Independent think-tank Civitas has called for a change in culture in both the government and individual NHS organisations to lighten up on bureaucracy and firmly put the patient back in the spotlight.

According to its hard-hitting report Putting Patients Last: How the NHS keeps the ten commandments of business failure, waves of government reform have positioned the NHS as a series of businesses, but the growing injection of the private sector disciplines into what is a public service is backfiring primarily because Whitehall remains reluctant to relinquish any control.

This, it claims, means that the “‘customer’ of NHS ‘businesses’ is not, in fact, the patient, but the minister”, and so NHS organisations remain focused on conforming to the latest government initiative rather than the provision of high quality care to patients.

“Blind faith in structure, process and satisfying government has made businesses immune to what is happening on the ground, where the world of people, cultures and emotion make the real difference,” the report states, and warns: “More of the same command-and-control attitude will not pull the NHS through the recession”.

The central theme of Civitas’ argument is that the health service is destined to fail as it seems to be following the Ten Commandments of Business Failure, as first described by former Coca Cola Company chairman and chief executive Donald R Keough. These are: stop taking risks; be inflexible; isolate yourself; assume infallibility; play the game close to the foul line; don’t take time to think; put faith in (external) consultants; love bureaucracy; send mixed messages; and be afraid of the future.

For example, with regards to assuming infallibility, the report asserts that politicians often claim the NHS is ‘the envy of the world’ when in fact “the outcomes it engineers are worse than other universal health systems in Europe”, and it cites figures showing that the UK actually ranked 16th out of 19 industrialised nations in terms of amenable mortality and 13th out of 30 countries in Europe on patient satisfaction.

Too close to the edge?
In addition, tough targets have become the focal point of operations often pushing organisations to the edge of what is acceptable in terms of care neglect, which fits with the ‘play the game close to the foul line’ commandment. For example, the four-hour A&E target has merely diverted the stream of emergency patients into clinical decision units, waiting in ambulances and premature discharge, the report says.

And another example is illustrated by the NHS’ increasing reliance on external consultants. Recent figures show that organisations shell out a breath-taking £350 million a year on external consultants although their effectiveness remains to be proven.

The report stresses in no uncertain terms that a sea change of emphasis is urgently needed to help the health service weather the recession. Report authors Peter Davies and James Gubb state: “It is time for NHS organisations to start backing people rather than processes [and] it is time for the government to stop over-estimating the importance of legislation, crude measurement and regulation as markers of success and put faith in power of frontline organisations to drive quality”.