Just how many jobs lost?
So who is right, the govt which claims that only a few hundred mostly non-clinical staff have been made redundant or the unions who say that the number is over 27,000 people in the last 18 months?
It appears that the unions have their figures right. The Information Centre for Health and Social Care (ICHSC) says that the number of people working in the NHS fell by around 17,000 between September 2005 and September 2006, equivalent to 8,118 full-time equivalent (FTE) staff, when part-time workers are taken into account.
Analysis of the figures shows a drop of 5,826 in the number of qualified nurses working in the NHS between 2005 and 2006. However, this figure includes 3,370 duplicate entries for 2006, leaving an actual fall of 2,456.
Equally, there were 18,342 fewer support workers for clinical staff, with a duplicate entry number of 2,719, leaving an actual drop of 15,243, according to the Department of Health.
There were 2,640 fewer managers and senior managers working in the NHS by September 2006 compared with the previous year, with 76 duplicate entries, leaving an actual drop of 2,564. The numbers of NHS staff in some areas increased over the year, leaving an overall drop of 17,390.
Even these figures are disputed with claims that what are called duplicate entries are not really that.
Peter Carter, general secretary of the Royal College of Nursing said the figures confirmed fears deficits were having a damaging impact.
“When you dig below the surface… the headline increase in nurse numbers is made up of double counting existing nurses working extra shifts.”
“Meanwhile, internationally recruited nurses, who make up a significant number of the extra nurses, now face the prospect of having to leave at the end of their contracts under new immigration laws.â€
The Guardian, the Independent, the BBC as well as the FT have details.
That dispute then brings us to the claims about GP pay with the release of a revised set of figures down from 30% to somewhere near 23%. But it looks likely that they will have to come down even further. They have removed the employees NI contribution of 6% from the pay figures but left the 14% employers NI contribution in, thus guaranteeing another round of headlines over pay in a few weeks.
It makes for a good PR strategy though, (it is working), to release information known to be incorrect so that GPs get tagged as greedy profiteers & then to let the truth come out in stages over a long period of time. Does no one remember the recruitment crisis that existed just a few short years ago with juniors talking about going on strike & GPs / Consultants being in very short supply? Was it a mistake agreeing to conflate the very necessary correction in pay that needed to happen with the new contracts demanded by the govt, which is one of the reasons why the media find it easy to over-simplify the argument?
Dr Rant presents a rebuttal.
And I will agree with his prescription for reform, with very limited changes.
But in the real world, in an example of providers cutting the cloth to suit the budget, dentists are reducing the number of complex or expensive treatments they provide on the NHS to match the limited funding offered.
Patients are being offered cheaper dentures, crowns and bridgework, with dental laboratories reporting that demand for more expensive alternatives has plummeted by up to 90 per cent over the last year.
Critics claimed the plunge has been triggered by a new NHS contract that the Government introduced last year. Dentists are offered three payments: £15.90 for check-ups and minor work, £43.90 for fillings or root-canal work and £194 for crowns, dentures or bridges.
But there are fears that many dentists are using cheaper treatments, such as dentures costing £40, because they will receive the full fee.
David Smith, of the Dental Laboratories’ Association, told a conference in Westminster yesterday that there had been an alarming decline in the amount of complex treatment being offered by NHS dentists.
Derek Watson, chief executive of the Dental Practitioners’ Association, said NHS dentistry was being steadily pared down to a “cheap and cheerful” service that offered a limited range of treatments.
And dispensing practices are going generic in an unintended consequence of Pfizer’s sole distribution deal with Boots.
The Dispensing Doctors’ Association (DDA), which represents the interests of about 5,000 family doctors in remote areas who dispense drugs directly to patients rather than through a chemist, says that many doctors resent the new system for adding an extra layer of bureaucracy and cost to their work.
The DDA says that doctors will always put patient safety first, but where identical drugs are available from rival manufacturers, many are opting to prescribe non-Pfizer products.
So while the health gap widens in retirement at the same time as facilities are thrown into chaos with little or no integration of service provision, people are still waiting for diagnostics according to new data. The IS Diagnostics contracts were supposed to have come on stream at the beginning of April to help meet the 18 week target but are already in disarray with the failures in the North West causing the DoH to re-examine its procurement strategy.
As I have said before, resources are being wrongly targeted on political priorities with poor analysis of clinical requirements & little regard for sustainability and results.
Doctors for Reform reply to Patricia Hewitt’s claim in her letter to the Telegraph that the NHS was free at the point of need.
But her words did not address the thrust of our paper, which is the new demand by patients to “top up” their NHS care. This is a growing trend; on Wednesday, a new product was launched to provide the latest cancer drugs, not yet available on the NHS to NHS patients.
The questions raised by these developments are not easily resolved, but they are important and should not be ignored - especially as they relate to equity of access to new treatments. One way forward, recommended by the Prime Minister’s recent policy review, might be to start the process of defining an NHS entitlement, to eliminate what is currently a postcode lottery in respect of many treatments and clarify the responsibilities of individuals and government.
All the while, Clostridium Difficile cases rise by 8% a year according to the Health Protection Agency (HPA) data which showed 55,681 cases were reported among over 65s in 2006.
From 2004 to 2005, there was a 17% rise compared to the 8% being reported last year, (though this was from a smaller base & was also the time it came into prominence).
There were 1,542 MRSA bloodstream infections from October to December 2006 - 7% down on the previous quarter.
The HPA does not look at deaths although figures from 2004 show that MRSA was mentioned on over 1,000 death certificates in England and Wales, while C difficile was listed on over 2,000.
Overcrowded hospitals running at close to 100% capacity with staff under stress do not help.
Improvement has to come from the bottom up with individual teams improving their capabilities of service delivery. Centrally mandated programs have a very poor record of actually delivering. People end up thrashing around in a frenzy, trying to meet impossible mutually contrary diktats.
So Polly Toynbee blames it all on unbridled consumerism fuelled by Blair’s ideology of choice. And she thinks that NHS staff have a sullen crew who never had it so good & who cannot be trusted to decide in patient’s best interest.
So Tony Blair has arranged to face the enemy to fight it out over a final reckoning at the King’s Fund. He will confront a host of doctors, managers, nurses and patients’ leaders with his record and hear their verdicts, starting a campaign to win the NHS back for Labour.
NHS morale is always at “rock bottom”, but now it’s in meltdown. Unison barracked a health minister this week over a 1.9% pay offer to nurses. Though nurses’ pay has risen in the last decade by a real 25% for the newly qualified, £19,645 doesn’t get them on the mortgage ladder. Doctors are in a fury at being ordered about, despite massive pay rises, better hours and 32,000 more jobs. Patients have persuaded themselves everything is worse, even though they tell pollsters their local NHS is pretty good. Spending has trebled, heart deaths are falling, waiting times for inpatients are at just an average 6.6 weeks and 90% of hospital patients report that their treatment was “excellent”. By almost every indicator, ask any expert, there is no doubt things are very much better.
What’s his legacy? It’s not yet clear that Blair’s market NHS will work. The Commons health select committee gave a devastating portrait of the inadequacy of primary care trusts to commission services. Staffed by juniors, far from being the commanding heights directing more services into the community they are the weakest link, so money is sucked out of them by hospitals willy-nilly. The dash for all-powerful foundation hospitals and private treatment centres may have fatally unbalanced the market in favour of providers. Consultants have always found a way to run the show, and their power is little diminished, but even that little has made them dangerously incandescent.
Meanwhile, the computer system everyone said could never work hasn’t worked, advice ignored. The junior doctors’ employment system is another case of electronic chaos. Some 50 Save Our Hospital campaigns are doing lethal electoral damage locally: shutting dangerously underspecialised A&Es is the right thing to do, but not at the same time as a savage clampdown on age-old deficits, so everyone thinks closures are cash - not clinically - driven.
More serious problems lie ahead. All but abolishing waiting lists has taken the brakes off NHS rationing. Everyone thinks they have a right to everything they have read about on the internet, right here, right now.
So an inability to publicly recognise the concern that NHS staff feel about the direction of the “reforms” doesn’t stop her from admitting the problems herself. And as pointed out, if staff were merely mercenary, they would not bite the hand that feeds them. As a consultant to the private sector as well as the NHS, I have no reason to annoy my potential client base unless there were serious concerns about the prospects for the future of healthcare in the UK.
But even she has to admit that:
The truth is the NHS is nothing like a market. It is a collective agreement to spend a set amount of money as efficiently and as fairly as possible. It is not open-ended - no health system ever is: private insurers strictly limit treatments according to the policy paid. The NHS has always been a better system, but it relies on a measure of understanding by citizens of the nature of the compact.
And finally, MTAS gets further play with the suspension of the site being reported.
The doctors themselves ask a few pointed questions about it all.
The Health Select Committee’s enquiry into the NCRS continues but the transcript is not out yet with just a few outlets covering it. Richard Granger says that consultation led to the delays. What consultation?