The chicken or the egg?
What came first? Was it the outsourcing of provision of services involving terminations of pregnancies to the private sector (where BPAS predominates) or was it the reduced willingness of doctors to participate or train in the field.
Most NHS hospitals these days do not perform terminations unless they are late term or involve medical complications, with very few trainees exposed to them. Was it a management decision that led to this distancing of the service from one of its components or was it the other way around with doctors reluctant to perform the procedure? Having said that there hasn’t been too much trouble involved in arranging one once I got through to the right people in my limited experience of maternity services. So has the lack of exposure to the service contributed to the increasing unwillingness reported by the RCOG to train in its provision?
The Telegraph & the Independent weigh in.
More than 190,000 abortions are carried out each year in England and Wales and the NHS is already struggling to cope. Four out of five abortions are paid for by the NHS but almost half of those are carried out in the private sector, paid for by the NHS.
The reluctance of NHS staff, both doctors and nurses, to be involved has led to a doubling of abortions paid for by the NHS, which are carried out in the private or charitable sector, from 20 per cent of the total in 1997 to almost 40 per cent.
Once the service has been outsourced, there is very little incentive for it to return to the hospitals. Without exposure to new trainees, where are the next generation of experts going to come from?
Richard Warren, honorary secretary of the RCOG and a consultant obstetrician in Norfolk, said: “In the past, abortion was an accepted part of the workload. People did not like it but they accepted that it was in the best interests of the woman concerned. Now people are given the option of opting out of the bits of the job they don’t like doing and if two or three say ‘No thanks’, it makes it easier for others to follow.”
My personal opinion is that there is simply very little exposure & not an active movement against it as such.
Speaking of training, I have a few questions for the Department of Health regarding the commitment to provide training opportunities in the Independent Sector facilities being contracted. The promise is to offer training in 35% of the activity if the units but there is very little clarity on the details, not to mention the fact that the very same educational theorists who made such a mess of MMC are involved in its design.
Whose version is more credible, the RCN’s or that of the govt?
Tony Blair said yesterday that a Royal College of Nursing (RCN) claim that more than 22,300 NHS jobs have been lost in the last 18 months was “greatly exaggerated”.
On the eve of its annual conference, the RCN said it was laying bare “the myth” that the debt crisis in the NHS had been solved.
In a report called Our NHS - Today And Tomorrow, the union described the deficits crisis as “real and entrenched”.
But the Prime Minister told BBC1’s The Politics Show: “Actually, there have been only about 300 clinical jobs lost.”
In my limited personal knowledge, pretty much every clinical service I have dealt with has had vacancies not recruited to and staff struggling to cope with the workload. I would believe the RCN version of events any day.
The RCN report said almost three-quarters of newly-qualified nurses were still unable to find jobs and condemned “rushed, uncosted and untested” Government reforms.
It outlined how the financial crisis had affected patient services, including for those suffering from multiple sclerosis, epilepsy and mental health problems.
The financial crisis has also hit waiting times, especially for diagnostic tests, and has led to the closure of community hospitals in rural communities, it said.
Furthermore, the vast majority (87%) of specialist nurses say NHS cuts are having an adverse effect on patient care.
Nearly half (47%) were aware of service cuts in their specialist area and almost one in five said they were personally at risk of redundancy.
More than half (55%) said they were aware of other specialist nurses in their field who were at risk of losing their jobs.
And it is not as if there is no evidence to swing it either way.
The figure of 22,300 jobs comes after the Office for National Statistics (ONS) said in March that the number of people working in the NHS fell by 11,000 in the last quarter of 2006.
Seems conclusive to me.
The Guardian suggests that strike action is closer than ever before.
A year ago in Bournemouth, Ms Hewitt was barracked by RCN delegates and not allowed to finish her speech. Mr Carter said the union had not attempted to get her back this year. “It was pointless bringing someone from government in because of how badly they have treated nurses and other health workers,” he said.
The union’s annual congress, which opens today in Harrogate, will vote tomorrow on an emergency resolution for action to force ministers to pay the full 2.5% recommended by an independent pay review body. Peter Carter, the recently appointed general secretary, said delegates were “angry, despondent and worried”. They did not want to strike, but they could not accept the injustice of the government’s decision.
Richard Smith adds his voice but like everything else coming from him lately, there is very little insightful comment. Amnesia seems to have developed regarding one section of the “reforms” that is causing disquiet amongst the profession - the one his company benefits from.
In fact the surprise is that there are any doctors left to vote Labour. Doctors, to be blunt, are stupendously pissed off with the government — and this is despite them being paid more to do less.
The most recent disaster involving doctors and the government has been little reported in the mass media, and yet I don’t think that I’ve seen such an upsurge of anger and despair among doctors in my 31 years as a member of the clan. It has to do with a new scheme for selecting doctors for specialist training.
Unfortunately for the grandees of the medical profession, most of the senior bodies - the royal colleges and the like - had signed off on the new system. It’s one of those classic issues where everybody is responsible but nobody is.
But this debacle - which is still unresolved - is just the latest cause of grief. Doctors in England generally feel that the government doesn’t know what it’s doing with the NHS. It has, they think, introduced so many unrelated and untested reforms at once that it has no idea what the effects will be. An editorial in the British Medical Journal compared the reforms with a bobsleigh run. Many doctors think that the government wants to destroy both the medical profession and the NHS.
Not much to be said about this one but I am not aware of there being any rules against state owned companies participating in tenders in general unless they are clearly barred at the outset.
The Liberal Democrats continue their campaign for a moratorium on further spending on CfH’s £12.4bn boondoggle pending an independent inquiry with a report expected this week by the Commons public accounts committee warning that the programme is descending into fiasco.
The YouGov poll for the RCN published yesterday suggests that the voters do not believe the spin.
In a survey of more than 2,000 members of the public, carried out for the Royal College of Nursing (RCN), health was the most important issue - ahead of education, defence, law and order, and the environment.
Asked about future NHS spending, 59 per cent thought it should be increased, 30 per cent said it should be maintained and five per cent said it should be reduced.
Participants were split over whether the increase in spending had led to improvements in the NHS, with 36 per cent saying things had got better and the same number saying they had not.
Asked what would happen if NHS spending were reduced from next year, 72 per cent said waiting lists would grow and the quality of patient care would suffer.
When asked in more detail about their healthcare priorities, almost half of those surveyed ranked hospitals above other areas, such as reducing waiting times, more health services in the community, care for the elderly and public health.
A third of those questioned said they wanted to see funding maintained at current levels, while 59% said they wanted it to be increased.
The extra money that has gone into the service since 1997 was & is still nowhere near enough to even bring us (8% but used to be around 6%) up to European levels of healthcare spending currently at 9.2%, let alone US levels of over 15%.
I am glad to see some recognition of this fact.
It was a triumph of spin for Blair that he got people to believe that the money was going to revolutionise services when in truth it just about allowed them to be maintained. Add in the extra targets imposed along with poor management & you have a recipe for cuts in services leading to massive public disillusionment. Less than 10 years of catching up isn’t enough to correct decades of under-investment.
But the man has a plan to go out on a high. Well, maybe there won’t be the cheering crowds forecast last year but there is always the scope to prepare his “legacy”.
Once the local election campaign is over, the Prime Minister will make a string of announcements in May and June, including the creation of up to 300 trust schools and an expansion of private treatment centres for the NHS.
The self-governing trust schools, pushed through Parliament with the help of the Conservatives, and the network of private centres contracted to work on NHS patients have been deeply unpopular within the Labour Party. But Mr Blair, who accepted yesterday that he has only weeks to go, has earmarked dates in May to set out the plans, as well as fresh proposals on policy for the family.
In a BBC interview Mr Blair said that his legacy would “stand the test of time†and acknowledged that the “final building blocks†of reform were being put in place.
The Prime Minister said that decisions over the next few weeks would “secure the long-term changes for the futureâ€. He denied that future policy announcements were aimed at binding his successor but were “doing what is rightâ€.
Not from where I am standing, they aren’t.