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Healthcare seems to have been a popular subject today going by the number of news items I’m unearthing.

The Guardian carries a release by the Royal College of Nursing that over 8000 nurses have written to their MP’s about their below inflation pay award which they equate to a pay cut of £570 a year in real terms.

Almost no attention appears on the other hand to have been paid to a report from the Faculty of Old Age Psychiatry of the Royal College of Psychiatrists who claim that that specialist services for older people with mental health problems, including dementia, are being cut purely to meet the financial pressures created elsewhere in the NHS, and to meet the demand of the Secretary of State that financial balance must be achieved.

“Services losing over 50% of their inpatient beds, up to 75% of their wards, more than 30% of their funding, complete closure of day treatment services without consultation and reduced access to specialist care”, said Dr Dave Anderson, Chair of the Faculty of Old Age Psychiatry. “Loss of community nurses, doctors, occupational therapists and psychologists has also been reported. Some patients and their families will now have to travel large distances to receive their care.”

“The Faculty also has examples of specialist services being dismantled and transferred to general mental health services, and wards for older people closed with patients transferred to wards for younger mentally ill people raising serious concerns for safety and quality of care, continued Dr Anderson.

“NHS managers are dishonestly calling this modernisation, service re-design or new ways of working, but this represents nothing more than asset stripping intended to achieve nothing more than to save money. This is not consistent with the Department of Health’s pledge to develop comprehensive specialist mental health services for older people. We have communicated our concerns to the Department of Health in writing on the 9th January, but have to date received no response.”

“We believe that the present blanket financial constraint enforced in the NHS is unjust, irresponsible and short-sighted. The Faculty is asking the government to stop this piecemeal destruction of specialist services that is unfairly penalising vulnerable patients and their families. Two thirds of people in acute hospitals are over age 65, and 50% of these people have a mental disorder. The Department of Health appears prepared to watch the ad hoc destruction of specialist mental health services in the NHS to meet financial pressures,” concludes Dr Anderson.

Hard to argue with that one but it appears only to have been picked up by the Daily Mail.

The Financial Times tells us that Paul Corrigan, who has served as Mr Blair’s adviser on health since 2005, is leaving to become director of strategy and commissioning for the NHS in London. He has been one of the main proponents of the government’s market-based reforms and his appointment presages a further shake-up of health services in London.

Mr Corrigan has been central to the government’s NHS reform programme, first as an adviser to Alan Milburn and John Reid at the Department of Health between 2001 and 2005, and then at Mr Blair’s side He was brought in to Downing Street to drive forward the reform programme after it appeared to falter in the early days of Patricia Hewitt’s tenure as health secretary and the final days of Sir Nigel Crisp’s spell as NHS chief executive.

Mr Corrigan, who takes up his NHS role in the summer, is an advocate of a division between the commissioning of healthcare and its provision. He also wants the private sector to provide bigger and better capitalised primary care and diagnostic facilities than the “small business” approach of traditional GPs. His appointment is likely to herald big changes for GP and community services in London.

I wonder if the NHS in London is going to like this very much, especially given that Anthony Sumara who hit the headlines with his proposals to outsource most of the activities of Hillingdon PCT has been appointed “Turnaround Director”.

It is very easy to cut deficits by cutting services & slashing the numbers of staff, the challenge being to continue to maintain them in difficult times. See the RCPsych release I mentioned above.

Niall Dickson from the Kings Fund passes comment on the HSJ survey from last week & asks how the execs are going to manage

variations in performance across the country and across different services, and the task of engaging clinicians in the running of services.

As Bill Clinton didn’t say: “It’s productivity, stupid.”

Well, I have a difference of opinion with the King’s Fund on a few topics & take them with a large helping of salt, primarily because of their lack of clinical nous, which shows in some of their policies.

Again in the FT, there is analysis of the announcement by John Reid, the home secretary of a fresh drive to charge foreign nationals, including illegal immigrants, for National Health Service care - but well ahead of the health department being able to say how that will work in practice.

Mr Reid announced pilot schemes to be run in three unidentified trusts in which hospitals and GPs will be able to check patients’ eligibility for free treatment against data held by the Border and Immigration Agency. From 2008, all foreign nationals will have to have identity cards with records held on a national database.

The Department of Health rejected fears that the pilots would result in NHS medical records and information being made available to law-enforcement officers. A spokesman said “categorically” that the information flow would be one way - the immigration agency providing data to the NHS. “We will not be breaching [medical] confidentiality in any way, or handing over records or identity information to the Border and Immigration Agency.”

“NHS trusts will only be able to approach the Border and Immigration Agency with the patient’s explicit written consent, in order to establish their exact immigration status to help establish a patient’s eligibility for free NHS care.”

If a patient refused, an NHS trust would have to consult the existing 68 pages of guidance on how foreign nationals should be charged, a spokesman said.

The department was unable to say last night whether trusts would be asked to trawl a list of known illegal immigrants against NHS records, a spokesman saying that “the details of the pilots are still being worked on”.

In 2003, John Hutton, then a health minister, promoted the idea of asking patients for utility bills or passports to prove residence, saying the introduction of a national ID card would make checking eligibility “much easier”.

But NHS trusts have been reluctant to take on the bureaucracy of such checks, with the health service having no clear idea of how much “health tourism”, or the supply of NHS care to foreign nationals, costs.

In the past, the British Medical Association has said it would be “totally unjustifiable” to try to charge impecunious failed asylum-seekers who have no money.

The Home Office appears to regard the pilot schemes as a potentially important building block in the development of the government’s ID-card system. But Connecting for Health, the NHS information technology programme, has consistently rejected the idea of using such cards to establish entitlement to treatment.

Is this really enough of a problem to spend more money setting up this elaborate mechanism? This pre-supposes that the ID card scheme is going ahead which is a gamble in itself. And what are the ethics of refusing to treat people because they have no money? Is any clinician seriously going to justify that to the GMC?

On a positive note, Centres of Clinical Excellence, a new entrant into the private healthcare maket with predominantly clinical shareholders has had its proposal for a mini-hospital near Bath approved. The FT approvingly describes the hospital as

attempting radically to raise the standards of hospital buildings by using the best-known British architects. It is an audacious move - a riposte to the dismal standard of design that has become the norm in an industry driven by the demands of the private finance initiative and a contractor-driven process that can reduce architects to peripheral consultants.

The ground floor of the £20m, 6,500 sq m building is dominated by operating theatres for minor surgery, providing natural sunlight and views across the surrounding countryside. That is a striking feature, given the enclosed and claustrophobic arena in which operations are often carried out.

The first floor functions as an administrative base with consultants’ rooms clustering around its edges, while the second floor contains the patients’ individual recovery rooms, each with a small patio or balcony giving on to the landscape. Ali Parsa, chairman of Centres of Clinical Excellence and a former investment banker at Goldman Sachs, describes the split as “clinic/office/hotel”. It is also, significantly, a hospital without corridors - certainly one of the first of its kind and forecast to come in at well below the prices of similar PFI projects.

Mr Parsa said: “We could just build another hospital but modern healthcare cannot be delivered in these badly designed buildings. You are at your most vulnerable when you are ill, you need to be in a building which makes you feel good. We thought let’s take the country’s best architects and challenge them.”

Good luck to them & hopefully the other players in the industry will learn a thing or two.

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This entry was posted on Thursday, March 8th, 2007 at 8:24 pm and is filed under Economics, Management, NHS, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.