NHS MANAGEMENT

Applying Detailed Scrutiny to the Ways in Which the NHS is Controlled and Managed

Applying Detailed Scrutiny to the Ways in Which the NHS is Controlled and Managed

Introduction

The NHS also operates a financial management training specialism within its Graduate Management Training Scheme. This is open to graduate entrants and is designed to recruit very able people, from both inside and outside the NHS, who can make an impact and rise to the top jobs in the NHS. The range of NHS posts initially entered by individuals from the Financial Management Training Scheme include business accountant, finance manager, locality management accountant and assistant unit accountant. The set-up process ensured that the interpersonal/clinical provision of one-to-one counselling was established as a measurable, auditable service that could withstand the same level of scrutiny as other NHS services, and with the same degree of professional accountability. The clinical governance document was moreover a transparent measure that had meaning at both Trust and local level, and it immediately helped to give the service professional credibility and secure ongoing contractual agreements. In effect, it set high standards of quality control for all aspects of service provision. From the initial selection and placement of the counsellor to the information going to patients and the guidance given to referrers, we were now actively engaged in continuously scrutinising what was being done and committed to introducing ongoing practice improvements.

Management and Control System in Healthcare

An obvious example of an area in which this 'continuous improvement approach' has been applied over the years is that of appointment attendance. As for many services within the NHS, achieving good attendance from patients and dealing with missed appointments has continued to be a challenge. This service has developed various ways of analysing and approaching the difficulty in order to identify different interventions that can help. For instance, we first separate missed sessions that have never been attended from those involving patients who are in ongoing counselling. In the case of new practices to contract with the service, we provide referral guidelines to help the doctors decide who to refer. As we explain, just because a person is really struggling to cope with difficult psychological or emotional aspects of their life does not necessarily make them a candidate for counselling; it is important that a doctor checks whether a person wants to engage in counselling as a way of addressing their difficulties before referring them to the service. We have found that when a locum doctor is in place, referrals to the service can often shoot up along with the number of initial missed sessions (Birenbaum, 1997).

Democratic accountability is essential to help improve the National Health Service. The moves made in England over NHS foundation trusts should be extended to other bodies such as Primary Care Trusts, including election of their boards of directors (by direct election, from within stakeholder groupings).

Assertions that 'democracy does not work' can on the one hand be seen as special pleading to maintain the hugely unaccountable appointment process, and on the ...