'Why I've no nostalgia for the old NHS'

KEN Jarrold is an NHS man through and through. When he retired this summer as chief executive of County Durham and Tees Valley Strategic Health Authority, it marked the end of an era.

Mr Jarrold, who is taking on a totally different challenge as a non executive director with the Serious Organised Crimes Agency (SOCA) has spent four decades as a manager in the health service and is something of a UK health 'guru'.

That's why, when he gave a keynote speech at the recent annual conference of the Institute of Healthcare Management, he was listened to in rapt attention by NHS 'suits'.

While he congratulated the Government for ordering the massive injection of funds into the NHS since 1997, there were some troubling aspects of his speech which should alert policy officials in the Department of Health that the wheels on the NHS wagon need some attention, and might even be pointing in the wrong direction.

Following that speech, in which he warned that the current set of "unco-ordinated" policies being pursued by the Health Department needed "urgent attention", Mr Jarrold warmed to his theme during an interview with The Northern Echo.

First, though, he wants to make it clear that the new-look NHS is very much to his liking. "I have no nostalgia for the way things used to be. There were many, many things wrong with the old NHS. It was not patient-centered. Waiting times were too long and we did not have proper service frameworks," says Mr Jarrold.

After eight years of the Blair Government, he says the NHS has "improved tremendously".

"It is to the eternal credit of the Prime Minister and Chancellor that they responded positively to the Wandless Report, which called for increased funding. Services are being organised around patients much better than they used to be and waiting times have improved dramatically," he says.

However, Mr Jarrold believes there is a risk of pursuing ideological theories at the expense of more practical, proven measures. "There is a danger of losing focus on patient and staff experience and believing the reforms are an end in themselves."

Mr Jarrold, the son of missionaries - who now takes a sceptical view of such blind faith - urges the Government to pursue a common sense agenda, instead of following fashionable fads. "Be pragmatic about what works and what matters in the health service. If it doesn't work then stop doing it," he says bluntly.

Specifically, Mr Jarrold is concerned about the merits of the policy of payment by results which is being put in place, a seismic shift in the way resources are distributed and which could have unexpected consequences for some hospitals.

As ever in the health service, funding is all, and while acknowledging the extra billions poured into the NHS in recent years, Mr Jarrold believes more resources are probably needed to do the job properly. He is also very concerned at the current financial crisis affecting a number of North-East hospital trusts, notably South Tees Hospitals, which runs the 1,000-bed James Cook University Hospital in Middlesbrough and the Friarage Hospital in Northallerton, and which is facing a deficit of £21m.

"These are very serious matters," he says.

Mr Jarrold thinks the Government needs to take a tighter control of NHS finances and should be prepared to increase funding.

"We have not put an effective financial strategy in place and there is every reason to believe that national policies have not been effectively costed," he says. "Although we have been given a lot of money there was an assumption that a lot was enough... that assumption needs to be considered," he says.

The former County Durham and Tees Valley boss is also partisan on the subject of NHS reorganisation. He says he is very concerned at the prospect of places like Darlington, Stockton and Hartlepool - all places with unitary councils which run social services on their patch - losing their own local primary care trusts.

But he is pleased to hear that the Department of Health is now giving the North-East the option of retaining so-called 'coterminous' smaller PCTs in a public consultation which begins next week, an option which was not on offer when proposals were initially revealed.

In common with the Government's own chief medical officer, Professor Sir Liam Donaldson, Mr Jarrold has misgivings about the Department of Health's halfway house stance on banning smoking in public.

"I am critical about the political courage gap on smoking. Not bringing in a complete ban was a great missed opportunity," he says.

Ironically for someone who has been an NHS manager for most of his professional life and was responsible for devising the code of conduct for every health service management team, Mr Jarrold is also worried about the excessive strains placed on NHS staff at a time when hospitals and GP surgeries are under intense pressure to meet performance targets.

"I remain concerned about some of the behaviour in the health service. There is bullying and harassment at all levels," says Mr Jarrold, who believes this is an area which needs attention.

Managers in the audience may have shifted uncomfortably in their seats at this point in his speech but they will have been cheered by Mr Jarrold's overall highly positive assessment of the current situation. He also made it plain that he does not agree with critics of the Government, who accuse them of selling out the NHS.

He is particularly pleased that reducing health inequalities in England, a vital factor for the relatively sickly North-East, is now a mainstream objective. "I very strongly support this Government's health policy because they have maintained the basic values of the NHS," he says.

Mr Jarrold says he is now looking forward to applying his experience as a former chairman of Darlington and County Durham Drug Action Team to his new role in fighting Britain's drug mafias.

He must be hoping that the powers-that-be at the Department of Health will heed his advice and, like the NHS, there will be a lot to look back on with satisfaction.