Chris Lancelot on... The Decay of the NHS

I can't help feeling that the only real beneficiaries of the constant restructuring of the NHS are the seminar companies whose brochures arrive with increasing regularity in my in-tray.

Whole-day conferences on extending your opening hours, making sense of practice-based commissioning, understanding the latest anti-ageist legislation... it is a real growth area. Judging by the attendance fees, it is also an extremely lucrative one. But how ridiculous that we need continually to attend seminars just to understand how to go about our daily work.

Underneath this lies a simple, damning truth. Everyone knows Parkinson's law: 'Work expands to fill the time available'. But Parkinson also formulated other laws: one of my favourites is 'Growth leads to complexity, complexity to decay.' How true. And it applies to the NHS in spades. Politicians and managers may feel they are improving matters when they invent ever-more complicated systems: but there's a tipping point, where the workforce spends as much time trying to work the system itself as they do on the work the system was actually trying to perform in the first place.

We have reached that point in the NHS. When first conceived the NHS was relatively simple - GPs, hospitals, nurses, public health doctors, and a few support workers. Everyone knew where they stood with a simple organisation like that. But now it's become so complicated - workforce initiatives, targets, budgets, health and safety, revalidation, working time directives, COSHH and so on - that we need seminars to understand where we fit in.

When the system is so complicated that it takes more effort to understand and run it than to do the work itself then something is very wrong indeed.

The antidote is easy. It's another well-known business principle: KISS - keep it simple, stupid! It's easy, effective and totally under used in the NHS.

We are now at the point where disillusionment sets in - where healthcare workers know their prime job of looking after patients has been sidelined.

This is where all the seminars in the world won't help, because the sense of purpose has evaporated. This is when dedicated professionals become disheartened and start to think about retirement.

Ah yes. Early retirement - but you may well not understand its complexities.

May I suggest a seminar?

Dr Lancelot is a GP from Lancashire. Email him at .

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