Whither 18 weeks?
This was going to be a measured article about the current state of the 18 week target but The Times carries news of a proposed new initiative by Tony Blair to “end waiting for treatment as we know itâ€. I would never have known! They might want to talk to their colleagues on the health desks before publication. What short memories these journalists have!
Hospitals are to be asked to work through the night & they will also have to expand the use of the private sector and develop “one-stop†community health centres where GPs and specialists work under one roof. Some patients could be sent abroad.
Andy Burnham, the minister of state for health, will this week tell hospital managers they must do whatever it takes to hit the target, with no restrictions from Whitehall.
He will highlight a scheme at Yeovil District hospital in Somerset, where staff work late four nights a week in return for time off in lieu. Keeping clinics and theatres running “out of hours†has enabled the hospital to process patients more quickly and efficiently, leading to dramatic falls in waiting times.
Pardon me for being sceptical but is this a new policy or an old one being ministered to by the spinners? It was controversial enough back then but in the current climate of deficits & treatments denied, does it really have a place or is it being pushed to meet political timetables?
Many PCTs are abusing referral management schemes, in flagrant breach of Government guidance, as they desperately seek to reach financial stability.
The DH’s operating framework for this year stipulates that triage schemes such as referral management centres and clinical assessment services should not be mechanisms simply for managing demand.
The guidance states that they must not lengthen the patient journey, and must abide by ‘clear protocols that provide clinical benefits to patients’. Additionally, it says the schemes ’should not be imposed on practices without their agreement’.
But GP leaders warned that PCTs across the country were now turning to such methods simply to cut deficits, despite opposition from GPs who were becoming increasingly frustrated in their attempts to refer patients to named consultants.
GPC deputy chairman Dr Laurence Buckman said that the centres were being misused by PCTs anxious to cut costs. He said: ‘There are very few PCTs now that aren’t using [centres] to slow up referrals. This is a device to save money, masquerading as improved patient management.’
There are close to one billion pounds (US thousand million rather than the UK million million) hanging on the Diagnostics procurement from the Independent Sector after all.
The Journal of the Royal Society of Medicine (JRSM) asked a year ago whether the 18 week target was such a good idea.
What happens to the hospital when the night staff are on holiday (the time off in lieu mentioned)? Do we employ more people to work the daytime shifts?
Did we just not cut hospital staffing, especially at night? What are we to make of this “working round the clock” idea when “Hospital at Night” was introduced claiming that there were not enough doctors to man the shifts properly due to the European Working Time Directive? Are the nursing rosters not at bare minimum strength as it is?
And speaking of the JRSM again, they carry an article questioning the current standards of nurse training.
Professors Linda Shields from the University of Hull and Roger Watson from the University of Sheffield argue nursing is under threat and being replaced by technicians, minimally educated healthcare assistants and unqualified health workers. Professor Watson said: “The government has gone for a quick fix to alleviate NHS financial pressure however nurses are being cheated out of a proper university education“.
On the face of it, yes, it is a good idea that people are not kept waiting unreasonably long periods for treatment. But the feeling that this is something aimed at a political sound-bite rather than a well thought out plan of service improvement lingers.
There are a few things the rest of us on the front-line are concerned about. I have seen enough drunk 10 - 14 year olds during my time in A&E, a number of whom progress to repeat attendance for self-harm (cutting themselves, overdoses etc., take your pick since the paucity of psychiatric support leaves them vulnerable) that I would try to fix those problems first.
I mean, it is not too edifying to read these headlines, is it? I know, clinicians share responsibility for not setting appropriate priorities but since the 80’s when they abdicated the administration of the NHS to non-clinical staff, they are feeling rather rudderless.
The question is, do PCT’s have the money to meet this challenge on a sustainable basis? On that, the jury is in & it is a slam dunk for the “No” team. If money has to be found for the contracts for ISTC facilities, then that money has to perforce be denied to an existing service.
And just for the heck of it, I want to highlight this again.