Big is not so beautiful
From the letters page of the Telegraph:
Let’s talk, Peter
We were disappointed by Dr Peter Carter’s assertion that one National Health Service manager in five is not up to the job (News, April 8). Presumably the new general secretary to the Royal College of Nursing is not referring to his former colleagues at the trust where he used to be chief executive?
If he truly believes what he is saying, we need to consider why. Is it the system that disempowers them? Do we support clinical leadership and middle management as we should? I hope we can have a constructive dialogue with Dr Carter about this.
(Dr) Gill Morgan, Chief Executive, NHS Confederation, London SW1
Let me help you with that Dr. Morgan & the answer is no, you do not.
Right on cue after my comments about statins yesterday, the Telegraph highlights the experiences of patients who had to come off them because of side-effects.
The British belief in the dogma that big is better is questioned by Simon Jenkins in the Times who calls it “Government by control freaks tying up services in knots”.
All over Britain bigness is seen as a virtue and smallness a vice in defiance of all evidence to the contrary.
It is a phenomenon of Tony Blair’s cabinet that almost nobody in it has run an organisation composed of people. When ministers found themselves in charge of the biggest corporation in Britain, they did what they did in opposition: make wish speeches and rambling pledges. They had no conception of how organisations work, which is why they have become obsessed with consultants, who have no obligation to deliver.
Over the road some 80 hospitals are being closed or “reconfigured†as being too small, defined as being unable to afford the expensive kit and computers being sold hand-over-fist to Patricia Hewitt, the gullible minister. She has not only removed out-of-hours GP cover to call centres, but patients must wait longer for an ambulance, drive further, suffer more pain and inconvenience and widen the NHS carbon footprint. She has put the patience back into patients. All this comes at triple the cost to taxpayers. The reason is that Hewitt is spellbound by the great god size.
We are then told of plans to announce a further £2.5 billion expansion of the ISTC programme by No 10 for Blair’s final days in an attempt to cement his legacy & the public interest can go hang.
Especially so when the RCN has launched an attack on “uncosted” reforms which have led to 22,000 job losses.
In a report called Our NHS: Today and Tomorrow, the union said three-quarters of newly qualified nurses were unable to find jobs. It also condemned “rushed, uncosted and untested” government reforms and outlined how NHS cuts had affected patient services, including for those with mental health problems.
The financial crisis had hit waiting times, it added, particularly for diagnostic tests, and had led to the closure of community hospitals in rural areas.
With this comes news of another shortage, this time of health visitors:
Caseloads ranged from one health visitor for every 160 children under five, to one health visitor per 1,140 under fives, according to the Family and Parenting Institute (FPI).
The Guardian highlights the threat to small hospitals:
Small hospitals face closure because advances in surgical techniques mean that they are no longer needed, according to a controversial report commissioned by the Department of Health.
As the Royal College of Nursing alleges that 22,000 NHS positions have been lost in the past year, the report from leading cancer surgeon Professor Sir Ara Darzi will argue that advances in fields such as keyhole surgery and the development of robots that can carry out operations under instruction from doctors hundreds of miles away have allowed services to be dramatically reorganised. His findings are expected to be highlighted this week as the Health Secretary, Patricia Hewitt, addresses the Royal College of Surgeons.
Let me go out on a limb here & prophesise that projects like the Da Vinci surgical robotics system that Prof Darzi is involved in will remain a niche activity for the next decade or more. The vast majority of care will still be delivered by individual surgeons & the pipe-dreams of super-hospitals providing care will remain just that. If anything Prof Darzi, the robotics should allow doctors to treat patients in smaller hospitals remotely and since patient choice is so much of a mantra, surely you should be looking to fulfil that requirement.
Especially so when you have hospitals splitting up mother and baby because there are no beds.
Newborn twins and triplets are being separated from their mothers and sent to different hospitals as neonatal units face growing shortages in specialist care for premature babies.
It means that most hospitals have no choice but to send families in three or four different directions, says one expert.
Neonatal units surveyed by Bliss, the premature baby charity, were full-up and unable to take new admissions for an average of almost one month out of six. Eight out of 10 units had to stop admitting new cases on at least one occasion, reveals research by the charity, to be published on Tuesday.
Babies are being transported an average of 126 miles for specialist care, with journeys of 200 or 250 miles not uncommon, the charity has previously reported.
Units could only afford to recruit enough staff if they were running at full capacity. They were often forced to choose between running at a loss or “squeezing an extra baby in”.
Her own intensive care unit - which has a capacity of 12 babies - took 18 babies over Christmas. Staff worked late, cancelled leave, borrowed equipment, and on one occasion were dispatched to a medical equipment supplier to buy extra stethoscopes.
The poor state of British dental health, facilitated by marketing of fizzy drinks to children is highlighted in the Times.
MORE than a third of children in England and Wales have decayed or missing teeth or fillings by the age of five.
The worst-hit cities include Middlesbrough, Manchester and Nottingham, and in the very worst areas — in South Wales — more than three quarters of five-year-olds suffer tooth decay.
Dentists blame the problems on sugary foods and fizzy drinks.
The study of 240,000 five and six-year-olds by the British Association for the Study of Community Dentistry, shows that, despite health campaigns encouraging children to avoid the most damaging foods, levels of decay remain stubbornly high.
The latest figures, for 2005-06, show that, for England and Wales overall, 39% of five-year-olds have decayed, missing or filled teeth, a slight improvement from 40% in 2003-04.
Dr Nigel Carter, chief executive of the British Dental Health Foundation, said that a ban on all junk-food advertising before 9pm would reduce tooth decay.
Look out for airborne porkers before this comes to pass.