Posts Tagged ‘Andrew Lansley’
Having ccompleted my ‘shift’ on the allotments I am shortly heading off to have lunch with two old friends from my NHS days. I have little doubt that the fate of our health service will be on the agenda. In common with the vast majority of those who dedicate themselves to the cause it is highly likely that my friends share my feeling of absolute horror at what is happening.
This morning we learned that Sir David Nicholson has at last decided to step down from his key position as NHS chief executive. The great mystery is why he has taken so long to find his sword, and why he will hang around until March of next year. I always feel sympathy for anyone who loses their job, but in this case my tears will be few since Sir David will have the consolation of a pension pot worth almost £1.9m. There is also the inescapable truth that he has failed utterly.
Many of those who have campaigned for a new NHS head have focussed on Nicholson’s role in regard to the Stafford Hospital scandal. But to me that is the least of his failings. It was he that introduced the destructive idea of a £20bn efficiency saving, a ridiculous concept that allowed politicians to claim that NHS funding has been ‘ring-fenced’. The reality is that Trusts have been driven to cut staff numbers and already almost 10,000 nurses have been shown the door. One doesn’t have to be Einstein to work out that services inevitably suffer.
In my view Nicholson’s other major failure was his bland acceptance of the so-called reforms of Andrew Lansley. These have caused chaos and even our dear leader was eventually obliged to move Lansley on. Any leader worth his salt would have stood up to be counted rather than comply with plans that he must have realised were a recipe for disaster. And until the NHS is led by someone prepared to fight his or her corner the service will continue to be used as a football by politicians on the make.
This was very apparent on Newsnight last night when Jeremy Paxman chaired a discussion on the collapse of A & E services. The doctors argued that the situation is now unsafe, with a reduced number of clinicians being swamped with increasing patient numbers. The politician said that we have to find a way of joining up the various services. What on earth does this mean? The situation is easily analysed, we now have too few A & E doctors and nurses facing increasing patient volumes due, in part at least, to the inefficient privatisation of GP out-of-hours services.
The answer is equally obvious. GP out-of-hours services must be located alongside A & E units giving everyone needing help a well known location where they can be seen by the appropriate people. Where this is in place the result is a vast improvement in waiting times and the end to the new era of ‘who do we contact’ which is now perplexing patients and is leading to dangerus situations.
It will take a braver man than Nicholson to bring this about since privatised profit-making companies will be unable to accept the concept of diagnosis and treatment taking precedence over costs.
Meantime Jeremy Hunt is too busy playing politics to actually do anything. He is pointing a finger at the ‘new’ GP contract introduced by the Blair government. It was ill-advised but are we really going to solve the crisis by constantly arguing about something that happened ten years ago? Clearly the Daily Mail intends to, for this morning it runs a story about GP’s “Refusal to do their jobs”. Have the writers seen at first hand the pressure that GPs are now working under, a situation made much worse by the decision to impose on them the task of commissioning?
To add to the general feeling of unreality now being experienced by many in the NHS we now have Mike Farrar, who is merely the chief officer of the NHS Confederation – a sort of unadmired Union acting for NHS Trusts – being given headlines for his loopy idea of patients being obliged to email their symptoms to their doctors. The majority of patients are inevitably elderly and would find this impossible. It is also highly dangerous, diagnosis by remote control is not to be trusted.
One can bang on for ever but I won’t. Suffice to say that Nicholson’s exit is a moment of opportunity. We are in the last-chance saloon for a service that is critical for every family and we need an experienced clinician in charge, someone prepared to dismiss crazy ideas from politicians.
We also need a halt right now on so-called efficiency cuts and an end to privatisation. Ministers would be better, and more safely, employed tackling tax-avoidance! Upset Amazon or let patients die?
THOUGHT FOR TODAY; ” Hospitals are at breaking point. The A & E care now being provided is frequently unsafe as a result of toxic overcrowding”…Letter to government of yesterday from senior doctors at 20 major A & E unit.
We codgers have followed with great interest the story of Pope Benedict XVI, and it had been my intention to focus on that this morning. But it will have to wait for something of immediate urgency has come to our notice. It triggered angry words as we cleaned out the hens, in fact so preoccupied were some of us that the normally cautious Tom forgot to duck when entering his hen-run. Blood everywhere. Jack was once a football ‘physio’ and Tom went home bearing enough Vaseline to grease an axle.
On many occasions we have banged on about the potential affect of the Lansley reforms on the NHS. When the national protests reached their peak, our dear leader ordered a pause in the preparation of the bill. Expecting fierce opposition from the Lib Dems, he was reportedly surprised they accepted relatively minor amendments. What swung them, and many of the protest groups, were public assurances from ministers that seemed convincingly cast-iron. When the Tory health minister Earl Howe steered the bill through a rebellious Lords, he promised : “Clinicians will be free to commission services in the way they consider best…they will be under no legal obligation to create new markets…this will be made absolutely clear through secondary legislation”. Now the legislation is open to public scrutiny and we know that the government lied!
It is only when you read the document that the dangerous truth emerges. Commercialisation and competition is written into its key section 75. It opens up virtually all of the NHS to public tender in a market supervised by Monitor. The new bill will be embraced by EU law and the new clinical commissioning groups (CCGs) will be obliged to advertise every service to any bidder. When Andrew Lansley told (in writing) every CCG that they would not be obliged to fragment services by putting them out to tender he was lying, gambling on no one reading the small print until it was too late.
And a second lie has emerged as the result of a reaction from the Royal College of GPs. From the outset we have been told that the reforms were aimed at “putting GPs in the driving seat”. Given that they already seemed up to their ears in work it sounded unlikely, but the government regularly produced one family doctor on TV to reinforce its claim. It was at it again this week, announcing more commissioning groups approved: “All 8000 GP practices in England will be members of a CCG, putting the NHS budget in the control of frontline clinicians for the first time”.
Dr Clare Gerada, head of the Royal College, immediately denounced this as “disingenuous” since all GPs are legally forced to join. Only a small minority of the CCGs are led by GPs, most are “not involved or in favour”. And, like us, Dr Gerada is shocked by the section 75 requirement for every service to be tendered out. She was even more shocked to learn that the role of Monitor, described by Lansley as “to promote competition” was quietly amended, after the Bill’s passage, to read “to prevent anti-competitive behaviour”.
In effect we now have the NHS budget in the hands of local bodies which include virtually no actively involved clinicians. They in turn are legally obliged to put every NHS service out to tender. There can be only one outcome; widespread privatisation and postcode medicine. Throw in the one thing we already knew – that the Bill releases the government from any legal obligation to provide medical care – and you have disaster writ large.
We are all guilty of saying little against this death-sentence for the NHS. It will soon dawn on Lib Dem MPs that they have been duped. They may pay a political price but that will be no consolation when, to quote one local GP, everyone wakes up to find that private companies are closing and centralising services to regional centres unaccessible to many.
We know from examples such as Mid Staffs that the NHS needs tighter controls. What we didn’t know was that abolition based on lies was on the way!
THOUGHT FOR TODAY; “When you say you agree to a thing in principle, you mean that you have not the slightest intention of carrying it out in practice!” ….Otto von Bismarck
Help! We codgers are sinking fast. Mud, mud, glorious mud, goes the song but our version has less printable words. The monsoon continues ,as do our trips to the hen-runs with buckets of dry earth excavated from the large greenhouse. For good measure we threw in six sacks of gravel and – here comes the ultimate irony – a lorry-load of duck-boards. For all of an hour the chickens were not paddling, and then the wet stuff increased in intensity. I have to admit that there was little Christmas cheer in evidence when we eventually steamed in front of the shed fire this morning.
However, the adventures of our dear leader usually raise a smile. Today we read that friends of Andrew Mitchell are hopping mad at the revelation that the prime minister knew from the outset that the police allegations of foul-mouthed abuse by the Chief Whip were false, yet he decided to say nothing for fear of offending his bodyguards. According to today’s press Mr Mitchell has suffered both depression and panic attacks induced by the sheer frustration of having to resign for something that he didn’t do. One does increasingly get the feeling that being led in battle by our dear leader would not be a calming experience!
But our morning dollop of wrath was aimed at another target. We are all pleased at the rise in the popularity of the Royal family who, we believe, do a good ambassadorial job. But we are inceasingly frustrated by the tendency of the Prince of Wales to speak out before checking the relevant facts.
Today he has made headlines at the expense of NHS nurses. The “age-old qualities of human kindness” are “palpably lacking in our hospitals and clinics”, he writes. Clearly he has been influenced by headlines in the Daily Mail as he is served breakfast by his retinue of servants. And it has to be admitted that there are examples of totally unacceptable behaviour. But to tar NHS nurses generally in this way is both disgraceful and hurtful to vast numbers of dedicated professionals for whom their role is a vocation.
The first thing one should do is to seperate nurses from ‘healthcare assistants’. One of the more ludicrous ideas of the last government was the replacement of trainee nurses by unqualified staff, many of whom have no intention of training. Working on the wards for them is simply a job and whilst some are excellent, some are not. In theory they are under the supervision of nursing sisters, in practice the enormous cuts in nursing numbers make that impossible.
It is several years since I chaired a Foundation Trust but even then there was great pressure from faceless people in London to ‘improve’ nurse/patient ratios. Their idea of improvement was more patients per nurse. They also introduced charts showing number of patients seen per hour by doctors and, amazingly, argued that the doctor seeing the most was the best one!
Since then the Lansley fiasco has made the situation much worse and it is often the case that one nurse is struggling to cope with a whole ward, assisted only by unqualified staff. One such tells me that she feels like the legendary cat of comic strips, continually skidding here and there and rebounding off the walls as another bell goes. Slowly but surely nursing standards are being eroded and it is only the sheer endurance of committed, but often tearful, nurses that is preventing total collapse.
I am sure that the Prince means well, and he is certainly right in believing in an holistic approach to medicine for the mind can be a powerful ally to recovery. But in sounding off as he has he has done he has achieved two things. He has offended and disheartened a lot of dedicated stalwarts in the NHS, and he has delighted Andrew Lansley and his successor Jeremy Hunt who continue to preach the gosple of privatisation. As we have already seen, all that leads to is a profit-first ethos, one in which every nurse is simply a costly overhead.
I have been present at various Royal visits to our hospitals. A select band of senior staff are lined up giving all the appearance of total calm. Perhaps Charles imagines that he has seen reality, he has not.
Without realising it the Prince has once again become embroiled in politics. He should tread with care for whilst the Royals are popular, the NHS is equally so!
Ever the fantasist, Harry disturbed our concentration on the chickens this morning when he outlined his cunning plan. At present Waitrose supply Columbian Black Tail eggs to government departments. He suggests we put in a bid to take over the service. Government advisers would then fail to check the numbers and award the contract to Scruffy Codgers Ltd. Waitrose would threaten court action, the advisers would realise they had cocked-up big time and we would receive bounteous compensation for costs we didn’t incur in the first place. Harry was subsequently calmed down by a well-aimed bucket of water.
Joking apart, it has to be said that when it comes to incompetence this government woiuld take some beating. The Transport Secretary, Patrick McLoughlin, appeared on Newsnight yesterday and explained that, once the department learned of the impending judicial review it had to check its numbers carefully. It occured to us plebs that maybe they should have done that earlier. As it is there is likely to be a bill of around £100,000 by way of compensation, not to mention the effects on passenger services of a long period of uncertainty.
Attacks on governments usually centre on ideology. With this one the rows are focussed on implementation. The train franchise fiasco is but the latest in a succession of them. Today we learn that the next act is about to hit the stage. Lansley’s reforms have pulverised the health service and the hapless Jeremy Hunt, fresh from his less than glorious handling of the Murdoch affair, is racing around cancelling bits of the plan not considered to be vote-winners. But it is too late for him to cry halt on the biggest act of privatisation in NHS history.
This week 398 contracts are to be signed. Some 37 private healthcare companies are bidding for a wide range of services including musculoskelal, hearing and physchology. In many cases those bidding have already failed to deliver the standard required after earlier successful trial bids. A perfect example was provided in Cornwall where Serco was awarded the out-of-hours service. It has been shown to have falsified data to cover inadequate night-time cover.
The biggest worry of all is the fact that one national service could be provided by a large number of different companies, each focussed solely on their patch. Postcode medicine is not to be yearned for. And how have the costings been arrived at given that cross-boundary cooperation will be essential. And how can bids be compared given that different suppliers have based their numbers on differing levels of clinical expertise?
In the hospitals themselves the NHS Foundation Trusts are being pressed to increase the number of ‘private’ beds up to 50%. How has this been costed, how will it effect those who cannot afford private insurance?
Dr Clare Gerada, chair of the council of the Royal College of GPs, said yesterday that as a result of all this the NHS is “in distress – and so are we”. This, she added, is “the mother of all top-down reorganisations”.
The Labour Party is in no position to criticise. Under Blair it made numerous attempts to outsource outpatient services, and when the outcry became overwhelming, paid out millions to companies such as Netcare to cover the costs of bidding and, in some instances, of actually acquiring buildings.
But someone needs to blow a whistle. In the north-west the bus company Arriva is taking over ambulance services, and Parkwood Healthcare is taking over patient advocacy groups. In each and every case there is need for detailed cost studies, the effect on the NHS should be carefully calculated.
Many believe that profit targets and patient interests will prove a deadly combination. But the coalition is hell-bent on privatisation, and the enabling act is now law thanks to the Lib Dems. But huge unanswered questions remain about the supposed financial benefits. Costing specialities such as surgery is a notoriously difficult task. How can it be that the private sector, which will employ surgeons at NHS pay levels and has to make profit for its shareholders, is claiming to be able to undercut NHS costs?
Based on the government’s record the probability is that our whole health service is being put in jeopardy for the sake of savings proposed by private companies using logic and numbers which have not been carefully scrutinised.
The government insists that every bid has been checked out to the umpteenth degree. That is exactly what Justine Greening and Patrick McLoughlin said when Richard Branson launched his attack!
The day on the allotments started badly, and I am not referring to the ever-weeping sky. Albert somehow managed to upturn a barrow loaded with corn and layer-pellets. More haste less speed comes to mind although my old pal has been known to be overtaken by the pet tortoise. Whatever the reason he has cost us and, in so doing, has created a tempting stopover for every mouse in the region. He is as popular as a rattlesnake in a lucky dip. Rather like Michael Gove.
Yesterday he announced the end of the all-ability GCSEs. In their place we are to have an English baccalaureate which will be made up of individual EBacc exams initially in English, maths, and the option of three seperate sciences, from September 2015 for examination two years later. Gove wants EBacc courses to be taught from 2016 in history, geography and languages, for examination in 2018.
Most people will welcome one part of the new grand design, the rationalisation of exam boards which, in their search for contracts, have played a major part in what Gove describes as the “dumbing down” of GCSEs. But this could have been achieved without the revolution now proposed. In effect this is a nostalgic lurch back to a world where a single three-hour paper is the be-all and end-all, and it risks jettisoning the real advances that have been made. These included assessment of effort throughout a school year, a measure equally important to would-be empoyers or universities. As with job interviews, some people can seize on to key facts learned parrot-fashion and present a seemingly impressive front. The result tells one nothing about attitude, workrate or commitment. It is entirely possible for a candidate who has worked hard throughout the year to screw up due to feeling unwell or overly nervous. There really is more to life than knocking out little essays!
Experts will chew the fat over this for many a month to come but one thing is clear. The proposed EBacc has absolutely nothing to do with evidence, successful reform or standards. The regulator Ofqual has produced no evidence that the GCSE is beyond repair. Neither has it produced any evidence of difficulties with the concepts of modularity and controlled assessment.
But right now there is a major concern for a generation of children and their parents. No thought seems to have been given to the potentially lost cohort of young people who will continue to take the existing GCSE until 2017. The exam has been so traduced by Gove that employers and universities will have difficulty in taking its results seriously. Terrible news for a vast number of children!
There seems to be no plan for subjects not named by Gove, there seems to have been no consultation with the teaching profession, parents or academics. In no other profession would such a significant reform be imposed in this way. Yes, there is now to be a period of “consultation” but the bombastic Gove has laid down the verdict in advance of the jury being called.
But for us codgers the greatest mystery is the insistence on imposing arbitrary quotas of high grades. Yes, the exams must be penetrating but what sense does it make to limit the number declared to be excellent. Imagine the outcry if the same principle was applied to, say, driving tests. We seem to have the only government in the developed world determined to drive down the percentage of high-achievers. Young Tommy may perform brilliantly but he may do so in a year when a whole raft of brilliant pupils emerge. Should that make him a failure?
This has all the hallmarks of Lansley’s disastrous NHS reforms. Some changes were needed but he consulted no one and produced a dog’s breakfast. It is hard to avoid the conclusion that Michael Gove is the same sort of man, an arrogant know-all.
The next generation deserves better!