Currently NHS trusts are run by bureaucrats behind closed doors. Open this whole system up , get rid of the red tape run management teams and put the power in the hands of local people and the clinicians
Hospitals should be run by doctors not administrative managers., and the doctors should be supported by locally elected people who working in conjunction with the doctors should decide what services are provided where, and the admin staff should be there JUST to provide support and information and not to make management decisions. These joint committees should decide what level of management is required , and where and by whom it should be provided. They may feel they want professional management in some areas, or they may feel they want Volunteer groups to run other areas –BUT it should be the decision of the local teams running the surgeries , hospitals and trusts — not some overpaid pen pusher with their own agenda.
The whole hospital set up should be run by this people/doctor committee. Each hospital, and surgery should have people nominated to go forward to manage the NHS at Trust level and all meetings should be open to the public and be on a rotating basis to cover the geography of the trust area , so that local people can travel the minimum distance to at least some of the meetings
You could effectively save a fortune in every NHS trust in the country .All the senior managers and departmental managers could be "let go "saving very hospital a fortune. The elected local people would only be paid as volunteers , the doctors would have their pay set by the local management team made up of doctors and local people. The admin staff would be non-management grade, there to support the clinical staff .. Each department to be run by the senior doctor (consultant) , and the day to day operation run by the ward sister with the help of his/her nurses . The cleaning and admin staff would work for the ward management team of doctors and nurses.
Central hospital services such as food and procurement, would come under the management of the main hospital committee with the day to day operation under the control of the head chef in the kitchen and the buyer in procurement or what ever support was deemed necessary by the local management team
There would still need to be central buying services to get scale discounts on purchases , but these would be out of hospital resources and the in hospital control would fall on the local teams. The in hospital buyers would have the choice to buy from the central supplier -or if they can get a better deal to local purchase.
As a possible further extension, those convicted of minor offences, where they are not a threat to the local community, , could be set to work in the grounds of hospitals schools ,parks, leisure centres , public buildings, and public parks, keeping gardens and roadways clean and tidy , being responsible for the upkeep of car parks and also working on a variety of other useful tasks . This would save further wage costs in the hospitals and elsewhere ,and also save on the cost of keeping many in short term prison stays.( a double saving)
I am not advocating sacking those admin staff who would normally do these jobs, but with the additional manpower at effectively little or no cost, a much better service could be provided (e.g.grass could be cut more often , public areas could be kept litter free, windows could be cleaned on a more regular basis –and so the list goes on)
One final thing ,, yes you still need to see how you are performing but give that information to the local teams and the local population so they can decide where changes are needed.