When you take on people as advisors, promising them the ability to influence matters, you had better not disappoint them. Or else you end up looking like the silly ass you are.
You know you are in trouble when even the medical students are against you!
The MMC team recently took on a couple of medical student advisors. Now the poor sods seem to have been misinformed about what their role really was even though more cynical minds can read it in the press release about their appointments.
“Dear Alan,
I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.
Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school
Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.
When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.
Yours Sincerely”
18.03.2007
Well said!
“Dear Professor Sir Liam Donaldson,
I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.
From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say. Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.
It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.â€
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.
Yours Sincerely”
31.03.2007
It is good to know that the coming generations of medics have some backbone. It will be sorely needed.
So claims the DoH with the release of guidance for PECs today stating that clinicians must be in the majority & that they should have a say.
Clinicians on new professional executive committees (PECs) will gain greater control over local NHS priorities, policies and investment plans under new guidance published today designed to ensure that clinicians from a multi-professional background are firmly part of primary care trusts’ (PCTs) decision making process.
New guidance for PECs, issued today by Health Minister Andy Burnham, advises that all PEC members should be appointed on the basis of their skills, competencies, and ability to lead. Clinicians must also be in the majority on the committees.
Strategic Health Authorities (SHAs) will oversee the new arrangements to ensure that PCTs are effectively engaging their clinicians and using their PECs to design and deliver local services.
Historically, many PECs have made a broad and valued contribution to the strategic direction and operational delivery of PCTs and to the wider healthcare agenda. However, other PECs have acted purely in an advisory capacity, functioning narrowly around a requirement to add clinical perspective to decisions that are taken elsewhere in the PCT.
Health Minister Andy Burnham said:
“Today’s guidance will re-establish and reinvigorate professional executive committees, giving clinicians from a multi-professional background a greater say on local NHS decisions.
“Whitehall will do less dictating on what these committees will look like. PCTs will be free to decide how many members they need to have and the NHS will be able to bring in extra members to tackle specific challenges.
“With the introduction of practice based commissioning and the delegation of budgets, there needs to be a stronger emphasis on commissioning. Strong professional executive committees can play a vital role in providing the effective managerial and clinical leadership needed.”
Dr Michael Dixon, NHS Alliance chair, said:
“This new guidance ensures clinicians are at the centre of all major decisions in PCTs. Hopefully, its spirit will be followed elsewhere in the NHS. We particularly welcome the department’s own commitment to support the ‘three at the centre’ PCT leadership team and the advice contained within the guidance for SHAs.
“Most importantly, this guidance will reassure PEC clinicians that their role and input is valued and essential. It will also encourage frontline clinicians to support the PEC and their PCT. That is particularly important for the success of practice based commissioning. The NHS Alliance is pleased that it was able to contribute significantly to the department’s review of the PEC.”
Dr Peter Melton, NHS Networks chair, said:
“NHS Networks was pleased to be able to support the formulation of “Fit to lead”. We had over 80 responses from a wide mix of individuals and organisations that we fed into the review. We believe that this document reflects the consensus view of re-energising, empowering and embedding clinical leadership into effective local NHS organisations. “The PEC Chair Network hosted by NHS Networks has drafted a proposed PEC Performance management framework. This framework is intended to support PCTs and SHAs with their effective implementation of “Fit to Lead”.”
The main guidelines for the new PECs are:
- PCTs to get the freedom to determine the structure and format of PECs according to local needs.
- Members to be appointed against competencies, placing the emphasis on individuals’ skills.
- PEC membership will be based on clear job descriptions, with appointments made on the basis of competencies.
- PECs should not be dominated by one clinical group.
- PECs to have a key role in driving forward practice based commissioning, including advising and contributing to the overall direction.
PCTs are expected to implement the new guidance by 1 October 2007.
This is one step better than current practice, having been involved in a few initiatives where the SHA has not been interested at all in letting clinicians anywhere near the decision making process. I am not convinced that this will do enough but it is a first step.
It still leaves out the roles of SHAs which in my experience has been to push unwilling PCTs down politically inspired routes.
But in the list of bright ideas thought up by armchair generals far from the front, this must rank fairly high.
Ministers are preparing to unveil a secret weapon in their campaign to woo dentists back to work for the NHS in England. Every practice that is able to provide a quality service and show commitment to the NHS is to be given something money cannot buy. A new kind of plaque.
Department of Health officials are convinced that dentists would treasure the opportunity to brand their premises with the NHS logo - one of the most recognised symbols in the land.
Those treating a high proportion of NHS patients will be allowed to screw the NHS plaque to the front door of their surgeries and use the brand to add extra professional kudos to their letterheads. As a badge of quality, the logo may also serve as an advertisement to private patients, who pay higher fees for fillings and extractions
Yup, I am sure that this will be as popular as the plague.
Doctors are trained to spot bullshit, and this is one area where paternalism, I would argue, is acceptable. Pharmaceutical companies produce next-level, postgraduate bullshit. Drug reps brandish literature that is the comedic parallel of the promotional stories you get in the media for supplement pills, but the tricks are far more complicated: they cherry pick the literature - looking only at the positive studies - they use surrogate endpoints - a blood test rather than a stroke - they use inadequate controls - a lower dose of the competitor’s drug. They do all this far more subtly than the homeopaths, or the fish oil gang, because they are addressing a critical audience.
Another illustration of why targets are bad:
Ambulance staff in Wiltshire routinely and systematically altered data to make it look as if the service was meeting targets.
A report from the Audit Commission found that in less than 15 months between April 2005 and July 2006 staff altered the timing of 594 emergency calls to make it appear that ambulances had reached callers within the target of eight minutes.
Last August the Department of Health admitted widespread altering of ambulance figures. A report showed that six out of 31 trusts had misreported response times. Wiltshire was not among them.
A virulent strain of the Clostridium difficile superbug has been linked to the recent deaths of 17 elderly patients at a hospital.
A further eleven who have the bug are being treated and five more sufferers have had bowel surgery at the James Paget University Hospital in Gorleston, Norfolk.
Health experts at the hospital said yesterday that they had not identified the source of the 027 strain of Clostridium difficile, commonly known as C.diff, and could not say whether patients contracted it in the hospital or in the outside community.
A survey of more than 1,000 GPs and hospital doctors showed that 70 per cent said that the NHS should not pay for every type of operation but there was no consensus on what the NHS should fund.
“The vast majority of doctors still believe that the NHS should fund the majority of care for surgical procedures, but only a minority think that fertility treatment, gender reassignment and illnesses related to lifestyle should be fully funded by the public purse.”
Dr Jonathan Fielden, the chairman of the NHS consultants’ committee, said the time was right for a debate on how the health service should be funded.
“There would probably be agreement on providing core services and agreement on not providing services such as cosmetic surgery or fertility treatment, but there would be grey areas. I believe these would need to be decided democratically at a local level, but this would have the effect of increasing the post code lottery,” he said.
The Telegraph covers Professor Crockard’s resignation as does the Times
Professor Allan Crockard was one cog in the wheel. The number of people who had their hands in the MMC / MTAS pie is much larger. The Post-Graduate Deans, members of PMETB, the various Royal Colleges, even some leading lights of the BMA have all at various times not done the right thing. Some persist in that attitude. See the letters from Allan Templeton & Steven Field that have been covered here.
As for non-medics, Prof Crockard’s letter names Debbie Mellor. Keith Chapman was part of MMC & is now also part of the review group. There are a lot more besides.
This is one such list I found:
Professor Martin Marshall - Deputy Chief Medical Officer, Department of Health
Professor Peter Rubin - Chairman, PMETB .
Paul Streets OBE - Chief Executive, PMETB
Professor Shelley Heard - National Clinical Adviser, MMC
Dr Sarah E Thomas - Lead Dean and Chair of the COPMeD Steering Group for Recruitment and
Selection into Specialty Training
Dr John Coakley - Medical Director and Deputy Chief Executive, Homerton University Hospital
NHS Foundation Trust
Professor Alan Crockard - National Director, MMC
Professor Justin Allen - Primary Care Adviser, MMC
Dr R Ashley Fraser - Medical Director, NHS Employers
Jenny Firth - Programme Manager for Medical Recruitment, Department of Health
Dr Moira Livingston - Non Consultant Career Grade Advisor, MMC
Debbie Mellor OBE - Director of Workforce Capacity, Department of Health
Dr Simon Plint - GP Director, Oxford Deanery
Dr Mike Watson - Director of Medicine, NHS Education for Scotland
Professor Howard Young - Vice Dean, Wales College of Medicine and MMC Lead, Welsh Assembly
And as for the politicians, acceptance of responsibility is a concept that does not exist in the rarefied reaches they inhabit.
And RemedyUK appear to have started the legal clock ticking. Their “letter before action” is on its way.
This is the text of Professor Crockard’s statement announcing his resignation.
I can confirm that I have resigned from my position as National Director for Modernising Medical Careers with immediate effect.
I care passionately about medical education and training. In 2003, I moved from my position as Director of Education at the Royal College of Surgeons to join the MMC team. At the college, we developed a competency based curriculum. When I joined MMC, we used the same principles to develop a curriculum for a new two-year training programme called the Foundation Programme which was launched in 2005.
It is now widely considered successful and fit for purpose. In addition the doctors completing the Foundation Programme this year seem as if they will match well into the new specialty training programmes.
The principles of MMC are laudable and I stand by them. More patients should be treated by trained doctors, rather than doctors in training. We should ensure our doctors are trained to explicit standards of competence and that they have a clear, transparent career structure to follow.
The recruitment of doctors into these new training programmes is separate to the development of the educational standards that MMC has been working to deliver. This recruitment process, through the MTAS system, undeniably needs to be reviewed. This process was developed outside my influence.
Moving to the last few weeks, I have become increasingly concerned about the well intentioned attempts to keep the recruitment and selection process running. I accept that in many areas and in many specialties, this round of recruitment and selection has been acceptable. But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system.
In the interest of the most important people in the whole process, the junior doctors, this must urgently be addressed.
That actual letter of resignation:
Dear Liam,
I wish to resign from my position as National Director for Modernising Medical Careers with immediate effect. I am increasingly aware that I have responsibility but less and less authority.
I care deeply about medical education and training. In 2003 I moved from the College of Surgeons where I was Director of Education to join the MMC team. At the College we developed a competency based curriculum. These ideas rolled over into MMC where the team put together the Foundation Programme which was launched in 2005.
It also involved coordination of the stakeholders in curriculum development, training the trainers and carrying out numerous road shows to set the scene for consultants and trainees. It is now considered successful and fit for purpose.
In addition the doctors completing the Foundation Programme this year seem as if they will match well into the new Specialty Training Programmes. As a prelude to new Specialty Training, MMC worked closely with PMETB and all the stakeholders to facilitate the new competency based curricula and set the scene for such a radical change in training.
Manifestly, specialty training is an order of magnitude more complex than Foundation, but it became obvious that the MMC team’s expertise was less used in planning of specialty rollout. MTAS was developed and procured by DH outside my influence.
An email (12 October 2005) to our team made it abundantly clear that “Debbie (Mellor) has been tasked with delivering a recruitment system to recruit junior doctor posts specifically FP’s and ST’s …….I am not clear how far you should (or want) to be involved in this. We don’t want to tread on any toes, but equally we need to be clear about what level of autonomy this Programme has”.
The MMC programme has been the subject of an OGC Gateway Review in September 2006 (DH331), they concluded “that the programme has made significant progress since the OGC health check in August 2005″.
The report overall was supportive of MMC, but there was one serious red risk. This was to “identify a clear break point for the MTAS project beyond which the contingency arrangements should be activated”. It also commented on the unclear leadership between DCMO and two senior responsible officers.
From my point of view, this project has lacked clear leadership from the top for a very long time. Moving to the last few weeks, I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages to the most important people in the whole process - the young doctor applicants.
I realise that the service must continue to allow patients to be treated and I know little of the law, but it seems to me basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured.
Equally devastating would be the suggestion of some stakeholders, that the completed interviews be discarded and the process be rerun.
I accept that in many areas and in many specialties, this round of recruitment and selection has been acceptable. But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system.
With my very best wishes.
Alan
Sure, this does not detract from the fact that I disagree with him on the rationale behind, detail of & effect of MMC as well but he has at-least recognised the strength of feeling out in the wider profession against this farce. Now is not the time to critique his letter of resignation. See also BMJ blog, late but they got there in the end. And it looks like the Scots have more sense as do the Welsh.
So now, my question for the Review Group is, just what is your rationale for carrying on?
Or at-least, so the rumour goes, of Professor Alan Crockard, National Director of Modernising Medical Careers & former Director of Education at the Royal College of Surgeons. If true It is one necessary step of many needed. This is in addition to him having been reported to the GMC for his various failures.
Professor Sir Liam Donaldson, said:
“With regret, I have accepted the resignation of Professor Alan Crockard.
We would like to thank Alan for his leadership over the last few years in setting up Modernising Medical Careers including the successful establishment of the Foundation Programme for the early years of postgraduate medical training.”
Press Officer - Newsdesk
Department of Health Media Centre
The list does not end here. As various documents that are slowly leaking out into the public domain show, the rot extends all the way across the top of various Royal Colleges & the BMA. And in this case I include people who claim that they privately thought MMC to be a bad idea but went ahead with it because it was policy. There is a professional responsibility involved & discharging it was & is not optional. I look forward to more of the actors in this saga being referred to the GMC.
I have only one message.
We are tired of you taking decisions on our behalf that damage the profession, based on self interest or cynicism.
Conduct your business in public with the opportunity for the profession to scrutinise your work. Do not hide behind faceless structures & pretend that you are doing the right thing when you are supine in the face of threats or worse, actively acquiesce to them.
Extrapolate this will you to the work rosters of staff on shifts, which after all have a similar effect on sleeping habits. See here for how things really happen. I wonder why the same people who call for airline style monitoring of professionals & quality assurance do not have a word to say about the other airline style refinements that could be brought in.
Speaking of sleep, sedation has been used to keep aggressive patients docile in most long-term care facilities. One inadequately trained healthcare worker in charge of a dozen or more confused patients was never sustainable & sedatives have been used to maintain a semblance of order. Well, it needs to stop, but do we then have the resources to care for them properly?
Drugs commonly prescribed to people with Alzheimer’s disease are accelerating their deaths by an average of six months, a study has found.
Up to 45 per cent of people with Alzheimer’s in nursing homes are given sedative drugs known as neuroleptics to try to control behavioural symptoms such as aggression.
In severe cases, the drugs may be justified. But a five-year study by the Alzheimer’s Research Trust showed that, as well as reducing life expectancy, they were of no benefit to patients with mild symptoms and were associated with significant deterioration in verbal fluency and cognitive function.
Nearly two thirds of health staff would not be happy to be a patient in their own NHS trust, a survey of more than 128,000 workers by the Healthcare Commission.
Just 39% agreed they would be happy with the care provided in their own trust, with 27% disagreeing and 33% neither agreeing or disagreeing - slightly worse than last year.
And 45% said patients were a top priority - down from 50% 12 months ago - with the rest either undecided or believing they were not a top priority.
Doctors should have their pay cut if they do not hit targets or increase productivity, a leading health economist has proposed.
Alan Maynard, professor of health economics at York University, said “demerit awards” were more effective at improving performance than bonuses.
And he suggested the NHS should consider taking away up to 2% of GPs’ or consultants’ annual salary.
But doctors said the proposal would “foster low morale”.
Professor Maynard said that, according to prospect theory, people value gains differently from losses as they place a greater emphasis on what they are losing.
He said the motivation to perform was not just driven by financial consequences but over the prospect of losing face in front of colleagues.
And GPs and consultants were good candidates for such measures as they were decision makers so had a great deal of control over how the health service performed, he added.
“The issue is whether this could be built into the GP and consultant contracts in order to get them to do higher levels of activity or more evidence-based levels of activity.
“But I believe it could be extremely effective at ensuring good performance.”
This from a guy who has a big measure of responsibility for the situation we find ourselves in currently. Isn’t it the evidence based levels of activity that are being blamed for the GP contract being over budget in the first place?
And remember also that before the contracts were negotiated (& I was against them because I felt that they gave too much away to the govt both on financial & professional matters) there was a very real chance of medics going on strike. Keep the talk up & you might help bring about such an outcome again.
NHS patients are officially forbidden from buying their drugs privately as this would mix NHS and private care. The Department of Health says patients must choose whether to be treated on the NHS, and accept what the NHS offers, or to go private in which case all of their care, not just the drugs, must be paid for. A Department of Health spokesman said: “You cannot be both a NHS patient and a private patient at the same time. Co-payments would risk creating a two- tier health service and be in direct contravention with the principles and values of the NHS.”
Everyone knows it happens. From patients buying unlicensed drugs on the net to visiting herbalists / Chinese medics or anyone else who can give them a semblance of hope. This in addition to the number of practitioners who have had enough of the rules & decide that their primary duty is to the patient. All of this when we quite often have the means to help them anyway, just not the money.
Writing in the Journal of the Royal Society of Medicine, Professor Sikora said the dilemma this posed for the NHS could not be ducked any longer. If it declined to pay for the drugs, patients would be forced to go without. The only alternative was to allow patients to top up their NHS care by paying privately for the drugs.
“There is now evidence of a growing use of co-payments to break through the access barriers in the NHS,” he wrote. “Cancer patients are beginning to develop sophisticated approaches to buying extra clinical services either from the NHS directly or through the selective use of the private sector to purchase upgrades to their basic NHS care.”
We already have a two tier healthcare system. To pretend otherwise is foolish. And dragging everyone down to the lowest common denominator instead of improving standards so that people benefit is rather objectionable.
The JCHR highlighted one case of a destitute Rwandan asylum-seeker who suffered bowel cancer and had a colostomy bag, but was refused treatment by a hospital and could not register with a doctor.
Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist. Last week, more than seven years later, the Department of Health slipped out figures showing that 55.7 per cent of adults and 70.5 per cent children had been seen by an NHS dentist in the previous 24 months. Yesterday, a report from the National Association of Citizens Advice Bureaux revealed that 77 per cent of the 4,000 respondents to their survey said they could not find an NHS dentist prepared to accept them. There is still a very long way to go to meet Tony Blair’s pledge.
Ms Winterton told the Today programme on Radio 4 that it was “unfair” for some dentists to seek extra cash at the expense of others who planned their work better.
She defended the system after being told of a practice in Fulham, south west London, which had been forced to put seven of its eight dentists “on holiday” despite demand.
Susie Sanderson, chair of the BDA’s executive board, said: “When the Government is failing to meet even its own success criteria for the new contract, then it’s time for urgent action.
“We now have a reductive, target-driven system that is failing both patients and dentists.
Rosie Winterton, the health minister, said: “The overall picture is that, despite the speculation, the number of dentists is growing and rather than leaving they are actually keen to expand their work for the NHS - hardly indicative of a failing system.â€
The National Health Service is to get a minimum of 3 per cent real-terms growth a year between 2008 and 2011, Patricia Hewitt, the health secretary has said.
Following last week’s Budget, and the chancellor’s settlement for education in the comprehensive spending review, Ms Hewitt told the Financial Times that the NHS “will continue to grow, and grow faster than the rate of economic growth -generally”.
Asked if that meant a minimum of 3 per cent, given Treasury forecasts that the economy will grow at 2.75 per, she said in an interview: “That is your deduction, but I am not dissenting from it.”
The figure of 3 per cent is below the 4.4 per cent that the 2002 Wanless review suggested was the minimum the NHS was likely to need after 2008.
The service will head towards reducing the total maximum wait for treatment to 18 weeks, and that “will not be an old, top-down, performance-management target”, but would be achieved by staff themselves reshaping the way services were provided.
The “staff” want to improve services. The last few years have been all about hobbling their ability to do so with increasing layers of management.
prompting claims ministers are pressuring the NHS to release patients early to help cut waiting times. Government figures, obtained by the Conservatives, showed that the number of emergency readmissions had risen by nearly a third since 2002.
Shadow health secretary Andrew Lansley said hospitals were discharging people too early because of NHS targets.
The government said readmissions were often unrelated to the earlier visit.
In the last quarter of 2002-3, 5.5% of patients were readmitted as emergency cases less than a month after being released.
By the last quarter of 2005-6, this had risen to 7.1%.
A Department of Health spokeswoman said: “The decision to discharge patients is made by clinicians.
I am sure that there will be plenty of clinicians available to test that statement.
An NHS Alliance poll of 651 GPs found 70% often received papers late and many said the forms were not complete, compromising safety.
It was things like these that the Electronic Patient Record was supposed to fix, simple solutions using existing technology.
Among information which was reported to be missing were the patient’s name, contact details, medication and treatment.
Incorrect or insufficient data on medication, such as potentially toxic drugs like warfarin, has even led to patients being readmitted to hospital because of complications such as internal bleeding and strokes.
In one instance, a discharge summary was received but failed to mention that the patient had just spent a week in intensive care following a stroke and heart attack.
Some 58% of GPs reported the problems meant clinical care was compromised in the last year, with 39% claiming it had put patients at risk.
Overworked staff with no time to even document what treatment they have provided sounds familiar all right.
Speaking of IT systems,
Professor Michael Thick, clinical officer of Connecting for Health said that interoperability was an issue which would be high on the computing agenda for a while, citing the two main systems suppliers in the National Programme for IT as an example of the problems being faced.
“The standards of Cerner and iSoft are based on different structures which are not necessarily compatible at the moment and given that we have not been able to agree on a consensus on coding, interoperability is something we are hoping for but will not necessarily happen.â€
Connecting for Health has today issued its tender for bids to join the catalogue of ‘additional systems suppliers’.
The tender in the Official Journal of the European Union (OJEU) for an ‘Additional Supply Capability and Capacity (ASCC) Framework Agreement’ is open to a maximum of 500 suppliers, for a period of up to four years. The estimated value of the tender is £100m.
This document appears to have leaked from the West Midlands Deanery. And this is the person the RCGP council in its wisdom has chosen to be the Chairman-elect!
Both MMC and PMETB are perceived by the medical royal colleges as being agents of the DH.
What is the RCGP position on this Professor Lakhani?
Is this going to change Professor Field?
Both MMC and PMETB have challenged the central role that the colleges had in postgraduate medical training. The colleges are also threatened by the increasing role of deaneries in the delivery and QA of training programmes.
The BMA has opposed the shortened training programmes and selection system.
The overseas doctors issue has polarised opinion – on one hand the feeling is that we need to protect the increasing number of UK graduates, on the other a desire to support the many thousands of overseas doctors who have come to this country – far in excess of the programmes that were available or will be available in the future – the eligibility of overseas doctors is a complex issue and the subject of recent judicial reviews and court action.
But MMC is live has already successfully delivered new 2-year Foundation Programmes across the UK – specialty training begins in August 2007.
MMC/PMETB together will raise standards and help produce the types of specialists and GPs that we need for the service and more efficiently.
Not really Dr Field. Maybe the compliant kind you would like though.
Can you tell us how many complaints were received about the Foundation year / GP recruitment systems when they were implemented & what actions the Deanery took in response?
The next problem is how to reduce the number of surgery and anaesthesia SHO posts while not adversely affecting the service and move their funding to create training programmes in specialties that the service needs e.g GP or acute medicine (In WM this means reducing surgery in year one from 120+ to 36 (the same in year 2 and 3).
What was the basis for this calculation?
GP selection has been under development since 2000 – it is centralised and run through an office in the WM deanery – it’s highly successful and has had no problems so far (though there is concern re functionality of the MTAS computer).
I disagree on that score, given that I personally raised complaints about the applicability of the system to medical recruitment. Gail Evans needs to be asked.
There are problems with the short listing system – the design of the questions did not discriminate enough between candidates – this is one of the major concerns of our surgeons.
We have had more applicants than we expected (12,700 in the WM – we planned for 8000) .
Increasing numbers of doctors from the Europe and overseas have applied for our training programmes - the problem is how to address the competing demands of the increasing numbers of UK graduates with the demands of overseas doctors – there will be unemployment of doctors because the number of programmes available across the UK (19000) is less that applicants (33000) – it was always like this because of the large numbers of EC and overseas doctors trying to get into the UK – this should have been sorted by the DH / Home Office but there continues to be problems with the eligibility rules for overseas doctors / HSMPS – fraught with legal issues.
Whatever do you mean Dr Field? What exactly were the DoH / Home Office meant to sort out?
Come right out & say it.
12,758 applicants to the West Midlands.
1568 WM candidates and 115 Defence candidates have been interviewed so far
3387 WM candidates have been called to interview (156 Defence).
10 our General Surgeons refused to interview Surgery ST3 candidates on the morning of their interview.
They voted and took action – one military surgeon and one administrator from UHB abstained.
Over 81 trainees were affected – all candidates were sent home after being spoken to by those consultant surgeons - some had travelled from overseas (one from Australia, one from New Zealand).
The surgeons issued a press statement and appeared on television. Note that the emails on the Drs Net UK and Telegraph discussion for a have all supported their stand. Many of our consultants have questioned their action particularly after seen how well the interviews have gone.
Straw man again. The argument is not that the candidates called to interview are not good enough, they are good doctors, as are those who did not get interviews. But other candidates who might have been as good or better did not get the same opportunities. To divert the argument by saying that everything is well because you are appointing excellent candidates at interview does not take away the fact that you are throwing away a large number of well trained & enthusiastic doctors. Which is why the problem is & always has been the smaller number of training posts than there are candidates, not the mechanism for deciding who is lucky enough to get selected for one.
On no occasion have the surgeons criticised the deanery except for stating that due to the MTAS problems we were not able to long-list before short listing for the interviews (they are correct for surgery). This resulted in a few ineligible candidates appearing for interview. Their anger is directed at MTAS; the computer problems and the short listing forms which they feel failed to discriminate between candidates at the ST3 level.
I would agree with many of their complaints but not their action which was wrong and many feel their actions are unprofessional.
The only interviews that we have failed to complete so far in the West Midlands are Surgery ST3 (our cardiothoracic surgery STC has postponed their interviews but have not refused).
We are working with them to rearrange the interviews for the ST3 cohort that was affected by their walk out. Some of the rebel surgeons did attend to interview for surgery at ST2 level last week.
There have also been a number of consultants who have raised similar concerns. Some have written to the press and the SoS. A few individuals refused to interview in anaesthesia and other specialties but the vast majority continued with their interviews.
Steve Field
March 18th March 2006
So though a large number of people have communicated publicly that they do not agree with what you are doing, you feel based on the few that you have spoken to privately that you are right?
Below is the text of what we submitted to the DH Review and more detail about the MTAS problems.
NHS West Midlands Workforce Deanery
Modernising Medical Careers – MTAS
Dear Keith,
I promised to send you an update and some thoughts re the process to date for use at the Review Group.
Following the walk out of 12 of our General Surgical colleagues, we have spent a lot of time reflecting on our own deanery processes and the MTAS system generally. I have met with the surgeons concerned and debated their concerns. While I disapprove of their action, they did raise similar concerns to those raised by deanery staff.
As you know, I presented our concerns at the last meeting of the Modernising Medical Careers Programme Board and would have also shared concerns at the UK Modernising Medical Careers Strategy Group if it had not been abandoned due to the fire / bomb scare. I have also listened to the concerns of the BMA and others when I chaired the UK Modernising Medical Careers Advisory Board, but I did not share my thoughts openly at that meeting.
Is this ethical? Have the courage of your convictions.
Update
The only interviews that we have failed to complete so far are Surgery ST3 and one person who was short listed for academic rheumatology has yet to be interviewed. You will be well aware that the surgical problem has featured across the national press this week. I know that the group have forwarded comments and concerns to the review group. We are planning to interview again for Surgery ST3 in 2 weeks pending news re whether the President of the RCS has gained agreement (or not) for all those with MRCS to be interviewed – I have sought clarification from the Modernising Medical Careers Team.
One academic group selecting Walport doctors for rheumatology have refused to interview because someone they feel should have been short listed (having looked at the academic forms) didn’t make it through the first stage. I am dealing with that problem.
There have also been a number of consultants in other specialties who have raised similar concerns but have continued with their interviews. The cardiothoracic surgery STC has postponed their interviews and awaits a national announcement from your review group.
An e-mail has been distributed to all STC Chairs within the West Midlands by three STC Chairs seeking support for an immediate suspension of round one. I have spoken to the authors, one of which was one of the surgeons. There has been a flurry of phone calls and emails from consultants that I have dealt with personally over the last 5 days – the concerns generally reflect those of our surgical colleagues.
Most interview panels and STCs have proceeded but we have lost a handful of consultants who have refused to interview.
I am sorry that some of the senior doctors in the West Midlands have been a pusillanimous lot.
Better news
We are beginning to get feedback from many interview panels that despite their concerns, they are able to select some excellent candidates from those interviewed. The mood is lifting in the consultants who have seen the interview process in action. There is nothing but praise for the deanery staff.
See above re straw man argument. Of course the candidates who turned up were excellent. So were those who did not get interviews, yet you are ending their careers.
MTAS
As a workforce deanery we have major concerns about the MTAS process that we have been involved in during round 1.
Having been involved in developing the GP selection system and having run the original MDAP process for foundation training for three years up to 2006, we are well aware of the advantages and the problems of electronic systems and are up to date on HR selection issues.
As I said above, show us the evidence that you took concerns into account & helped the doctors whose careers you damaged during the past 3 years.
The timetable for delivery was tight but became impossible because of the delayed functionality of the MTAS system and its many glitches.
My staff, like those of other deaneries, worked very late each night and over the weekends in order to try and meet what was an impossible deadline. We had 12,700 approx applications – we had expected about 8000. Luckily we had fantastic support from the multiprofessional deanery admin and specialist staff.
We remain very concerned that the change to the London UofA created an apparent 10 day delay in functionality which produced further problems down stream. The closing date for short listing should have been delayed further and not announced just before the weekend – this together with added pressure from some DH staff to deliver caused undue pressure, forced staff to work 12 hour days over the weekend and put the deanery at increasing risk of error. EWTD!! We could not practice what we preach to our junior doctors. I cannot and will not expect my staff to work under such conditions for round 2.
Nothing new there, yet you stuck to the deadlines, why?
Some suggestions
While we have lessons to learn re our internal deanery systems, I will address the national issues below.
We must all work hard to regain the confidence of our juniors and seniors. A unified communications strategy is essential. Any changes must be communicated as soon as possible. A regular flow of information is necessary to keep our consultants and juniors on board. Deans have an important role to play in this. Information on applications per specialty, competition ratios, numbers of interviews and success rates must be made available quickly; regular updates are essential. Our CEOs must be kept informed so that they can make plans for their consultants to be released from service in good time.
The access to the system for overseas doctors must be clarified as a matter of urgency.
Tell us what you really mean Dr Field. And communicating what you have already decided as opposed to genuine consultation is useless.
We have debated the situation at length and believe that we should proceed with the round one interviews but we must make changes for round two. We do not believe that interviewing all applicants for round one is feasible. We do not believe that it would be supported by the service. If that decision is made then David Nicholson would need to add his weight to the decision and work with SHA CEOs to ensure that consultants were freed up for the deaneries.
Really? Lets just say that most doctors disagree with you.
We believe that the MTAS system is the way forward. But, it is essential that the MTAS electronic system is refined and the bugs / glitches sorted out. The E system for long listing and short listing must be reviewed and streamlined. The short listing criteria need reviewing e.g. more marks for academic excellence, more discriminatory questions and better instructions to help assessors give marks is essential.
You were involved in the development of this system. You were warned. Where is the evidence that the system was tested? Why did you let a flawed assessment process go ahead? Did the lives of the 33000 trainees whose careers you were managing not matter?
We believe that the GP system of a factual MCQ followed by multi station selection is the way forward for all specialties. The GP system was developed over a 6 year period and works well. We acknowledge, however, that it is too late to develop and validate MCQ tests for the specialties. We must concentrate, therefore, on short listing and the interview process.
The GP selection process might or might not work. But given your performance so far, it is for you to prove your expertise.
The new timetable must be realistic and allow time to change the short listing forms and develop the interview process in partnership with deans, the royal colleges and deans. The timetable must allow adequate preparation time and most importantly, rest for deanery staff – this is a safety issue not just for the staff but also for the candidates, in order to reduce the potential for error. All deans want to provide an excellent service; therefore, deans be supported and must be involved in reviewing progress throughout and must have a veto on delivery dates free from any external pressure.
You had a professional responsibility. You did not discharge it.
Professor Steve Field
Head of Workforce and Regional Postgraduate Dean
NHS West Midlands Workforce Deanery
8th March 2007
Some detailed MTAS issues from the West Midlands
I asked my deputy to collate the problems encountered with MTAS 2 weeks ago (we are now collating the issues in more detail but I add to this paper Alan’s original complaints for information – more will be available soon)
As you know, I presented these concerns to the Modernising Medical Careers Programme Board – these are his words:
Long listing
We were led to believe that the long-listing flags would highlight specific areas of the application form requiring attention so that staff could investigate that area. In MTAS when a flag shows the staff have to go through all 15 pages of the application entry criteria looking for the relevant area. This adds a considerable time to the process which on average is approximately 15 – 20 minutes each application. We were aware that the vast majority of the applications would be submitted in the last couple of days (Friday 2nd, Sat 3rd and Sun 4th Feb) thus making it impossible to long-list before short-listing commenced. Attempts to access MTAS in order to long-list were very slow during the period leading up to the closing date. The long-listing/shot-listing guidance was also issued very late.
The first opportunity our staff had of seeing the Entry Criteria screens was on 22nd Jan – the day applications opened to candidates.
Due to the time that it took to undertake long-listing most candidates will be allowed to progress though to short-listing. (This is the only complaint that our surgeons appear to have with the West Midlands part of the process)
There would have been more, they just chose to raise one clear concern you could not deny.
Short-listing
Staff started the process of identifying applications for each of the specialties/levels first thing on Monday 5th Feb. A decision had already been made that the West Midlands would not use the electronic short-listing process as we had concerns that this part of MTAS would not be ready. We gained this function on the Friday.
In order to be in a position to service the pre-organised short-listing panels a decision was made to start printing off applications, which at that stage did not include the applicants reference number. They then had the laborious task of double checking the screens and writing the reference on the top of the applications. At approximately 4.30pm on Monday 5th Feb a reference number started to appear on applications although the specialty and level was still not present.
The printing of a batch list summarising the applications was difficult as applications were sometimes missing from the print.
It was not possible to count the number of applications either for each specialty, level or total number of applications received for the whole Unit of application.
Short list forms – we had several cases of data loss when we tried to use the computer – but either way the white-space questions were not written with an understanding that most of the doctors would look so similar – i.e. 5 years of medical school and 2 – 3 years of foundation / SHO and the academic questions could have offered marks for Masters degrees etc. Someone who was coached could gain lots of marks and be a poorer candidate who was honest and factual. Plagiarism software was absent.
All posts had to be individually added to MTAS as there was no bulk upload facility. This resulted in double data entry from our own spreadsheets and resulted in approximately 10 days additional data entry each from 3 people. This was available for Foundation selection.
The computer was extremely slow on a number of occasions which often lasted some hours.
The National Short-listing Scoring Indicators cannot be used by short-listing panel members as they do not have an area for the applicant number to be added or for the panel member to add comments and their signature. A whole series of additional score-sheets have had to be produced for each specialty and level.
Functionality was very late arriving – this seems to be a general problem with Methods (Consulting- the firm responsible for the software).
Again, it was your responsibility to make sure that the process worked or else call a halt to it.
There has been no national training on MTAS looking specifically at the ST module – this is due to the modules not being available until the day of launch. Training had to be done in a piece-meal fashion with staff as and when elements of MTAS become available.
Bugs on MTAS
There are numerous bugs identified such as:
GP questions appearing on the CMT long-listing sections
Application “sign off†by applicants not being mandatory
Employment history start dates not being mandatory – making it impossible to gauge the length of an applicants experience.
The Plagiarism Finder did not work
Countless problems with data loss – we lost over 1300 applications on the day before the closing date and had many separate episodes of data loss – candidates also appeared on the screen unannounced during the short listing period! – As a consequence, the staff have no confidence in the system.
The Oxford cardiothoracic surgery imbroglio. The report is less interesting for the headline value which is that mortality rates are within acceptable limits but rather for the methodology & what the Healthcare Commission think makes a good unit.
The BDA poll found 85% of dentists believed the new contract had not improved access to NHS services and 97% did not think it had removed dentists from the “drill and fill” treadmill.
The Citizens Advice report acknowledged this has been a problem and said extra money must be targeted at areas where there is a shortage of services.
The report was compiled from evidence given by nearly 4,000 of its clients, research on the 152 PCTs and government statistics.
It said that there had been “little evidence of any real growth” in services and in a quarter of PCTs no dentists were taking on new patients.
It said 2m patients - compiled from government estimates - could not get access to an NHS dentist, with most deciding to pay for private treatment, go on a waiting list or not get treatment at all.
And it added people in rural communities were particularly disadvantaged as they had to rely on public transport, forcing them to take expensive, difficult and time-consuming journeys to reach a dentist.
In my experience, service users often have a lot to say about the care they receive - what works, what doesn’t, and how things might be improved. Their workers have plenty to say as well, after years of experience on the frontline, dealing with issues as they arise, coping with the impact of changes dictated from above. And, generally speaking, these two groups agree.
This is not a scientific survey, mind; it is what I have observed. The trouble is that what they have to say does not always fit neatly into boxes. And it is not always what the powers-that-be want to hear.
The policy makers want figures to prove things are getting better; to prove that it does not matter if, according to a report by the mental health charity Rethink, spending on mental health services is down by £30m - a figure the Department of Health disputes, putting the decrease at £16.5m.
Who cares either way? It is money well saved. Just look at these statistics. According to my local trust’s annual report, last year’s service user survey “showed that 95% of service users consider that their psychiatrist listens carefully to them and 97% feel that their psychiatrist treats them with respect and dignity”. But what does this mean? And does that include the “Yes, to some extent” answers, as well as “Yes, definitely”? In other words, everything other than “No”?
The Financial Reporting Advisory Board (FRAB), a body which advises the Government on its accounts, has indicated that the Treasury’s previous definition of what PFI debt should fall on its books should be scrapped. A FRAB working group said the way the Government accounts for PFI makes it too easy for it to manipulate the figures so they either fall inside or outside its own debt totals.
The finding, which is expected to be endorsed by the FRAB, undermines recent calculations from the Office for National Statistics finding that only £5bn worth of PFI debt should be added to the national accounts. Its figure was far shy of the combined £48bn value of all PFI projects - but only because NHS debts were classified as belonging to the private sector.
The FRAB’s working group warned that many of the PFI debts were being left off the balance sheets of both private and public sectors. It has urged the department to withdraw the system no later than 2008-09.
Some analysts think this could add an extra £20bn to the UK’s net debt, potentially catapulting it above the 40pc of gross domestic product level Gordon Brown pledged to avoid under the terms of his sustainable investment rule.
The Department of Health spent £74.3bn in 2005-06, £2.7bn more than its original “near-cash resource limit” of £71.6bn. Ivan Lewis, the health minister, told parliament in December the NHS deficit was “the main reason” for the overspend.
The Conservatives accused the government of concealing the true extent of the overspend by using “sleight of hand” in the government’s accounts.
They said the government brought its books close to balance because it underspent on the “non-cash” part of the health budget, which included writing down the future cost of medical negligence claims.
They explained that the £2.7bn shortfall comprised a £1.5bn overspend on “near-cash”, or current spending, together with £1.2bn that has been taken from future annual expenditure.
Since according to Treasury rules the “near-cash” overspend must be paid back in the following year, the NHS will have to find an extra £1.5bn in 2006-07 to cover the previous shortfall.
On top of that, figures in last week’s Budget show that resources for the DoH will be £900m lower in 2006-07 than anticipated by the Treasury at the beginning of the financial year.
Bad news if it pans out. Not much more to be said.
Now “absolutely confident” that the National Health Service would record a small surplus at the end of this financial year, Ms Hewitt said it could now use part of the £450m contingency reserve that strategic health authorities had built up to find the £179m needed to end a rule that the health department had long accepted was “unsustainable”.
Under resource accounting, a trust that overspends not only has to pay that money back the next year, but has to do so after the same amount is knocked off its budget.
The “double whammy” rule had affected 28 NHS trusts, “making it impossible for them, in some cases, to get out of debt”, Ms Hewitt said.
The accounting rule will still apply to primary care trusts as they are chiefly purchasers, not trading bodies like hospitals.
Some of the 28 trusts will now record a small surplus. Others, however, including Hinchingbrooke, the Queen Elizabeth in Woolwich, Whipps Cross and Mid-Yorkshire, will still be left with deficits not caused by the accounting rule that range from £12m to £21m. These will still have to be paid off over time.
Ms Hewitt told the Financial Times there remained “a small number” of hospitals - thought to be between 15 and 20 - with financial positions so serious that they were unlikely on their own to recover.
With the first take-over of an NHS hospital by a foundation trust expected to be formally approved this week, further foundation trust take-overs “may well be the solution in some cases”, she said, “but it won’t be the solution in every case.”
One surprise is that detailed work has shown the “double whammy” effect on hospitals - which has been inconsistently applied across the NHS - is smaller than original estimates that it would cost £500m to £600m to remove.
Ms Hewitt said the ending of the rule was the final part of a big set of financial reforms that would make the NHS finances “much more transparent” and “much fairer” in future.
They would end a trend that had seen healthier but overspending parts of the country being subsidised by other parts, chiefly in the north and Midlands, that had bigger health problems but which had, nonetheless, tended to break even or make surpluses, she said.
That definition of healthier but overspending has been questioned. I wait to see what the details are.
I try to look at motives, the behind the scenes machinations why a position is taken & make it a point not to be influenced unduly by any personal consideration or gain. Well, I try anyway but not always successfully. Claiming to be holier than thou is not realistic.
I am sure that my outspokenness on here has put off a few potential clients but there is only so much I can compromise on. Wired goes into it in a little more detail.
Radical forms of transparency are now the norm at startups - and even some Fortune 500 companies. It is a strange and abrupt reversal of corporate values. Not long ago, the only public statements a company ever made were professionally written press releases and the rare, stage-managed speech by the CEO. Now firms spill information in torrents, posting internal memos and strategy goals, letting everyone from the top dog to shop-floor workers blog publicly about what their firm is doing right - and wrong.
“You can’t hide anything anymore,” Don Tapscott says. Coauthor of The Naked Corporation, a book about corporate transparency, and Wikinomics, Tapscott is explaining a core truth of the see-through age: If you engage in corporate flimflam, people will find out. He ticks off example after example of corporations that have recently been humiliated after being caught trying to conceal stupid blunders.
No, this post is not brought on by any major crises of faith or ethical dilemmas & I am not aware of the location of a smoking gun.
But just how far will people go to hide negative opinions, especially if personal gain is involved?
I recently posted a few comments on a major newspaper’s website, nothing libellous or close to but pointing out mistakes / economies with the truth of one of their star columnists. None of the comments made it past moderation. Once is possibly an error, twice less likely to be so. More than that & there is likely to be something going on.
Today, I posted on a site that takes in quite a bit in industry sponsorship. The comment questioned the value of a particular transaction & drew attention to its poor record of performance. No show. I can only think that the fear of offending an advertiser was greater than the commitment to telling the truth.
Hiding from the truth doesn’t make it less correct or even go away. Intellectual honesty is a pre-requisite.
The co-founder of iSoft, the embattled IT company at the heart of the government’s troubled £6.2bn NHS IT upgrade project, was sacked yesterday after being suspended since the beginning of August.
The company said Steve Graham, former commercial director, had been “removed as a director” and had “ceased to be an employee of iSoft.” This move follows his suspension on full pay of £385,000 from August 8, “following an initial investigation into possible accounting irregularities in the financial years ended 30 April 2004 and 2005.” Another employee was suspended alongside Mr Graham, but the company refused to disclose their identity. A spokesman for the company said the financial terms for Mr Graham’s departure had not yet been agreed, but added: “It is not our intention to pay any compensation.”
As I do for the BMA or the Royal Colleges, especially after their behaviour over the years.
I am not capable of the cognitive dissonance, the moral bankruptcy of the position that “I’m al-right jack” & that other peoples problems are of no consequence.
The MDU guidance on the Electronic Patient Record is worth considering fully. It is difficult for me to understand how anyone who considers fully the positions being eluded can go along with current CfH plans.
“GPs will need to consider, therefore, whether they can rely on implied consent, or whether they need to seek express consent from their patients in order to upload their data onto the summary care record.
“GPs will need to consider a number of things. They will need, for example, to satisfy themselves that the CfH [Connecting for Health] publicity campaign had indeed reached all their patients, that all their patients had read and understood the leaflets and, if the GP had not heard from them, had decided not to seek an appointment with the GP to ask any questions, and not to ‘opt out’.â€
In clinical medicine, these are the current ethical transgressions that are being ignored. Is a life in the “Third World” any less sacrosanct than one in the West?
Tens of thousands of elderly Americans have received life-prolonging care as a result of their long-term-care policies. With more than eight million customers, such insurance is one of the many products that companies are pitching to older Americans reaching retirement.
Yet thousands of policyholders say they have received only excuses about why insurers will not pay. Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state.
“The bottom line is that insurance companies make money when they don’t pay claims,†said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. “They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.â€
The survey found that half of patients in south-east England were waiting more than six months, compared with 0.2% of patients in the north east. In December last year, when the survey was carried out, a third of patients were waiting longer than that for colonoscopies or sigmoidoscopies and a fifth for gastroscopies.
What I can say is the waiting list for colonoscopies is so long, it was not worth referring patients unless as emergencies.
How ever these are not procedures that can be performed in facilities without full back-up & the way to improve the service is to expand the NHS provision, not to set-up IS treatment centres that cannot deal with these investigations & instead take away more minor procedures, destroying training as well as the financial balance of service provision.
The NCT, which provides paid-for ante-natal classes for women, started to compile reports from members about local cuts last October.
So far it has been told 19 areas across England and Wales have either cut or closed ante-natal classes or visits to maternity units - designed to help expectant parents become familiar with the surroundings in which they will have their baby.
And as for this story about EU migrants overwhelming the NHS provision of obstetric care, there has been enough demonisation of asylum seekers & other immigrants over the past few years. They are part of the same common market that lets British pensioners get their knees replaced early in France or British holidaymakers seek treatment in the rest of Europe. Deal with it. Besides, anyone with the name Furedi deserves closer scrutiny for political motives.
In the Nineties, the link between the allocation of funding and the meeting of local residents’ health needs was broken as block funding was abandoned and, in its place, hospitals were established as financially independent corporations that were expected to generate money in order to break even.
What happened? Trusts sold off land, cut back on staff and contracted out services as a way of producing revenue.
It is this need to develop income-generating schemes that is behind the contracting-out of car parking, as well as the privately owned restaurants, newsagents and coffee shops that now litter hospital lobbies.
The companies that manage these facilities, eager to increase their profit margins, can charge premium rates because they know they have a captive market. They are mercenaries not bound by the founding principles of the NHS - and the Trusts are happy to collude with them because of the income they generate.
At present, sales from the clinical care unit of Capio, at £18.3m, only represent 9 per cent of turnover. But the division, which was formed in 2004 to provide primary and secondary healthcare facilities, is the fastest expanding. Industry watchers believe that the combination of new contract wins and the addition of Mercury Health could take revenues from the division to more than £200m by 2010.
According to people close to the situation, the purchase will be funded by a mixture of debt and equity. There is expected to be a placing of 5m shares with institutions, worth about £33.7m based on last Friday’s closing price.
Care UK edged out Cognetas, the private equity group that is understood to be working with Mercury’s management team to do a buy-out, and Inhealth, a privately owned healthcare service group, to acquire Mercury Health.
For the year to March 31 2006, Mercury made revenues of £14.6m (£349,000) and operating profits of £1.5m (loss of £345,000).
The sale will allow Tribal to refocus on its core support services business and pay down debt. It is expected to receive net cash of £52m from the sale.
To readers from far & wide:
The server logs make for interesting reading, telling me just who is visiting the site & the topics that interest you.
So can I invite you to participate in the discussion, by telling me why I am wrong if indeed I am so & generally shedding a little light on this brave new world we inhabit.
It is more fun that way, honestly!
. Feel free to comment on the Wiki.
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