‘Leave my NHS alone!’: Our Last Taboo

Austerity. Cutbacks. Recession.


Protecting ‘our’ NHS has becoming the temporary raison d’être of many an opposition leader over the years often to find that once they are in power that the grim reality of maintaining the National Health is a daunting one.

When the NHS was first conceived by Aneurin Bevan all those years ago it was during a vastly different political landscape. At the time doctors operated as independent operators charging at will for their pills and potions. The prices were in many cases extortionate and subsidies were limited for the poor.

People simply avoided seeing their doctor in favour of dangerous, unproven remedies and practices.

And then the NHS.

The NHS was created so that the poor could access essential medical services at any time and in any place without fear of the costs. The NHS was born to care for those who could not care for themselves and was there to be cherished.

The envy of the world.

But here’s the problem we now use and abuse the NHS without a second thought. We’ve pushed it far beyond its original boundaries of operation and we’ve attempted to develop it with increasing bureaucracy and ever limited resources.

We’ve decided universal, free healthcare is our right.

We expect efficiency and excellence and strike with an iron fist when standards aren’t met.

All the while we question why healthcare staff feel they need to be rewarded.

It’s the public sector stupid! Don’t expect a pat on the back.

The NHS now can’t cope with the burgeoning population, the masses in Accident and Emergency whilst trying to compete with the funds being pumped into medical research institutions across the world. The NHS is clearly our right isn’t it? How dare we even question it?

The NHS is our last taboo. Even questioning that we may have to tear it down and rebuild it is beyond belief. Whilst we complain and procrastinate about its constant failings we are happy to hark back to its founding principle of free, universal care.

Instead, politicians undertake backdoor reform programs knowing that they need to do things differently whilst living in the fear that should things go public then out of Whitehall they go! Transparency and accountability is then lost and sensationalist headlines reign.

What’s the key? The solution?

Context, my friends, context. We have to recognise where we were and where we are and be honest with ourselves before we can move forward.

No-one will deny that something needs to change but we need to consider that NHS reform like any other plan must be done without emotions clouding our judgement.

Agree or Disagree? Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd






PFI and the NHS: A Case of Misplaced Accountability

The NHS is suffering. I don’t think I really to point that fact out.

I wish I had the solution to fix our woes but instead I despair both as a clinician, trainee, student and strategist.

However, the reason I despair might not be the one you expect. You see I am an advocate of public-private sector partnerships and collaborations. In fact, I believe the future survival of the NHS and delivery of free, universal healthcare will rely on these partnerships. Here’s the the thing though.

Privatisation. It’s a dirty word.

If you believe the vociferous protestations of the medical establishment and leftist establishments you would think that private firms are the grim reaper incarnate here to destroy hospitals whilst taking all our money.

The real problem is neither one of public sector bodies or privatisation rather its one of accountability. Private Finance Initiatives (PFIs) allowed health infrastructure to be developed and maintained by private organisations whilst holding public bodies, chiefly hospitals, indebted to them for vast periods of time. In many ways it’s a rather large, exorbitant mortgage.

And a mortgage by its original French meaning is an ‘engagement ’til death’. How fitting.

So when these PFIs were undertaken who was accountable? Certainly not the doctors and nurses delivering the services on the frontline, neither the departmental managers. Seemingly, not the chief executives or chief financial officers. However, on the flip side the private sector has in many cases done very little wrong. In the majority of cases they have delivered what they agreed upon and are merely collecting their debts.

Who does this leave? Only one answer. Government.

As this was a cross party project I won’t be expecting a shred of accountability to be accepted by any side any time soon. Is PFI an unmitigated disaster? A beautiful dream turned sour in its reality? Probably, yes, for now.

If I had a solution, then I’m sure others would have thought of it too but I can’t help but feel that we can still trust the private sector as long as we define the boundaries in which it has to operate. As long as we recognise that NHS services are unique in their complexity and so require a unique degree of supervision and regulation.

Sometimes, we have to accept an uglier truth. Cuts need to happen, unsustainable services need to be shutdown and workforces cut.

Wholesale, difficult reform and re-structuring has to happen.

Who am I to talk though. I’m sure the boys up at Richmond House have it covered. (I hope)

Agree or Disagree? Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd

When did privatisation become a dirty word?

From the moment the Conservative party returned to a semblance of power the media has fretted about the risk of privatisation. Alas, they were given the ammunition they needed with the subsequent push for NHS reforms by Andrew Lansley.

Privatisation that dirty word had reared its ugly head. After the dismal failures of rail privatisation even I couldn’t help but read about the reforms with a mixture of despair and scepticism fully aware of the storm that would be brewing. And  so I was proved correct with every Royal College (even the most obscure) coming out of the woodwork to spew vitriol about reforms.

“This is backdoor privatisation!”

“Save our NHS, profits will destroy care,”came the shrill cries.

Now hold on a second, right there. Private corporations around the world provide exceptional services to the great and the good on a daily basis. There have been disasters, of course, but lets take a second to review. Companies function on the basis of a central tenet:

Competition. Who selects the best competitors in a capitalist market?

Consumers. They vote with their wallets.

How about the NHS? Well, I don’t advocate wholesale privatisation, in fact, I think that would be a disaster.

However, what will define the best competitors in privatised system? Two words.

Clinical Excellence.

Privatisation doesn’t necessarily mean independence and government can still define the rules of the game that we play. Regulation is needed most at this moment in time but with a purpose. We can regulate the services that can be privatised and most often they will be the most difficult to deliver at which the NHS is already struggling. There is no solution but we need to take stock of our NHS and its ability to cope with our ageing population amongst other issues.

We can find a solution. The answer isn’t as simple as UK vs US or public vs private. It’s not black and white.

Whether we like it or not the likely solution will involve a private sector solution to a public sector problem.

And before you go any further, it doesn’t have to disrupt the final point of care that patients receive.

Agree, disagree,discuss? Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd



The NHS: A Private Sector Organisation?

Last night in the London 2012 Opening Ceremony an entire segment was devoted to the National Health Service, celebrating one of our greatest institutions, Great Ormond Street Hospital.

Marvellous. The envy of the world! Or so Danny Boyle would have us think.

Public sector healthcare, free for all, caring and treating anyone and everyone. In your face America! With your privatised systems, health insurance and extortionate bills.

Hold on. Let’s take a second.


Whilst doctors and nurses were jiving in the Olympic Stadium I wondered through which set of rose tinted spectacles had Mr Boyle surveyed our greatest public sector institution. Has he visited any hospital wards recently? Has he been on a waiting list? Perish the thought of becoming ill abroad and having all the terrible fees to pay.

Mr Boyle, excuse my vitriol but healthcare is in a state of flux of reform and re-organisation where elderly care services are failing and where front line healthcare staff are struggling with a terrific lack of resources whilst trying to maintain world class care for all our patients. Yet at the same time the culture of our NHS is one of unabashed arrogance where we think we know best and refuse to acknowledge the need for any sense of reform!

The P word. Privatisation. You have whisper it if you’re anywhere near a hospital because the loathing that will be dumped upon you should you mention it as a viable solution will be lethal in its ferocity.

If I told you that the NHS was only public at the point of care but that really the driving machine is a hybrid of public and private collaboration would you believe me?

I could list for you a range of privately contracted services:

  • IT in Primary Care
  • Courier Services for Blood Products
  • Catering Services
  • Deep Cleaning Services
  • Infection Control Services
  • Payroll Processing
  • Estates Management
  • Portering Services

These are just a few of the pivotal services in NHS trusts that are often contracted out and supplied (often successfully) by private groups. We have not even mentioned the range of private surgical centres embedded within NHS trusts shortening waiting lists that trusts cannot handle in which operations are performed more swiftly, more effectively and more cost-effectively.

Private sector institutions are not the angels saving the NHS and neither are they the death knell for free healthcare for all. Some have failed abysmally but the significant majority are silently providing the services we rely on to treat our patients effectively in a timely manner.

I am not advocating wholesale privatisation but I think vast swathes of the population need to recognise the real NHS. The NHS that is being propped up by the forces that so many seem to despise.

Profit incentive? It’s running the NHS already.

Agree, disagree,discuss? Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd

“Olympic sized effort, Olympic sized change?”

It was inevitable that I’d make an Olympics themed blog after our magnificent opening ceremony. Living in London I’ve witnessed the politics, news headlines, procrastination, moaning and then later nostalgia, pride and euphoria associated with the world’s greatest event. One of the single most important issues associated with London 2012 is the issue of sustainability and long term change through investment in East London. From the aquatics centre to the Olympic stadium they have all been earmarked for long term use.

But here’s the thing.

Can investment alone lead to sustainable long term change?

A news segment on the BBC interviewing Stratford locals was rather poignant as a rather annoyed market seller exclaimed,

“How many of us will be at the Opening Ceremony? Not many I’ll tell you that!”

Personally, I believe the investment will be worthwhile, but what’s been created is an unprecedented set of resources for East London. However, the key to the legacy they create will only be achieved through effective management. London 2012 must align its objectives with the slew of private investors who will wish to take over the facilities in due course. Moreover, a sustained trickle of investment in local, grass-roots clubs and societies must occur and an open dialogue maintained with local leaders.

It’s good to talk and we don’t do it enough. Future investors must understand the purpose of our Olympics and the same way that Millenium Dome became the O2 Centre, a fantastic entertainment centre so to must our our Olympic facilities became centres of sporting inspiration, achievement, local pride and most importantly accessible resources.

So will London 2012 leave a long term legacy in our local communities?

Well, if the organisers remember why they wanted the Olympics and make sure they’re talking to our communities then maybe, just maybe we’ll feel the ripple of 2012 for decades to come.

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
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“Where have all the leaders gone?”

In the wake of Lord Oakeshott’s vicious rebuke of George Osborne, I’ve been drawn to a rather glaring observation.

Where have all the leaders gone?

I mean the ‘work experience chancellor’ is a rather harsh description for George Osborne but worse still because there is a grain of truth to it. A lack of worldly experiences could really be hampering the development of some of the world’s greatest nations. Are leaders born or are they chiselled out of the ether of life experience? I mean the word leader has really become a brand or a stamp placed upon people with increasing ease.

Let’s take the NHS for example. Doctors, nurses and allied healthcare professionals are branded leaders on an alarmingly regular basis based purely on what I can only determine as elder status and in some cases being the only soul in the room willing to deal with middle management and the never-ending bureaucracy. Even more unnerving would be those who are using their new ‘leader’ status to merely climb the rungs of power treating their new post as simply a pit stop in their inevitable rise to world domination.

Now, of course only those who aspire to lead will actually go on to lead. However, the definition of leadership has become confused with the notion of being ‘the boss’ and in some sectors is even viewed as such. Worse still, ‘leadership’ roles are handed out seemingly as prizes whereas in many cases they are a tool to pass on difficult tasks and unrealistic objectives.

It’s my view that those who want to lead must be identified early and nurtured for their prospective future roles. In healthcare, one of our biggest issues is that there is not enough of an emphasis upon developing leaders from a clinical background. Instead, we are merely selecting the most senior person who is willing to take the responsibilities of management.

Herein lies another problem since there is an ingrained culture of mistrust and suspicion between clinical staff and management. In many cases, the most senior staff who represent clinicians have an already fixed word view where adaptation and acceptance of new ideas and reforms simply have no place. Instead these ‘leaders’ become obstacles and worse those leaders/clinicians/managers who are trying to bring in genuine quality reforms are hampered by never ending bureaucracy.

So where have all the leader’s gone? I’m sure they’re there. We can find them and we can nurture them but we need to develop the right infrastructure and cultural systems to bring these people to the fore instead of merely branding anyone and everyone a “leader”.

Leadership like anything else is a combination of nature and nurture.

It’s time we did a bit of the nurturing.

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
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Evening Sessions #22: Warzone Globalisation

Iraq and Libya.

Apart from being war torn and oil filled in recent years they have also become trade and investment opportunity hotspots.

And don’t they just know it. Emerging economies around the world are constantly wooing international investors and professionals with tax-breaks, subsidised investment opportunities and lucrative collaborative projects. As a strategic consultant based in the traditional, European and US markets the opportunities in the emerging economies call like the Wild Wild West.

Iraq and Libya (even Egypt) are different though. Regime change is like a ‘reset button’ often clearing the slate of past business contracts and negotiations leaving them open for new bidders and negotiators but it importantly offers a different type of opportunity. Often depending on the type of regime change it can create an intellectual vacuum and openness to new ideas and concepts.

Maybe this doesn’t have to be a problem anymore?

One of the reasons I’ve been focusing on a combination of discussing change and cultural psychology in my blogs is that there are new economies where a highly tailored approach can yield remarkable dividends. Just like the transmission of management concepts from the USA to Japan and then back again, there are emerging, almost infant, economies where tried and tested strategic theories can be applied.

Corporate strategy is a young field still finding its feet in traditional economies many of which are in recession. The emerging economies may offer the resources and open minds to take the application of corporate strategy further and sooner.

Ultimately, it will be the adventurous, brave and foolish who seek to ply their trade in these high risk territories.

But maybe, just maybe the rewards will come true.

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
If you’re enjoying this blog series then take a second to follow and forward it on!