Mr Reid, who declared himself 'rather fed up' that 'the same mistakes are made time and time again', said the 'Balkanisation' of the NHS into many more organisations had aggravated the situation. Some managers who knew 'nothing at all' about how to deliver health care had come into the NHS from outside.
His comments to the Commons Select Committee on the Ombudsman followed his damning report last week on the way the NHS handled complaints and treated patients. Complaints to him rose by just over 4 per cent in 1992, and by 12.8 per cent to 1,384 in the year to 1 April. Since then, complaints have surged again, up 25 per cent on the same period last year.
Greater awareness of the right to complain, promoted by national and local patient charters, had contributed, Mr Reid said. But so had the splitting up of the NHS into many more separate organisations in the internal market.
Mr Reid emphasised that he was not criticising the reforms. But he said that previously 'you had one health authority responsible for a whole area. Now you have it Balkanised into a number of health authorities.' Smaller entities ought in theory to be closer to the user, but with more organisations involved, 'communications, if they are poor, will become worse'. Many complaints involved poor communications.
In addition, 'some people have come into the health service who know nothing at all about how to deliver health care,' he told MPs. Some had come in at the top of organisations and were responsible for the quality of care, but had not 'taken the trouble' to find out about the excellent guidance that existed on how to discharge patients or handle complaints. He had been glad to hear Virginia Bottomley, Secretary of State for Health, say that managers who failed to remedy such defects 'ought to go'.
He also complained about a failure to act on NHS guidance which stated that where transfer to a nursing home would have financial consequences for the patient or the patient's family, it should be agreed in advance in writing. In his experience, 'almost invariably' that was not complied with.
His comments came as David Blunkett, Labour's health spokesman, is expected to signal today that Labour is moving towards another large-scale reorganisation of the NHS by turning local authorities into the purchasers of NHS care.
He is due to give a keynote speech to a Partnerships for Health conference in London in which he will emphasise Labour's new willingness to see private finance in NHS projects. But he is expected also to indicate strong interest in proposals from the Association of Metropolitan Authorities that local authorities should purchase health care as one way of making hospital and community services accountable.
Community care has also thrown up the need to develop 'the essential link' between health authorities and personal social services, he believes. Labour is consulting on its health plans, and Mr Blunkett's stance stops short of a commitment to a local authority route.
He is also expected to welcome private finance for new NHS facilities, in the development of occupational health services and for primary care facilities in new shopping or industrial developments. He believes there should be no ideological rigidity in insisting that either private or public finance should be used when the NHS needs capital. He remains opposed, however, to deals which introduce more private beds into the NHS or result in the privatisation of health care facilities.Reuse content