{"id":352856,"date":"2025-12-17T00:57:11","date_gmt":"2025-12-17T00:57:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/au\/352856\/"},"modified":"2025-12-17T00:57:11","modified_gmt":"2025-12-17T00:57:11","slug":"improve-the-nhs-fast-or-people-will-fall-for-the-charlatans-so-says-a-departing-trust-head-wed-do-well-to-listen-polly-toynbee","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/au\/352856\/","title":{"rendered":"\u2018Improve the NHS fast or people will fall for the charlatans\u2019 \u2013 so says a departing trust head. We\u2019d do well to listen | Polly Toynbee"},"content":{"rendered":"

I catch him before he slips out of the NHS ahead of Christmas. After 46 years in the health service, no better time for an exit interview with a leading NHS trust chief executive, who has seen the best and worst of it. Nick Hulme is in brutal truth mode. He has one foot out of the door of his East Suffolk and North Essex NHS foundation trust<\/a>, just as the resident doctors strike for the 15th time, amid a rampant flu crisis. But he\u2019s off, his time is up<\/a>.<\/p>\n

\u201cI can\u2019t remember a time when the NHS was at such risk,\u201d he says. Labour has put in more money and staff, productivity and activity has risen a bit, waiting times down a bit, yet waiting lists stay stubbornly high<\/a>. \u201cThat\u2019s dangerous ammunition for Nigel Farage and the Conservatives,\u201d says Hulme, \u201ca narrative for people who want to kill the NHS.\u201d<\/p>\n

Nick Hulme. \u2018He has survived many a 10-year plan, forgotten in a year or two, but enthuses about Wes Streeting\u2019s 250 neighbourhood health centres.\u2019 Photograph: Pagepix Ltd<\/p>\n

Private practice is soaring<\/a>, but it fell steeply when Labour last cut waiting to historic lows. That could happen again. He says that at the \u201ctop of Bupa\u2019s risk register is the danger that NHS waits fall\u201d. He scorns politicians promoting \u201cchoice\u201d<\/a>, when that would require spare capacity, and at the moment the system is running red hot. He\u2019d be tougher on consultants keeping their lists long to fuel demand for their private practice, but the BMA and Royal Colleges<\/a>, with their professional silos, are hard to confront. \u201cLook how they oppose physician associates<\/a>, used widely across Europe,\u201d he says.<\/p>\n

He laments how in the pandemic everyone did everything, out of silos, acting up and acting down collaboratively: he thought it was a new dawn, but afterwards they went straight back to their restrictive practices. Once a shop steward for the now defunct National and Local Government Officers\u2019 Association (Nalgo) trade union, he knows about demarcations. He started out as an 18-year-old porter, rising to a brief (unhappy) time inside Boris Johnson\u2019s No 10.<\/p>\n

Our conversation covers familiar NHS territory of forever dilemmas and paradoxes. He is full of enthusiasm and frustration, strong conviction and infinite exasperation, struggling to make the system work despite rotating politicians with spinning targets, austerity and reorganisations. Hulme is exceptional, yet typical of many of the best public servants, confronted like them with the effects of poverty and inequality beyond his doors. His trust has a delightful cottage hospital in affluent Aldeburgh, worth a fortune if he dared sell it, boasting a dementia-friendly \u201cpeaceful sensory garden<\/a>\u201d kept by its many volunteers, who collected \u00a3320,000 for a new X-ray machine<\/a>. But his patch includes the poorest places, too: Jaywick and Clacton. \u201cWhat couldn\u2019t we do for Jaywick with those scanners. They have fewer GPs, too,\u201d he says. A Clacton family just told him they wouldn\u2019t go for smears or screening, as it took three bus rides with small children.<\/p>\n

These facts about warped NHS<\/a> spending priorities are hard but not impossible to change, he thinks. Poor places get less, the older patients dominate resources, maternity and children are neglected, shifting funds to prevention looks near unattainable when the public always demand more treatment. He says 70% of patients in his beds are over 65, with 75% suffering the diseases of poverty \u2013 smoking, obesity, diabetes, missed early diagnoses \u201cand poverty itself\u201d. The NHS spends expensively on the effects of poverty that could be more cheaply prevented. He would run a social priority list, treating \u201cthe Clacton postman\u2019s knee, off work for a year, run out of sick pay, before getting the retiree back on the golf course\u201d.<\/p>\n

The day we talked at Colchester hospital, he was bristling over an infuriating Care Quality Commission inspection after an interview checking if his trust is \u201cwell-led\u201d. \u201cBut whatever their judgment, I\u2019ll be gone!\u201d The last inspection found Colchester \u201crequires improvement\u201d. That grates. He agreed reluctantly to add to his trust a hospital Jeremy Hunt called \u201cthe worst in England\u201d and did well to lift it out of \u201cspecial measures\u201d. Marked down over documentation, he asked the inspector, who had no background in acute hospitals: \u201cBut did you encounter any poor care? \u2018No\u2019, he said.\u201d<\/p>\n

Nothing is easy. His gleaming new \u00a390m orthopaedic<\/a> <\/a>centre<\/a> has mostly private-style single rooms, en suite. \u201cBut that costs 30% more in nursing than bigger wards.\u201d He is disappointed that fast-flowing throughput hasn\u2019t raised productivity more: some surgeons do four operations when they used to do three, others still only do three but could do five, under scrutiny from the new Epic electronic data system. \u201cWhy do some wards turn around an empty bed in 20 minutes, others take three and a half hours?\u201d It relieves stress in a ward to keep beds empty, but people wait in corridors. \u201cNHS work was easier when I began, and more fun,\u201d he says. \u201cMost patients weren\u2019t very sick, staying in for two weeks after a hernia.\u201d Pressure to raise productivity means chasing every unforgiving minute: electronic labels halve the time to take a blood test. \u201cBut what do they do with that extra time? Chat or do more tests?\u201d he says.<\/p>\n

Nick Hulme with the then prime minister, Boris Johnson, at Colchester hospital during the Covid pandemic, May 2021. Photograph: Glyn Kirk\/AFP\/Getty Images<\/p>\n

The orthopaedic centre is still not full: that requires the integrated care board \u2013 a local control system undergoing yet another interminable restructure \u2013 to close units in district generals to send patients here for better specialist treatment. Will that happen? He sighs, recalling a time he closed a dangerous A&E in a small hospital: it took 42 public protest meetings led by a local MP, and many doctors admitted in private the unit was unsafe, but not in public. He jokes that he would be a new Beeching (the man who shut more than 2,000 railway stations) closing district general units, to send patients to further off specialist centres. But others plead convincingly too for the decentralised familiar local.<\/p>\n

He has survived many a 10-year plan, forgotten in a year or two, but enthuses about Wes Streeting\u2019s 250 neighbourhood health centres<\/a>. However, remembering similar clinic plans<\/a> in Ara Darzi\u2019s 2008 report, experience makes him wary: \u201cWill hospitals swallow up all the money again?\u201d A rumbling under Aneurin Bevan\u2019s founding principle worries him most. \u201cUnless the NHS improves fast, people will fall for charlatans offering snake oil alternatives. This is the best system, but not producing the best results.\u201d He departs with hopes and fears \u2013 and sharp words for privileged resident doctors. \u201cNot many have such a guaranteed very good job and pension for life, starting at \u00a338,000, \u00a3109,000 once fully trained.\u201d He thinks they forget their privileged state, out of touch with what others earn in the NHS.<\/p>\n","protected":false},"excerpt":{"rendered":"I catch him before he slips out of the NHS ahead of Christmas. After 46 years in the…\n","protected":false},"author":2,"featured_media":352857,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[64,63,137,500],"class_list":{"0":"post-352856","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-au","9":"tag-australia","10":"tag-health","11":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/352856","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=352856"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/352856\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/352857"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=352856"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=352856"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=352856"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}