Patient safety
Something for the Department of Health to pay attention to, what with the whole point of the ISTC programme being to transfer common elective procedures away from full service hospitals and into smaller facilities that lack proper round the clock medical cover & proper critical care cover.
Hospitals in the US transfer patients via emergency ambulance services when they can’t cope (by design) in exactly the same way that is proposed to happen here. And people have died.
Should a hospital be able to handle a medical emergency?
The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.
That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.
The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.
These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.
Funny how the model we are being told to emulate is under attack in its country of origin.
Federal and state officials say they are now reviewing the guidelines to toughen the rules and make them more specific.
Will the DoH learn from this maybe or will this be spun away as have so many other concerns before it?
Patient safety is at the forefront again with the Telegraph picking up on the downgrading of maternity care providers & the restrictions on embryo transfers reported yesterday.
“For medical and safety reasons, we think single embryo transfer is a good option for a select group of people.
“But such a policy must be accompanied by full NHS funding as recommended by the NICE guidance. In Belgium, where there is a single embryo transfer policy, infertile couples are offered up to six free cycles of IVF, which makes the system extremely fair.â€
Somehow I don’t see this happening.
Prescription charges have now officially been dropped in Wales. I am not au-fait with the costs involved in actually collecting the charges but I do not believe that the administration involved comes cheap.
The social care commissioning agenda gets another push in the Guardian with Ivan Lewis, the care services minister at the Dept of Health, proposing to say that
…. hundreds of thousands of older people would enjoy a better life if all GPs could routinely prescribe care, and that better support for people needing everyday help could be afforded if the government shifted resources from hospitals to GPs, district nurses and care assistants.
His department, however, is bracing itself for an NHS budget squeeze, expecting funds to grow by no more than 3% a year from 2008, compared with a level of more than 7% over the past five years.
So, as said before, fine words, unrealistic policies.
And the GMC comes under attack from paediatricians over the rules for expert witnesses. My opinion - Extreme cases make bad rules, in the same way that Bristol did for the centralisation of services, Alder Hey did for tissue retention & Shipman did for professional regulation. There are a few bad apples yes, but the effort to be seen to do something means that political considerations take precedence over sensible solutions. Witness Liam Donaldson’s proposals on medical regulation.
Max Pemberton in the Telegraph deals with free choice.
And finally, the Financial Times looks at the case for the take-over of indebted NHS trusts by their foundation peers.
Heart of England, one of the first foundation trusts, which in its first full year of operation recorded a small £5m surplus on its £265m turnover, is taking over the nearby Good Hope Hospital in Birmingham. By last April, Good Hope had an accumulated deficit app-roaching £20m on a turnover of just over £100m. Its own board judged it “no longer financially viable”.
There are a number of reasons for trusts going into deficit. Chronic under-investment is one of them, as is admittedly poor management. But most management has hitherto been centrally directed.
There are some 15 to 20 NHS trusts which are effectively insolvent, having deficits so large they look to be irrecoverable within 10 years.
There will be more, after all PFI is a millstone around many necks. The destabilisation of the finances of existing NHS units that will happen as a consequence of the DoH parcelling out contracts for the most lucrative services is a train wreck waiting to happen & is being ignored by those negotiating these deals.
Ms Hewitt is determined not to present the deal as writing off deficits. The new NHS financial framework requires trusts that overspend to take on interest-bearing loans. “We will no longer have a system where hospitals overspent, the deficit got huge, then got written off against a recovery plan, but the overspending just started up all over again,” she said.
But in reality, Good Hope’s deficit has had to be dealt with. Heart of England has received a few millions in one-off payments as a “sweetener” to take Good Hope on. And more than £17m of Good Hope’s historic deficit has been turned into public dividend capital - capital that is in effect underwritten by the Treasury. Heart of England pays a permanently low interest rate on that, and it is technically repayable. In practice, however, public dividend capital is rarely repaid. The local health authority has in effect accepted that it will never see the money back from Good Hope’s overspending.
Well, that is political accounting for you.
The future now depends on the financial disciplines to which Heart of England is subject having the desired effect. In future it will have to generate a surplus, and borrow for its own capital needs, to survive.
It has, however, taken on the liability in spite of the fact that the government still has no regime in place that spells out what happens should a foundation trust fail. None of the current 62, though, is yet close to that.
Immediate catastrophe is unlikely but what can happen is a slow attrition of services & hence income over the next few years. I wouldn’t offer odds on the NHS existing in its present shape in 2020.