infection control from staff, visitors and patients alike. Whilst other changes are to the detriment of patients interests, for example cancer diagnosis rates are a ticking time-bomb for which an urgent plan is needed to avoid an increase in cancer patients being diagnosed too late to save their lives.

But little time, or column inches, has been dedicated to the evaluation of changes which took place in our hospitals during the initial moments of the pandemic, but have snapped back to the status quo due to the joint elastic forces of bureaucracy and vested interest.

One example of a positive change within our NHS during the pandemic was doctors taking back control over their rotas. It may come as a surprise to many readers that unlike nurses and midwives, whose shift patterns and staffing levels are arranged by ward Sisters and Matrons, doctors’ shifts and annual leave is approved by mid to low-level administrative staff serving in a role known as a rota-coordinator. These rota coordinators who have no clinical skills or experience, are employed to follow a tick-box approach to staffing levels. Instead, we should be trusting those with the clinical knowledge and experience necessary to make informed decisions on these matters.

It is not just the rota these admin assistants control, they are also the arbiter of whether a doctor is able to take annual leave on a particular day. From speaking with doctors, I have heard examples of the remarkable inflexibility of some rota-coordinators. The requirement to book a single day off six weeks’ in advance seems absurd, especially if you have childcare responsibilities. In fact, I have heard of one ridiculous example when two doctors were able to arrange between themselves to swap equivalent shifts, however, this was rejected out of hand by the administrator for no clinical reason and seems to be needlessly obstructive. With this in mind, it is perhaps not surprising that in 2019 only 57.4% of Foundation Year 2 doctors, (those in the second year of practice after completing their degree), continued to undertake clinical roles after completing their foundation programme. Newly qualified doctors, who have spent five years (or more) in education and two years conducting further on the job training whilst working in incredibly demanding roles find it a shock that they have so little control of their own lives, and there seems to be no way in the foreseeable future to take it back.

So what changed during the pandemic? With administrative staff sent to work from home, but with home working equipment or adaptions not yet available and clinical staffing levels of heightened importance, doctors- (often Registrars, the most experienced doctors below Consultants) took over and were able to set rotas to suit clinical care needs. In effect, a similar arrangement to nursing and midwifery staff. However, this elastic band of positive change, which strained and stretched during Spring, has now returned to its saggy and relaxed normal state. This is not acceptable. We should always be learning in Government and this is one example where improvements can be made. There are no doubt countless other examples across the NHS that we can learn from in this pandemic, whilst staff and systems have adapted to the demand.

As Welsh Conservatives, we believe it is not only our duty to deliver excellent healthcare, free at the point of use in every town and city across the country, but to also to ensure that administration is focussed, so that it doesn’t get in the way of clinical staff delivering for patients. We should put doctors in charge of clinical staffing decisions, which will ensure staffing levels are appropriate, whilst enabling a more flexible approach, which will hopefully improve morale and retention of our hard-working doctors. Let’s cut the elastic band of bureaucracy within our NHS and make a more patient focussed NHS, because ultimately this is the reason the NHS exists.

Councillor Tom Parkhill is a Conservative Councillor for Llanishen & Thornhill on Cardiff Council.

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