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NHS watchdog chief warns: 'Reform now or the health service will go bust'

Private sector must get more involved, argues head of the CQC

A fundamental shift in the culture of the NHS is needed to prevent it reaching crisis point.

The head of its official regulator has warned that “radical change” is required to rid the NHS of outdated working practices, cure it of widespread bullying and heal the damaging rift between managers and clinicians.

David Prior, chairman of the Care Quality Commission (CQC), also said that without “major long-term change”, the UK’s health service will “go bust”.

Writing in the Sunday Telegraph, Mr Prior called for greater input from the private sector, the merging of hospitals and changes to the way the NHS is held to account – particularly, the scrapping of waiting targets.

Mr Prior said that despite seeing much worthy of merit in his 12 years working for the NHS, he has also been “too often shocked by some of the behaviour I see”.

“To do the right thing, sometimes you have to speak out against the organisation that you love,” he said.

He highlighted the “alarming” revelation that a survey of 100,000 NHS staff found one in four had been bullied. He also described the NHS as having a culture that “stigmatises and ostracises” whistleblowers who raise concerns or complaints.

His warning comes at a time when the NHS is struggling to emerge from crises such as the Mid-Staffs scandal, where hundreds of patients died and suffered neglect, as well as facing rising costs and an ageing population.

Mr Prior, a former MP and deputy chairman of the Conservative Party, who was appointed to run the CQC last year, said: “Too often it (the NHS) delights in the ritual humiliation of those deemed to fail, tolerates and institutionalises outdated working practices and old-fashioned hierarchies, and can almost encourage 'managers' and 'clinicians' to occupy opposing camps.

He also highlighted a “them and us” relationship between hospital managers and clinicians and drew unfavourable comparisons with the United States, where “many clinicians are on the executive teams”.

“There is little to envy about their funding model. But when it comes to the way the health care organisations themselves work, there are powerful lessons,” he said.

Mr Prior called for a major restructuring in healthcare provision, with more successful hospitals taking over failing ones, shared services, improved community services and better care outside hospitals.

More competition - with more entrants into the market from private sector companies, the voluntary sector and other care providers - is needed to drive up standards, and measures of hospital performance need to change, he said.

”We need the Government to change the way it holds the NHS to account: an end to trusts being blindsided by waiting targets that miss the point, skew priorities and have unintended consequences.“

Mr Prior added: ”Without serious change, the NHS will deliver poor care, and ultimately go bust.“

Additional reporting by Press Association