The current controversy surrounding the purchase of Cervirax rather than Gardasil for the NHS immunisation programme against cervical cancer demonstrates just how poorly procurement is understood and practised by most of the public sector. Penny wise, pound foolish might be another way of putting it.
Not to mention the more controversial SAT marking contract with ETS, a company that is now being described as a Powerpoint warrior. And to think the Office of Government Commerce publicised this procurement as a case study in “best practice”. Then there is Northern Rock to consider along with the the ghost of Equitable Life to display the fallacy of the current fashion for light-touch regulation. (Of-course the private sector fares no better, with any number of monuments to failure littering the landscape.)
Value needs to be calculated by looking at the total cost or benefit of a project, not just the rather inadequately defined attributes initially described. There are likely to be broader disadvantages or benefits stemming from a course of action that will need to be considered by decision-makers.
In the healthcare sector, this attention to the full extent of any issue is our raison-d’etre. Unfortunately this is a lesson that most seem determined to ignore.
Inadequately specified & poorly designed programmes forced through by functionaries remote from the coalface will not work. Accenture left early & now Fujitsu have exited the programme. CSC & BT have made a number of promises but have failed to deliver and I wonder just how long they have left.
Will this serve as a warning for other similar programmes in the healthcare space? Going by past experience, I am not holding my breath.
Consultancy services provided by us will aim to advise the client of the most appropriate strategy / service to fit their expressed need. This applies also to third-parties claiming to “understand” what the client wants when there have been no demonstrable instructions to that effect and that supposed “understanding” is denied by the client. We will not act in a manner contrary to our judgement & expertise.
FrontPoint Systems is in dispute with Methods Consulting over services contracted to be delivered to Eastern and Coastal Kent Primary Care Trust.
There has been plenty of assertion / anecdotal evidence to suggest that continuity of care matters. Now there is more hard evidence to show that there is a benefit to patients seeing their own GP instead of walk-in centres & A&E departments. This is in addition to plenty of US research which shows the same.
After adjusting for measures of medical need, demographic characteristics and other covariates, we found that increased emergency department use by elderly patients was associated with lack of a primary physician, lower continuity of care with the primary physician, low overall use of primary care services and residence in a region with more general practitioners per 1000 population. Furthermore, lower continuity of care and low overall use of primary care services appeared to have a stronger effect on emergency department use among urban than among rural residents, whereas absence of a primary physician had a stronger effect among rural residents.
A much bigger & more robust study then than the British one.
Something to consider when commissioning services perhaps?
The surroundings were plush. I pushed through a large front door just off ……………………, to find a beautifully decorated room with sunken, red leather sofas, plasma screens showing videos of patients’ success stories, huge windows and fresh flowers on the tables. Everybody was friendly, polite and professional.
Or
………………… was a trek to get to, perched in some industrial estate in north London. No sofas or Tatler here. Just the radio.
Perhaps patient satisfaction questionnaires filled in immediately post attendance are not such a good idea then, do I have agreement?
The 2007 NCEPOD report on the management of trauma is out & makes for uncomfortable reading, especially with the wide variation in performance of what should be standardised responses to presentation at A&E.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
Consultant led trauma teams would be ideal but even one staffed with registrars would be a start.
All patients with severe head injury should be transferred to a neuro-surgical/critical care centre irrespective of the requirement for surgical intervention.
Hmm, this will require a massive increase in neuro-surgical / rehabilitative capacity & a sea-change in attitude.
More about accountability then & I am warming to my theme, what with well argued comments from a number of commentators.
How can you police the competence of a chronically incompetent organisation where the probability of discovery of any single error is very low? Answer: make the consequence of discovery very high. That way you provide the correct incentive to staff and ministers to be competent. They will multiply the probability by the consequence - knowing that it is unlikely that their mistakes will be unearthed, but that if they are unearthed they cannot expect the press and public to be all sweet reason.
I have to agree with this well reasoned opinion from Daniel Finkelstein as also I do with the following from Simon Jenkins.
Who bears responsibility for the deaths of hundreds of Britons from hospital infections, almost certainly the result of the privatisation of cleaning services? Should it be the Tory health ministers who instituted the policy or Labour ministers who failed to reverse it? When should “responsibility” mean resignation?
All we know is that not a week passes without something going wrong somewhere in the public sector and an almighty row ensuing over “whom to blame”. The reason is that the dinosaur’s head is too far from its foot.
The nearer a school, hospital or police force is to its client the easier it is to identify responsibility and thus allocate blame. In the private sector, blame attaches to whoever makes the mistake. The same applies in properly “tiered” democracies. In most cities abroad, a poorly performing school, a corrupt planning decision or a fiscal scandal is accounted to the elected mayor. If the relevant service is provincial, it is to the governor, if national to the minister. Accountability is clean. The franchise bites at each tier.
In Britain nothing bites but an occasional general election. Nobody down the ladder of public administration accepts blame since performance is dictated by Whitehall. The reason why so many police cars crash is that government offers more money the faster that 999 calls are answered. Hospitals are dirty because ministers want cash diverted to lower waiting times. Yet when these policies go awry, the centre pushes blame back down the line.
Continuing with the theme, a local GP has his say in the letters section of the Times.
As a GP representative for 20 years I have never before dealt with such an arrogant hospital management which treated its employees, including consultants, with contempt, some threats and a degree of bullying.
Management styles of the type we have experienced in Maidstone over the past four years should have no place in the NHS. We must never allow any trust in the UK to be run by such a publicly unaccountable and — and in the end — ineffective regime again. Other communities should be on their guard and “whistle-blowers” protected.
GPs who fail to provide out-of-hours services could be penalised if their patients seek treatment elsewhere, a leaked NHS document suggests.
According to the letter, “recharging” would mean surgeries on the General Medical Services (GMS) contract, which has allowed 90 per cent of doctors to opt out of providing out-of-hours care, would be charged if their patients are seen elsewhere.
Just as soon of course, as the GPs also have control of the various other services that would affect their patients health & precipitate an attendance at A&E. After all, they can’t be held responsible for things that are not totally under their control. And then we could disband the PCT & possibly the SHA which would really be an improvement.
The Lancet Neurology reports on the experience of a pilot in Paris where a 24 hr immediate access TIA clinic cut the incidence of stroke over 1 yr post TIA.
The 90-day stroke rate was 1·24% (95% CI 0·72–2·12), whereas the rate predicted from ABCD2 scores was 5·96%.
What we do currently is organise a few basic blood tests & see them as outpatients within the fortnight. Another article shows us why that is inadequate. Other analysis here & here.
The cinderella services need greater resources. It has all been said before, to no great avail. And this is why I advocate clinically led services & commissioning, rather than the current fashion for politically prioritised fads such as extended opening hours or a poorly designed & useless IT system.
The HFEA confirmed that figures showing the clinic had the highest success rate in the UK for babies born through fertility treatment were correct and added that it did not intend to criticise Mr Taranissi’s clinical standards, treatment or patient care.
The HFEA had also carried out raids on Mr Taranissi’s clinics - the Assisted Reproduction and Gynaecology Centre (ARGC) and Reproductive Genetics Institute (RGI).
In June, the High Court ruled the searches were “unlawful”.
I suspect that the BBC are going to have to pay out a substantial sum.
Indian doctors on HSMP visas wishing to train or work in Britain won a major court ruling in their favour Friday after judges decided employers will now have to treat them on par with doctors from Europe.
The court case revolved around a challenge to a health ministry guidance that would have compelled prospective employers - such as hospitals - to discriminate against non-European candidates, first by establishing that their skills were not found in Europe and then, if selected, to apply for work permits for them.
However, in a unanimous ruling, three judges of the Appeals Court called the ministry guidance “illegal”, sparking instant celebrations among campaigners of the British Association of Physicians of Indian Origin (BAPIO) on Diwali day.
Anthony Robinson, a solicitor for BAPIO said: “As is widely acknowledged, the NHS has for many years relied upon the contribution of doctors from overseas, and in particular the Indian sub-continent, in order to provide a quality service in times of shortage of British doctors.
“Now that more British graduates are coming through, the Department of Health is trying to get round the rights of HSMP doctors who have already made Britain their home because it failed to plan ahead.
“This follows similar abrupt changes in the immigration rules that unfairly affected thousands of overseas doctors living in Britain who having once been made welcome now found themselves forced to leave the country without any proper warning.”
Unfortunately a number of those affected have already made alternative plans & even left the country but it is still a positive development showing the DoH that they will be called to account. The BBC archive is a good way of exploring this further.
The head of the national NHS pay negotiations is facing a series of strikes in his own backyard for failing to pay out on a deal he negotiated as part of the Agenda for Change agreement for 1.1 million health workers.
Electricians and maintenance staff at Doncaster and Bassetlaw hospitals foundation trust are to walk out every Monday this month over the refusal by Joe Brayford, the trust’s human resources director, to offer £3,000-a-year retention and recruitment payments which should be given to staff across the NHS.
With shorter training pathways and less emphasis on experiential learning, the CCT holder of the future will not be the same as the CCT holder of the past. Trained doctors will be competent doctors, but it will need to be recognised that they may not possess the same degree of clinical expertise expected of a clinically autonomous consultant.
I rather think that NHSE are missing the point here. If your much vaunted new training pathway is producing specialists with less expertise, surely you need to be looking at improving the quality of the training, not downgrading the end-product. That after all was the excuse & promise at the time of its introduction. Or is there another agenda?
Employers believe a modest oversupply of doctors is required to provide flexibility and improve quality by giving some choice in selection.
What do you define as a modest oversupply? Are you aware that people who took up CCSTs in 2002 on your promises of consultant expansion are coming to the end of their training only to find that there are no jobs for them? We are not talking about people 5 years out of high school here, they have trained for 15 - 20 years & one would have thought that the NHS would consider that sufficient notice.
Urgent work is needed to determine whether the graduate numbers coming through medical school now reflect the level of trained specialists that will be needed in ten years time, and if this matches the capacity to train them. If this is not the case, we either need to be honest with these students now about their career expectations, or look for ways in
which we can increase our training capacity across all sectors.
Fine, no objection from here. I hope you find the time to inform them before entry to medical school too as they could then go off to study something else instead of working themselves to an early grave.
I have some difficulty understanding the next bit. Would someone like to explain it to me?
Clear and transparent decisions need to be made as to whether we strive for UK medical self-sufficiency in developing doctors for the future, or we continue to include international medical graduates in our medical training plans. The first is not a position that carries full support from employers or many stakeholders, while the latter would demand that we act now to reduce student numbers in UK medical schools.
Do you mean to say that you will try to continue with the exploitation of IMGs currently prevalent?
And for a detailed take-down of Jeremy Lawrence’s trash in the Independent, visit Dr Rant in addition to the Ferret Fancier.
To readers from far & wide:
The server logs make for interesting reading, telling me just who is visiting the site & the topics that interest you.
So can I invite you to participate in the discussion, by telling me why I am wrong if indeed I am so & generally shedding a little light on this brave new world we inhabit.
It is more fun that way, honestly!
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