Posts Tagged ‘Nhs Reforms’
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.
One news story above all others dominated our chatter on the allotments this morning. Sir Fergie, the patron saint of all codgers, has announced his retirement. We can easily understand the reasoning, but we are disappointed for here was living proof that old ‘uns can hold their own in the new whizz-kid age. We had expected him to carry on into his eighties and to continue to yell abuse at referees from his wheelchair. But God help whoever takes over for Fergie is to join the Man Utd Board!
Meantime our dear leader is in yet another hole. Nigel Lawson’s attack on the EU has fired up the many Tory MPs who see a legal commitment to a referendum as the only hope of slowing down the rise of Nigel Farage. And there is growing uproar in Westminster about the strange treatment by the police of Nigel Evans. David Cameron must be feeling the onset of Nigelitis. The only available cure is to apply for the Old Trafford vacancy. At least he would then hear crowds singing his praises, something less than likely in his present role as Nick Clegg’s dad.
Of more immediate concern to us codgers is the growing evidence of an impending collapse of our GP services. We are all ancient now and, between us, could write a book about the important part played in our lives by what we grew up to call our family doctors. Until recently the familiar figures were always there when we needed them,, and always knew our family history, a key factor in diagnosis. Now the traditionally small practices are being merged into larger impersonal ones where you seldom see the same doctor twice in what feels like a production line. And where one senses a weary resignation, a feeling that retirement cannot come too soon.
So what has happened? Until fairly recently most GP practices comprised partners, with the occasional use of locums to cover holidays. The first change was the ending of the obligation to provide out-of-hours services. Then came a massive increase in the amount of non-clinical work imposed on partners. They now face additional responsibilities such as staffing, performance management, premises and accounts, and the advent of commissioning and the transfer of more work from secondary care is the last straw. Oh yes, and GPs are to face regular revalidation.
Seeing patients has become but one of many tasks and many GPs are retiring early rather than deal with rising bureacracy, stress and burnout. Some of our brightest doctors are going to work abroad and we will soon be back to “golden handshakes” to recruit GPs to high-demand areas.
One early outcome of the new pressures is a shift away from partnerships towards salaried roles. A salaried GP, or a locum, can see their pateints and deal with their associated paperwork. And that is it. The majority of young doctors are now female and they tend to opt for salaried positions. To be able to afford them, partners are having to cut back on what they pay themselves to maintain practice solvency. Not surprisingly partners do all they can to cope without recruiting additional staff.
This crisis is building at a time when hospitals are under great fnancial pressure. The result is that GPs have lost their intimate link with consultants and have to contend with patients waiting sometimes months for specialised help. To make things even worse GPs are no longer allowed to make referrals to specific consultants, and have to explain to patients that private medicine is the only route that enables them to do that.
Thanks to Lansley’s so-called reforms GPs now face an even greater embarrassment. Patients are becoming aware that the new commissiong groups are now responsible for regional budgetry decisions and are beginning to question whether the doctor’s motives are always in their best interest. Throw in the inevitable growth of postcode medicine and the near-total collapse of care for the elderly and disabled and the picture of chaos and general disgruntlement is complete.
What is now happening is that we are training doctors only to offer them working conditions so hostile that they leave or go into private practice. Personalised care by a GP who knows his or her patients will disappear. Smaller surgeries will no longer be viable and will be swallowed up by larger impersonal organisations with little continuity of care. As practices struggle to survive incomes will diminish, but at the same time the government expects workloads to continue to rise when practices cannot recruit or retain staff.
What is now happening is unrealistic and unsafe and risks destroying a vital service that we have always taken for granted. However ministers choose to dress this process up it is really about saving money. This is happening alongside a marked reluctance to address tax-avoidance which is costing the treasury countless billions.
Yesterday tax experts representing most of our large tax-avoiders visited Downing Street. They offered voluntary co-operation, a sort of ‘God make us honest, but not just yet’. It won’t do and a government committed to retaining essential services would have shown them the door!
THOUGHT FOR TODAY; ” Given the scale of cuts it is increasingly difficult to shield vulnerable people from the effect. Some of the peple we have responsibility for may be affecetd by serious reductions in services – with more in the pipeline over the next two years. Councils plan to make £800m cuts in adult social care over the next 12 months. Around £104m of this will be made through the complete withdrawal of services”….Sandie Keene, president of the Association of Directors of Adult Social Services.
We spent much of the time devoted to hen-cleaning this morning with our minds elsewhere. We were trying to work out just how Ian Duncan Smith would manage to survive on £53 per week. We failed. We even resorted to my Gran’s method involving a row of tins on the mantelpiece. But by the time we had put enough in the containers marked gas, coal, electricity, bus fares, washing powder and soap the amount left for the food tin would only stretch to a packet of crisps. We can only conclude that he is a good deal cleverer than us.
If we are honest we have to acknowledge that there are many aspects of his welfare reforms that are beyond our understanding, but it does seem certain that one hell of a storm is brewing. Our dear leader tells us that the Churches are out of touch and that the great British public is solidly behind IDS and all his works. We suspect that it will prove to be a zillion miles behind him when the first stories of chldren on the streets hit the headlines. But we only suspect, what we know for sure is that the death of the NHS will be an equally big issue come the 2015 election
This is not the first government to launch a massive top-down reorganisation of the health service, but it is the first one to do so whilst imposing massive ‘efficiency savings’. The result is that the service is already in meltdown. And yesterday it underwent its greatest upheaval snce 1948. Mis-sold as putting GPs in charge of the budget, most GPs say it does nothing of the kind; only a third told a Pulse survey that they are gaining more power.
Instead GP leaders say blame is devolved without power, their relationship with patients poisoned by mistrust. The GP is now the rationer, not the patient’s advocate. And given the reductions in funding measured against the increasing demand of an ageing population they see no prospect of developing the community alternatives to hospitals of which ministers talk.
There are many worries surrounding the GP issue. Least monitored of all health professionals, over a third of them have financial interests in private healthcare ventures. Suddenly they are open to suspicion of conflict of interest on several fronts. But that is their worry, not ours. Ours centres around the dictats they have to follow in regard to bringing in maximum competition.
The new Commissioning groups will have no altetrnative to offer all services to all prospective providers. NHS services will find themselves bidding against the likes of Virgin Care or the giant American United Healthcare. They are likely to cherry-pick easy and profitable services – outpatients, diagnostics, routine surgery and simple treatments – leaving behind A& E, cancer, complex surgery, the elderly, the mentally ill. NHS hospitals will in effect be left with that which is unpredictably expensive. The best estimate is that at least half will become financially unstable and liable to closure.
In an attempt to save themselves, many of the threatened hospitals will take up the Lnasley plan to re-allocate up to 49% of their beds to private medicine. One way or another the number of hospital beds available locally will reduce dramatically.
The trend is already underway. Figures for 2011-12 from analysts Laing and Buisson show that the English NHS increased its private purchasing by 10.7%. Since private companies will use the NHS logo you will not know who is providing the service, and you will have no way of knowing how much profit is being made since such information is covered by confidentiality clauses.
Ministers will follow the lead of Labour’s Patricia Hewitt in trumpeting the value of competition. But health is not a market and fragmentation will destroy the cohesion and local availability of services. It will also substantially increase postcode medicine, where you live will determine your fate.
Not surprisingly many will argue that the Staffordshre experience demands that changes be made. They are right and given local mismanagement a case could be made for total privatisation of the whole hospital. But private providers are not interested in total responsibility. Therefore failing managements must be replaced rather than pardoned on the basis that nurses were solely to blame.
Those that understand the NHS know that these issues are not the only threats. Two weeks ago the government abolished networks. Over the past few years I have been involved with the cancer version. It has integrated services across regions and shared resources and skills. Many patients have benefited. Lives have been saved. Now it is gone and the excellent nurse in charge sent packing.
Sorry about the air of doom. But that is how it is. The bumbling ministers of the last Labour government and this one have succeeded in destroying the NHS. MPs in constituencies that lose their hospitals will pay the price come 2015.
But it is all of us that will pay the ultimate price!
THOUGHT FOR TODAY; ” But the privilege and pleasure, That we treasure beyond measure, Is to run on little errands for the Ministers of State”…W S Gilbert: The Gondoliers
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
Very cold but dry this morning. But as we cleaned out the hens we cheered ourselves with the thought that each day brings Spring a little closer. Albert was quick to respond to any signs of raised spirits by telling us that there is heavy rain on the way. Hopefully his chickens are incapable of understanding his pronouncements, for our knowledge of avian treatments do not extend to infectious depression. If egg production is any indication all is well for, surprisingly, egg production remains high during what experts tell us is the annual ‘switch-off’ period.
As always on Thursday mornings our chatter focussed on the weekly ritual of Prime Minister’s Question Time. Yesterday’s comedy show provided a classic example of the farcical nature of politicians in action. QT itself consisted, as always, of a shouting match between dashing Dave and Ed the Eagle Miliband. Labour’s Michael McCann beat them both for the best gag when he asked if Atos had passed Richard 111 as fit for work. But it was Earnest Ed who managed to turn our dear leader’s features a strong shade of puce when he remarked that the Tory leader should be content that he has almost half of his MPs behnd him.
Our dear leader bellowed. “I am”, he screamed “a marriage man. I want to defend marriage, to encourage marriage, to defend marriage, any sort of marriage!”. Suddenly we had a vision of Cameron as Marriage Man, a superhero who leaps into action whenever marriage – straight, gay or transgender – is under threat. He wears grey, striped figure-hugging underpants, a black cape with tails and a silk topper. Young folk would call him on his Marriage Mobe.
Great fun, proof positive that our leaders really are at war with each other. Not really, for next up was the Mid Staffordshire hospital report. Suddenly we had Dave and Ed, united in solemn contemplation. Ed nodded approval as our dear leader made his public apology. He is brilliant at heartfelt apologies for things that are not actually his fault. Perhaps years later we will get an equally moving and sincere apology for having spent 33 months making the economy even worse than it was.
But by now any sense of theatre had vanished for we were into the inevitable talk of action based on the report by Robert Francis QC on the 31-month inquiry into the appalling failures of the Mid Staffordshire NHS Foundation Trust. To those of us with extensive experience of the NHS it is really a collection of what Basil Fawlty would call the bleeding obvious. Sadly it lacks bite. Yes, the culture needs to change but no, the people responsible for that culture are the wrong people to lead its change. Of course there should be criminal proceedings and of course Sir David Nicolson is not the right person to head up the Department of Health.
But when, oh when, will someone grasp that one body of people make or break our hospital services. The report does mention in passing that there are now almost one million ‘healthcare assistants’ employed on wards. It goes on to suggest that they need training. Wrong. They shouldn’t exist at all. As we have pointed out before on this site they are seen as a cheap alternative to qualified nurses, and as more and more real nurses have been shown the door, they have been entrusted with patient care for which they have no qualifications and, in many cases, no sense of vocation.
I have banged on about this before but yesterday evening something happened that prompts me to risk repetition. I had a telephone call from a Ward Sister in the Midlands. She has for some time been in despair at the reduction in qualified nurses at her disposal. Now she has been told that each ward cluster is to be managed by one Sister instead of three. The long-standing practice has been for each of the eight-hour shifts to be under the control of a Sister. Now two of them will have no Sister present and will rely on a Staff Nurse assisted by, mainly, unqualified staff.
When I chaired an NHS Trust I maintained constant contact with the Sisters. They are invariably highly qualified and dedicated, and see their role as ensuring that all of the nurses reporting to them behave professionally and with compassion. Anyone who has watched the BBC series about the true story of Midwives/Nurses in the fifties will know that the Sisters were the driving force, the ones feared yet respected by staff and patients alike. That is how it was, that is how it continued to be before successive idiotic politicians decided to ‘reform’ a service that they simply did not understand. Labour reduced the nurse-to-patients ratios, the coalition has made things even worse by enforcing massive cuts.
Yes, there need to be changes to management styles - as Francis rightly points out basing healthcare on financial considerations alone is bound to fail. But until someone has the wit to return to a significantly higher ratio of real nurses to patients and to ensure that every shift is in the charge of an eagle-eyed Sister problems will continue. At the very least the government should ask the public if it is comfortable with the conseqences of endangering lives by cutting nurse numbers. Given the waste apparent in so may other facets of the nation’s life they would, one suspects, receive a clear answer.
I know this sounds very simplistic but those of you who have recently spent time as an in-patient will probably accept its validity. Unless of course you are able to afford private hospitals where the Matron and her Sisters have their fingers on every pulse!
THOUGHT FOR TODAY; “The mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive. To put it more accurately, it is not so much that you use your mind wrongly – you usually don’t use it at all. It uses you. This is the disease. You believe that you are your mind. The instrument has taken you over!”…..Ekhart Tolle in ‘The Power of Now’