Weekend blues
Not much has been happening over the weekend I guess other than the BMA Junior Doctors Conference in London on Saturday which made the news by calling for the resignations of Patricia Hewitt & Lord Hunt.
The motion of no-confidence in the JDC executive was not carried but this was the wrong setting for it anyway. And given that the webcast reminded me of those model UN sessions for high school students, I did not expect much else. I am veering towards the view that the hot-house atmosphere of medical schools & the NHS delays the worldy maturity of a number of medics. But the BMA need to be more responsive as an organisation to their members & also to improve their media strategy.
There is though progress on the legal front with the Remedy UK sponsored challenge listed for hearing in two weeks. Both Dr Grumble & the Ferret Fancier go into this in detail.
Speaking of training, the Telegraph discusses the raiding of training budgets by SHAs.
The cuts come despite a promise by Lord Hunt, the health minister, that last year’s transfer of £340 million from health authorities’ training funds to a contingency fund to help meet the NHS deficit would be a “one-off”. David Nicholson, the NHS chief executive, had also assured staff that training budgets would be reduced “for one year only”.
But even though Patricia Hewitt, the Health Secretary, claimed earlier this month that the NHS financial problems were now “fixed”, six of England’s 10 strategic health authorities have taken £136 million from dedicated training budgets to store in “investment reserves” that will be used to offset future debts.
Figures compiled by the Conservatives show that the impact is greatest in the south and east. South Central, the strategic health authority covering Berkshire, Buckinghamshire, Hampshire, Oxfordshire, and the Isle of Wight, is to reduce its training budget by 12 per cent, and the East of -England authority (comprising Bedfordshire, Cambridge-shire, Essex, Hertfordshire, Norfolk and Suffolk) by 10 per cent.
The surveillance society comes under attack by the Information Commissioner but I fear that he is fighting a losing battle as too many people are complacent, having no understanding of the risks.
The conflict between clinical priorities & political imperatives flares up in Scotland with an attack by
Professor Charles Court-Brown, an orthopaedic surgeon at Edinburgh royal infirmary, who has accused ministers and NHS managers of sacrificing the needs of emergency patients by using scarce resources to meet “artificial†waiting list targets.
“There are increasing numbers of surgeons employed simply to do elective or non-emergency work but very few surgeons are employed only to undertake emergency work.â€
Court-Brown’s criticism, which is sure to embarrass Labour, follows the claim last year by Clive Davis, chairman of the British Medical Association’s Scottish consultants committee, that surgeons had been asked by NHS managers to postpone cancer operations in order to bring down waiting lists for wisdom teeth extractions.
I seem to remember that there is an election due there shortly.
The treatment of AMD continues to get traction in the media as does the policy of some PCTs to exclude people from treatment on the grounds of weight or their smoking status. The decision to exclude people from treatment is not a medical responsibility unless there are overriding grounds to do so for either of the above reasons. This is a decision to be taken on a case by case basis with regards to the health of the patient, not as a matter of policy.
Pat Wood, from Sutton-on-the-Forest in North Yorkshire, was told by North Yorkshire and York Primary Care Trust it would pay for one of the drugs only if she goes blind in one eye and the disease then spreads to her other eye.
Margaret Maslowska, 82, from Eastwood, near Nottingham, is blind in one eye and losing the sight in her second eye due to AMD. Nottinghamshire County Teaching Primary Care Trust is refusing to pay for the medication.
Nottinghamshire County Teaching Primary Care Trust issued a statement saying: “We do not routinely provide treatment that is being investigated by Nice until the final appraisal is published.â€
Not a good enough defence, having already been contradicted by the DoH for one. Are clinicians really going along with this?
“Those decisions are being made by individual doctors all over the country. In a few places doctors have come together collectively through the primary care trusts to put in place guidelines for all of their patients.
“This isn’t a matter for managers or indeed Government ministers to decide who gets what operation - it’s a matter for doctors and always has been.
Really? Would any of these clinicians be willing to defend these restrictions publicly or to their colleagues?
This brings me back to my argument about trying to work with a failing policy in the stated hope that you can influence it for the better from the inside. This is a misguided approach & produces no worthwhile results. What you end up doing is providing cover for others to defend those self-same policies.
We are told that deficits are improving.
According to figures from three-quarters of the way through the 2006-7 financial year, one in three hospitals and primary care trusts, which pay for local services, were not expecting to balance their books.
But NHS bosses have insisted overall the health service will break even.
This is because regional health bosses have built up a contingency fund of £450m from savings made to budgets, such as training and public health, and held back £1.1bn of extra funding.
These are not savings. We need to start calling them by their proper name which is cuts in training & services.
And the battle for the soul of BUPA is described in the Telegraph.
First-round offers are due to be submitted to Citigroup, BUPA’s long-standing adviser, this week. Among those queuing up to bid are some of Britain’s largest private equity groups, including CVC Capital Partners, Cinven and BC Partners. Blackstone, the US house, is also expected to bid.
“The sale begs the question, what’s the role of third-way companies that are not plcs or charities,” says Bryan Sanderson, BUPA’s former chairman who stepped down last November. “BUPA is a provident association. It’s about the patients.”
Bryan Sanderson left the company last November, seven months before his official retirement date at next month’s annual meeting, after a disagreement over plans to sell the portfolio of UK hospitals, a key plank of the business. Sanderson argued that as a provident association one of BUPA’s core activities was to provide the best care for patients, which he felt included providing hospital care.
“I have no quarrel with the board but a watershed had been reached,” Sanderson told The Sunday Telegraph. “You have to think about what a provident association is for. At a time when there is a lot of anxiety about NHS hospitals, is this the right time for BUPA to be exiting? A provident association should exist for its customers, they must come first.”
The board’s decision to sell the hospitals business - even thought it only accounts for 11 per cent of sales - raises the prospect that BUPA’s provident status could eventually change and lead to a break-up of the group. It is understood that BUPA has in recent months rebuffed several offers from private equity groups that valued it at more than £5bn.
Instead, the decision to consider the sale of the hospitals, say supporters of the move, is based primarily on the rationale that the business has greater potential to grow outside of BUPA. It has been unable to expand as fast as it would like, notably blocked by the competition authorities from buying Community Hospitals some seven years ago. It has also sought to win NHS business, for example by providing independent treatment centres.
Selling the hospitals would also put to rest long-running suspicions that BUPA’s position as both the biggest health insurer in the UK and one of the biggest hospital providers is a conflict of interest. Although both businesses are run separately, divided by Chinese walls, suspicions have lingered as to whether BUPA, as an insurer, is always acting in the best interests of subscribers. According to BUPA, some 18 per cent of its subscribers are treated at its hospitals.
Operating on its own would also open up new opportunities for the insurance business. One potentially lucrative area of growth for the private sector is in providing commissioning services for primary care trusts - in effect, how they plan and deliver services - under the Commissioning Framework. BUPA has signalled its interest in bidding for these contracts but as both an insurer and a provider of hospital services it could be accused of a conflict of interest; in other words, if BUPA Insurance ended up commissioning care services, BUPA Hospitals would have to be excluded. Selling the hospitals does away with that conflict.
As I have previously mentioned, it depends on what the vision for BUPA really is. I would prefer it to provide services rather than commissioning them on behalf of the NHS, the necessity for which I do not accept. As has been said before, we are importing the wrong elements of the US healthcare system.