To date, proceeds for government from refinancing under the voluntary code amount to only £93 million. This amount is well below the indication provided by the Office of Government Commerce at the PAC hearing in 2003 that proceeds would be in the order of £175-200 million. The shortfall may be a reflection of some investors opting to defer refinancing in favour of realising gains through selling their shares in the secondary equity markets.
With more than 750 schemes costing £54.5bn already approved by the Treasury, Edward Leigh MP, chairman of the committee of public accounts, said: “Local public sector officials taking forward PFI projects such as hospitals or schools are often painfully lacking in commercial experience. The ill-conceived Norfolk and Norwich hospital refinancing in 2003 demonstrated this all too clearly.”
The Guardian & the Independent are interested with both feeling that the City runs rings round the public sector.
A pledge made three years ago to have 3,000 experienced nurses in post by March this year has been delayed, with social workers and less qualified staff having to make up the numbers looking after patients with chronic illnesses.
The department’s latest estimate is that there were 1,470 community matrons working in the NHS in December, with an official NHS workforce survey suggesting that fewer than 100 were recruited last year.
What people do not seem to realise is that once services are slashed, it is very hard to build them back up again. Of course by then policymakers have lost patience & gone on to the next flavour of the month. From that bastion of management, the HSJ:
Breaking up an established ward and re-deploying large amounts of staff can destroy a ward and its team in four to eight weeks.
An £8bn increase in NHS spending in England this year will buy 390,000 extra operations, 400,000 more outpatient appointments and a new outreach service to help thousands of vulnerable people with long-term medical conditions such as diabetes and asthma, Patricia Hewitt, the health secretary, said yesterday.
The biggest-ever hike in health spending would dramatically reduce waiting times. By the end of next March, 85% of patients needing hospital treatment will have been admitted within 18 weeks of referral by a GP. Ninety per cent of those patients who can be treated without admission to hospital will get the care they need within the same deadline.
Other priorities over the next 11 months will include building up a squad of 3,000 community matrons to treat 220,000 long-term patients in their homes, avoiding the need for repeated visits to hospital.
And I saw the porcine aerial display squad practising manoeuvres nearby. This is what comes of not asking enough searching questions.
Despite all the spin, patients are not fools. They recognise a continuing therapeutic relationship with their doctor is more powerful than any polyclinic where they can see the next generic doctor on a taxi-rank principle and have to start from scratch again at each consultation. Patient satisfaction is at an all-time high - including with access.
Sure, if you ask people if they want us open at weekends, they might say yes - until they realise that we will then not be there on Monday; I already work 55 to 60 hours a week. We do not work in isolation. Other services are closed out of hours and we cannot work efficiently unless they are open, too.
David Nicholson, the National Health Service chief executive, last week announced a new “leadership team” that had a single post of “director-general for commissioning and system management” in place of separate roles that reflected the “purchaser/provider” divide in the NHS.
With some in the private sector worried that Gordon Brown’s accession to the premiership might lead to a dilution of, or even a halt to, the government’s market-based reforms, Ms Hewitt said the decision to end the distinction between the two roles should not be seen that way.
The responsibility for ensuring that more hospitals became foundation trusts, and that more staff moved out of the NHS to create not-for-profit “social enterprises”, was being devolved to the 10 strategic health authorities, she said.
The move towards making NHS providers more independent needed to be pursued “primarily at the regional level”. London had led the way by creating its own separate purchaser and provider organisations, she said.
The new leadership team would not have a formal annual agreement with ministers over what the NHS should deliver.
Hmmm, an increased emphasis on social enterprises at a time when she needs to sell this idea to the NHS. Or am I being too cynical?
Health Investor (May) says that NHS managers have asked the Department of Health to keep cleaning services in-house and stop them being included in Private Finance Initiative contracts.
Moving on to MTAS & the application for review is being heard in the courts today. Channel 4 produced a very good segment in the news last evening highlighting its pericious effects & which can be watched again online.
In a further sign of the mood of militancy, 72% of those who took part in the survey disapproved of the way the doctors union - the British Medical Association - had handled the situation.
Now for some wishful thinking. Doctors should be treated like gods says the Daily Telegraph. Now why would they want to do that? Am I dreaming?
In a truly decent world, surgeries and schools would be like palaces. Places such as the Brompton would be like cathedrals. Head teachers would earn as much as chief industrialists and hard-working GPs would be subject to the admiration of teenage wannabes and local authorities proud to pay more for their heroes. Great hospitals would be filled with art and would stand glittering on the hill of every city.
But we don’t think like that. We live in a society that is much prouder of its regiments than of its hospitals - keener to protect its citizens against alien ideologies than opportunistic diseases - and that is a terrible shame. It is shallow. It lacks hope and courage and goodness. In a perfect world, our nurses and doctors would fire our imaginations and our teachers would bang the drum. We would treat them like gods and pay them like rock stars.
Instead, we want to cut their wages. Politicians want to use doctors as something to kick around when the polls are against them. I don’t know where it comes from, but there has lately been a natural inclination in our culture to reward excellence with resentment - or even the bid for excellence, as no one would say that our services are always and everywhere as good as they should be. But neither are they the fag-end of hope, as some people would have us believe.
It is nice to be appreciated sometimes. Now for converting the other 54 million residents of the UK. One person at a time, that is how you build support.
The Prime Minister rejected yesterday the idea of an independent board to run the NHS – rumoured to be high on the list of initiatives Gordon Brown plans if he takes over.
Tony Blair said in defence of the NHS reforms that a board would not be able to take the necessary tough decisions. He told a meeting at the King’s Fund in London: “We needed to introduce competition and independent providers. You are never going to get the profession to take these decisions.â€
Mr Blair compared his NHS reforms with those made by Margaret Thatcher on industrial restructuring in the 1980s. Such changes were unpopular at the time, he said, but “once you are out the other side†they were seen in a different light.
I do not like the idea of an NHS board unless it is properly constituted with clearly defined terms, has a balanced membership & functions in an open & transparent manner.
Mr Blair’s defence of his health policies over the past 10 years appeared designed to restrict his successor’s scope for changing them.
Mr Blair conceded his NHS reforms were unpopular with voters and the health professions. He said changes in public services were always “extremely difficult” while they were being pushed through, but opposition soon faded.
Not because they think you are right after all but because they have better things to do such as treating patients.
We are told that more managers are the answer. We are told that this is necessary because the NHS is going down a more business like footing. No one seems to ask why, when there is little evidence to suggest that these changes can deliver results.
The NHS Confederation has produced a nifty booklet of facts about managers to support its claim. It says that, contrary to popular belief, there are more beds than managers, five times more, and that not all managers are grey-suited men; 59 per cent are women and judging by the photographs, they favour black clothing.
For the record, more managers are not the answer. Better managers are, ones that know to get out of the way.
Of the nine acute trusts in the northern region, five code from case notes, two use discharge summaries and two use a combination. There have been reports of 40 per cent error rates in coding. Our audit work has shown that case notes produce accurate tariffs, but a loss of income of 20 per cent was reported when discharge summaries alone were used.
To illustrate this, an orthopaedic department with an income of £30m per year (based on local trust figures) may lose £6m due to coding error. Across all departments (assuming similar levels of inaccuracies) this may represent a huge loss of income per year for the trust involved.
Many trust are currently forecasting heavy deficits for this financial year. It has been suggested that recent national hospital job cuts in nursing, medical and administrative areas may be a direct result of a loss of expected revenue from PbR due to inaccuracies in coding. This could result in further job cuts, trust downsizing, and even hospital closure.
Firstly, the benefits of this administrative beancounting over a system of block payments have not been demonstrated. And if they indeed are, the infrastructure needs to be put in place to support such a system before it is implemented, surely?
PbR will create competition between providers to drive down costs, possibly to the detriment of patient care. Providers unable to compete will attract fewer patients and less money. In addition, the current HRG classification is limited and cannot appreciate the many differences in case-mix complexity. Fixed tariffs may be inappropriate in some cases but several US studies have shown that elective procedure tariffs do not reflect actual costs and often result in financial loss to the unit performing them.
The DoH report, Good Doctors, Safer Patients, put forward the use of hospital episode statistics in the process of clinical governance, appraisal and revalidation of hospital consultants. However, reports have shown that data routinely collected for these episodes is not good enough for monitoring performance of individual doctors. Over 80 per cent of physicians had little or no confidence in centrally held data concerning their practice. Reasons for this were inaccuracies and questionable relevance of data collected. If the accuracy of this data improves, statistics and league tables may be a reliable representation of a clinician’s practice.
However, in an effort to drive down costs and increase profits, patient care may suffer. It is of the utmost importance that other, non-financially driven performance indicators are developed to counteract this.
I would & have gone further but nice summary there.
Research carried out by Professor Ann Blandford and Professor Peter Lunt, of University College London, suggests that new technology doesn’t always fit well into settled work practices within the NHS.
Health service workers report that pride in their knowledge, skills and the ability to solve problems creatively is being undermined by new technology. What’s more, previous experiences or accessibility and reliability problems mean that they do not trust the new systems that they are being asked to use.
The study also suggests that new technologies work most effectively when they are adapted to fit into existing practices, and have been developed in dialogue with NHS staff.
Tell me about it!
I have been banging the drum about this for a long long time.
Faced with flagging enthusiasm for private finance initiatives (PFI), a Bristol hospital is trying to pique the interest of bidders by offering to pay some of their costs.
The £347 million scheme involves two hospitals with 947 beds and is expected to go out to tender in two or three weeks’ time. The firms that finish second or third on the bidding shortlist are likely to be reimbursed for some of their bid costs.
David Powell, the director of capital projects at the North Bristol NHS Trust, says the reimbursement proposals are something they are “seriously consideringâ€. One option includes giving the third-placed bidder a smaller sum than the second, and another option is to compensate only the second placed firm.
The move follows previous problems in finding bidders for PFI hospitals. A £350 million scheme at Whipps Cross in North London had only one bidder, and in Plymouth the bidding process for a £340 million hospital was scrapped after two of the three bidders pulled out.
Cambridgeshire and Northamptonshire county councils have withdrawn from the Department of Health’s (DoH) shared services project — NHS Shared Business Services — fearful of breaking EU procurement laws.
The two county councils were to have joined 100 health trusts that share finance, human resources (HR) and procurement systems but have scaled down their plans. Cambridgeshire will now allow Northamptonshire to use its finance and HR systems.
“It is a bit of a balancing act about whether we go for that kind of large-scale project that others could buy into or a smaller agreement just between the two councils,†says Stephen Moir, the director of people and policy for Cambridgeshire. “The former would obviously need a lot of guidance from central government.â€
A DoH spokesperson says that it had not examined European legislation and it was up to each council to seek its own legal advice.
There are a large number of such initiatives on shaky legal ground.
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€
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?
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.
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.
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.
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?
KKR and Stefano Pessina seem to have sewn up Alliance Boots with their £11.39-a-share dusk ‘n’ dawn raid buying 90 million shares in the past two days. They now hold 25.6 per cent of the company and will have to raise their offer to the price they paid in the market. That was clearly too tough a number for Terra Firma, Wellcome Trust and HBoS to beat – they have walked away.
The deal marks the first time that a member of the FTSE100 index of UK blue-chip stocks which employs more than 100,000 and has 2,600 healthcare outlets across the UK’s high streets and a further 350 outlets elsewhere in Europe and Asia has fallen to a private equity bid. As well as the High Street retail arm, the company is a wholesale supplier to more than 125,000 pharmacies, health centres and hospitals.
The KKR-Pessina offer values Alliance Boots at a 4.5 per cent premium to their original £10.90 a share offer, recommended last week by Sir Nigel Rudd, Boots’ chairman, and his board. It is 40 per cent above the price at which Boots shares were trading before the approach.
Terra Firma said today: “Boots is a critically important national institution, and we are naturally disappointed not to be able to execute the bold vision we had for the company and its critical role in the provision of healthcare in the UK.”
I wonder if there is a plan B, especially with the BUPA hospitals still in play.
Anyway, it looks like Andy Burnham did not have an easy time after all at the Unison conference in Brighton. The BBC has it too.
Health minister Andy Burnham was booed and heckled by health workers today when he tried to defend the government’s policies on the NHS, which threaten to spark a summer of strikes.
Mr Burnham faced a wall of silence when he stood up to address Unison’s health workers’ conference in Brighton. Dozens of delegates held up posters which read “low pay, no way, NHS here to stay”, and there was regular heckling while the minister delivered his speech.
Care homes come under scrutiny by the joint Human Rights Committee with complaints of people being put into care homes that do not meet their needs and given the wrong drugs without their consent.
“We are seeing too many instances where it is accepted practice for old people to be treated in a low level way,” said charity boss Gary Fitzgerald.
The committee is examining the rights of old people in hospitals and homes.
It heard that people were being given the wrong medication - or medication was being used as a form of “chemical restraint” for dementia sufferers - which then became part of their routine care.
There was a “definite link” between over-medication and homes that were short staffed, the committee heard.
In a rare instance of an NHS trust actually listening to protesters, Chesterfield Royal Hospital NHS Trust today backed down over plans to close a midwife-led maternity unit following massive local pressure and government guidance promising every woman the option of such a delivery.
The plan to permanently close the unit - which has been temporarily closed since the autumn - prompted 5,500 local people and the commissioning primary care trust to protest when it was announced as non-negotiable in a consultation document on revamping maternity services.
Today the trust bowed to this pressure - and to the threat, by the Maintain Our Maternity Services (Moms) campaign group, to seek a judicial review over the handling of the consultation.
The trust’s chief executive, Eric Morton said: “We have received around 7,000 individual replies to the consultation from local people and organisations… With over three-quarters of replies commenting solely on the Darley maternity unit, it was immediately clear we needed to make a decision about this.”
The unit, which had closed while midwives underwent training, will now reopen with at least three extra midwives recruited.
Mortality rates in NHS hospitals are under the spotlight with the release of figures from Dr Fosters showing those for individual trusts. I must caution readers though that the research did not investigate causes of death at individual hospitals & that baseline measurements are difficult, though the figures were standardised to take into account a range of risk factors, such as the age of patients, sex, social demographics, the level of deprivation in the area and whether a patient has any other illnesses.
And the cure is worse than the disease. The penalty for losing a star (for example due to financial failings) is to lose money available to services which then leads to wards closed the rest being overcrowded, then leading on to outbreaks of MRSA & C. diff with people dying at the end of the trail. The people designing these sorts of management protocols do not understand clinical care.
I have to call this BBC headline misleading & point out that the study did not set out to establish a positive correlation between publication of league tables & success rates.
The researchers, led by Mr Ben Bridgewater, said: “If publication of surgical mortality data had driven surgeons to turn down significant numbers of high risk patients we would expect to see that reflected in the number of high risk cases coming to surgery.
“This study suggests that the effect may not be as large as is feared.
“If public disclosure can drive data collection and analysis, but does not create significant risk averse behaviour, its introduction may be beneficial in other areas of medicine.”
Very poor standards of journalism.
I would like to see doctors refusing to provide cover for PCTs who are neglecting patients health. If the PCT doesn’t have the funds, do not pretend that there is no clinical need for the treatment.
Pretending that treatment for wet Age related Macular Degeneration (AMD) is only needed once the patient has gone blind in one eye and developed wet AMD in his second eye is unethical.
One in five secondary school pupils in England, some as young as 11, took illegal drugs last year.
Sir - As one of the 23 British computing professors who, for a year, has been urging Parliament to rethink NHS IT plans, I agree with Max Pemberton (Health, April 23) about the limited value of computers.
Twenty years ago, when computers were a mystery to most, the job of our profession was to develop the technology and find ways to exploit it.
Now that the Government has fallen in love with the machines, our role has switched to warning, against our own career interests, that computers are only tools, of often overestimated benefit, which can easily be deployed in ways that do more harm than good.
Figures published at its conference in Brighton showed there were almost 59,000 assaults on NHS staff in England between 2005 and 2006. The highest number was in London, 5,700, followed by West Yorkshire and Trent which both reported more than 3,600.
A summer of discontent across the NHS in England and Wales was threatened yesterday by Unison, the public service union, in protest at a below-inflation pay increase.
Representatives of the union’s 450,000 health workers voted unanimously at their conference in Brighton to ballot for industrial action up to and including strikes.
I wonder how Andy Burnham finds the temperature of the water today.
Inflation is 4.8 per cent. Nurses pay is to rise by 1.9 per cent. How can you justify that? K GRAIN, by email
We will never do anything to take us back to the days of raging inflation and double-digit interest rates. So this year, while we accepted the recommendations of the independent pay review bodies (including 2.5 per cent for nurses), we also decided to stage the pay rises with 1.5 per cent from April and the rest from November.
Will you be on holiday on 1 August when those unfortunate 12,000 plus doctors without posts join the dole queues? MAGGIE WRIGHT RN, Doncaster
It is simply not true that 12,000 doctors will be without posts. There has always been intense competition for training posts and that is true again this year, even though more training posts are available than ever before. A large number of this year’s applicants are already working in non-training jobs in the NHS, which will still be there in addition to the training posts.
Untrue but then who cares. Even the latest leak from the Review Group admits that they simply do not know.
Why have you taken no action to tackle the systemic failures in some out-of-hours GP services? SANDRA MILNER, London
The local NHS, through the primary care trust, now has to ensure that there are proper arrangements, meeting national standards. Eight out of 10 patients tell us they’re happy with their local out-of-hours service
Lies, lies & statistics.
Which is the greater disaster for the NHS : the IT system nobody wanted or the Private Finance Initiative rip-offs? CHRIS SMITH, by email
Talk to the consultants who are already using the digital imaging system (Pacs). They love it. No more time wasted, waiting for delayed or lost X-rays; GPs and specialists able to view images simultaneously; more accurate, faster diagnosis for patients. As for PFI, we couldn’t have built or refurbished over 100 new hospitals without it.
The introduction of PACS did not require a £12 billion system & should have been possible 5 years ago for about 5% of the price. What the NPfIT was supposed to deliver was the Spine as well as EPR in the acute setting, neither of which look remotely likely according to the original timetables. And Allyson Pollock has already deconstructed PFI.
Do you agree with the opinion of the junior doctors surveyed by the BMA who believed the NHS would be sold to the private sector within 10 years? NADEEM AFZAL, Birmingham
No. We will never change the values of the NHS - a universal service, tax-funded, based on clinical need and free at the point of use. But where the independent sector can help give NHS patients better, faster care, we will use it.
I doubt it will take as long as 10 years if certain people are allowed their way. Though Doctors for Reform try to make the case for it today, I am sceptical. Patients should not have to pay more to obtain the basics of appropriate healthcare. The fact that we are not able to provide it now should not lead us to give up the fight. The FT & the Independent get in on the act.
Let me repeat, it is possible to do better. The reason that I am so critical of the DoH is intense disappointment at the wasted opportunities that are being used by cynics to put forward their own agenda.
And why is the rehabilitation of patients not given as much of a priority as the initial injury?
This article makes for difficult reading but there are similar stories from adults as well.
Every year, an estimated 20,000 children in the UK will acquire a brain injury – some minor, some life-threatening. Here, as in the US, where hundreds of thousands of children sustain brain injuries every year, it is the most frequent cause of disability and death among children and young people. The Children’s Trust in Tadworth, Surrey, which for over 20 years has provided care and therapy for children with multiple disabilities, is home to the only specialist rehabilitation unit of its kind in the country; its 12 beds account for three-quarters of the UK’s total provision.
The National Childbirth Trust, the charity that provides information for new parents, has discovered that antenatal classes have been reduced or cut in 13 different areas in England. Five Primary Care Trusts have asked the NCT to provide classes after complaints from midwives. There is no statutory duty for trusts to offer classes, making them an easy target for budget cuts.
The struggle for Boots gets bitter as the the parties snipe at each other & there is more speculation about Terra Firma’s plans for BUPA.
The £106 million break fee is payable to KKR if the Boots board goes back on an agreement to recommend the £10.6 billion terms outlined last Friday. Sources within Terra Firma, the investment company headed by Guy Hands, believe that the break fee is at least £50 million too much.
In reports that further suggest deteriorating relations between the protagonists, it is suggested that the Terra Firma-led consortium will strip Boots of valuable assets. These reports, it is thought, emanate from advisers close to the KKR/ Pessina camp. Each side appears to be accusing the other of plotting a Boots break-up that is against the interest of thousands of workers.
Nuffield Hospitals, the not-for-profit private hospital operator, has pulled out of negotiations to provide operations for NHS patients using mobile operating theatres in the West Midlands.
The move is a setback for the Department of Health’s drive to get up to an extra 250,000 patients a year treated in private sector facilities through a second round of independent sector treatment centres (ISTCs).
Some 13 schemes have reached preferred bidder stage but it is now nearly two years since they were first announced, with none having yet reached financial close. Nuffield cited costs and delays in concluding the deal as the reason behind its decision.
The move comes as most of the companies bidding for the second wave of ISTCs now say privately that they do not believe the programme will reach the government’s original - and repeatedly confirmed - target of spending £550m a year to treat 250,000 patients annually. Most now expect it to add up to only £350m.
I hope that the DoH uses this as an opportunity to review the entire programme, not jump headlong into a deal with the alternate bidder. There is increasingly an unacceptable concentration of work in limited hands, based on very sketchy evaluation & a flawed tendering process.
The letters column of the Times has consultants writing in to vent about the Public Accounts Committee report:
Despite the evidence of independent surveys showing that the average consultant worked 50 hours a week, he boasted hat he would get more work out of us by “imposing†a 40-hour week. Either Mr Milburn is mathematically challenged or, more likely, his socialist preconceptions would not allow him to believe that consultants really did work that hard. The result was inevitable, and we are now under pressure to reduce our hours in order to bail out cash-strapped trusts.
Until 2003 I was working 55-60 hours per week and being paid for 37.5 hours. With the new contract I am paid to work 52 hours and still work 55-60 hours.
And we still talk about increasing productivity & hear nonsense from the govt’s pet healthcare advisers about negatively incentivising doctors to work harder by cutting their pay.
Unison, the largest public sector union, said that a new pay and grading system, dubbed Agenda for Change, was under threat from claims lodged by a number of health workers against North Tyneside primary care trust and health unions.
Solicitor Stefan Cross, representing the workers, says that Agenda for Change failed to end pay discrimination and continued to protect the earnings of male union members at the expense of women.
Karen Jennings, responsible for health workers at Unison, said: “Agenda for Change involved detailed discussions between NHS employers, the government and all 20 health unions and organisations. At every stage of the negotiations expert and legal advice was sought and given, making this challenge even more bonkers. It is a disgrace that ‘no win no fee’ solicitors should attempt to wreck a pay system that has resulted in 90 per cent of women getting a better deal.”
I am not too sure about this. I have heard from a lot of people from different backgrounds that AfC is not being applied properly & that a number of professions have actually lost out.
The two-year pay settlement for teachers in England and Wales could be reviewed because of rising inflation.
The independent body which advises the government has asked for its permission to reconsider the current pay deal. Ministers are considering the request.
The settlement, with 2.5% rises last September and next, included scope for a review if inflation were to pass 3.25%. The headline rate is now 4.8%.
Just how then are 0% rises anything but a pay cut & no wonder nurses & other staff are prepared to strike.
About 50 per cent of twins need special care at birth. In 1975 there were 6,000 twins born annually. Now the figure is 10,000. This rise is caused almost entirely by IVF. A quarter of IVF pregnancies result in multiple births, ten times the natural rate, largely because clinics implant more than one embryo to increase success rates.
Assisted reproduction combines desperate parents with private clinics whose fortunes depend on success rates, and that means implanting multiple embryos and more multiple births. This results in more babies needing NHS special care and fewer staff to go around. If the staff to baby ratio were higher, lives could be saved. A recent study indicated that if each baby in specialist care received one-to-one treatment, the incidence of deaths could be cut by 48 per cent.
Quite a few leaps in the article but the one thing that is not mentioned is that in most countries with a single embryo policy, multiple cycles of IVF are funded by the state but here in the UK getting on the list for even one cycle can be a struggle.
So when the government announced reforms last April to the way that dentists operate that were designed to help more people gain access to an NHS dentist and so encourage more regular visits to the dentist, health officials welcomed the idea.
But one year on from the implementation of the new contract, the British Dental Association has declared that the most radical shake-up in NHS dentistry for more than 50 years has failed.
Dentists complained that meeting these targets put undue pressure on them and one in 10 dentists did not sign the contracts, resulting in a loss of around 2,000 dentists from the NHS.
The effect of this exodus is that more people have struggled to find an NHS dentist and have moved to private practices, and are having to cope with the accompanying higher charges. The cost of a dental crown could be almost double the NHS charge.
Between 2001 and 2005 spending on private dentistry in the UK jumped from £1.45bn to £3.07bn.
No one seems to be learning the lesson that ignoring the professionals is a recipe for failure.
The differential pricing of cochlear implants is to be the subject of an OFT inquiry with the postcode lottery also making an appearance.
The cochlear implant costs £12,563 in the UK compared with £7,770 in Sweden.
Nottinghamshire PCT says that the case for a second implant is unproven, though children in other areas now routinely receive two.
“The evidence for bilateral implants is there; colleagues in Finland can’t believe that we would only offer one. Two ears are clearly better than one.”
Among the pharma related issues in the news, the battle for Boots finally gets under way in earnest:
The board voted to recommend a formal £10.90-a-share bid from the private equity group Kohlberg Kravis Roberts and Boots’s deputy chairman, Stefano Pessina, at a board meeting late on Thursday night. The bidders had proposed to pay £10.60 but were forced higher when the Alliance Boots board told them that Terra Firma was planning a £10.85 offer. Their new bid is £900m more than KKR first offered six weeks ago - and £3bn more than most City analysts thought the company was worth before either bid emerged.
Less than four hours after Alliance Boots and KKR announced they had reached a deal, Terra Firma, run by the financier Guy Hands, and his partner, the Wellcome Trust, slapped an even higher proposed bid on the table, of £11.26 a share. That bid is subject to Hands’s team completing due diligence and is not yet a formal offer.
Alliance Boots yesterday defied regulators by signing a second exclusive drug distribution deal, in a move that gives it control over the delivery of nearly a quarter of the UK’s medicines.
The deal with AstraZeneca, the UK’s second-biggest pharmaceuticals company, was condemned by critics yesterday as a “nail in the coffin†for smaller wholesalers. Under the agreement, UniChem, the drug wholesaling arm of Alliance Boots, and AAH Pharmaceuticals, part of the German drug wholesaler Celesio, will be the sole distributors of AZ’s prescription medicines to doctors, pharmacies and hospitals.
The tie-up with AZ comes seven months after Unichem signed an exclusive distribution deal with America’s Pfizer, the world’s biggest drugs group, triggering an investigation into the drug wholesale market by the Office of Fair Trading (OFT).
Documents have surfaced on industry insider websites allegedly describing illegal drug marketing practices and AstraZeneca has since launched an investigation into the activities of several employees.
Mike Zubillaga, who was regional sales director for AstraZeneca’s Mid-Atlantic Business Center in Wayne, Pennsylvania, was quoted in a internal newsletter saying: “I see it like this: there is a big bucket of money sitting in every office. Every time you go, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money.”
Unfortunately for Mr Zubillaga, who was intending to motivate his sales staff to sell more cancer drugs, an industry blogger got hold of the newsletter from a whistleblower and published the comments, sparking an online debate about the ethics of drug companies.
Concern was raised after another comment from Mr Zubillaga in the same newsletter appeared to highlight a more serious issue. He allegedly appeared to be suggesting sales staff should counter-promote drugs, which is selling by comparing another company’s drug, a practice prohibited in the US.
Peter Rost, a former marketing executive at Pfizer, who first posted the newsletter on his “whistleblower” blog two weeks ago, wrote: “AstraZeneca lacked the internal controls to make sure the truth didn’t get out, and now they are trying to show they are holier than thou, by firing the guy who said what everyone knows to be true … Instead of a reprimand, AstraZeneca created a sacrificial lamb to cover the corporate rear end.”
I wonder if No Free Lunch get a boost in membership from this.
Sir - Recently, I came up against the full might of our proud nation’s new NHS computer system (Letters, April 19). We all, our dear leader tells us, want choice. I was offered “Choose and Book”, which is supposedly a part of the system that is actually beginning to work.
I was given a password and went as instructed to nhs.healthspace.
That was the first problem. I use a browser that is chosen by all who have tried it in preference to the one that comes with the computer. But although the NHS began working on its system in the past century, it is still under construction. The first response I got was that the system could not cope with my decent browser.
So I downloaded the old-fashioned browser. Did that help? Not a lot.
“Choose and book your appointment,” it said on top of the document that I was given at the local surgery. But as soon as I tried, the NHS website went into a sulk from which it never recovered.
Nothing was having any effect. So I resorted to the telephone. A surprisingly cheerful woman explained, as though to a toddler, that I could get no further because there were no appointments.
What none at all? At any of the hospitals within a day’s train ride? None at all. If there is no such thing as an appointment, it was not very polite of the NHS to offer the temptation to try to get an appointment. It hardly seems like £12 billion well spent.
John Ticehurst, Chard, Somerset
The problems do not lie just within the provision of IT services. The integration of information systems into the delivery of healthcare is also one of the largest change management programmes in the world. It has however not been given more than lip service in that direction & any number of lost opportunities litter the field.
IT is an enabler, not an end in itself. Something that appears to have been forgotten by CfH & the people making the decisions.
Rather than Connecting for Health gathering forces for a final push, a limbo is developing. Mr Granger is expected to leave soon yet everyone must maintain the fiction that he is still influential.
PAC chair Edward Leigh wants someone to ‘get a grip’ but there is no clear hand on the tiller during the vital transfer of responsibility to strategic health authorities. It is time the programme, and its pugnacious boss, retired to the sun.
There is more interesting news from the HSJ:
Comparative analysis of patient safety using a set of US indicators has heightened concerns about the quality of NHS trust coding, according to a Dr Foster Intelligence study.
The company had planned to publish trust-by-trust comparison of performance on patient safety against nine of the US Agency for Healthcare Research and Quality indicators. But returns from trusts revealed such variance and lack of confidence in secondary level coding that Dr Foster plans to work with a selection of trusts on a study of how to improve safety reporting.
Something that I have been saying for a while. It is not just the safety data however but also the rest of the data infrastructure. It is not a solid foundation to rely on for the development of an internal NHS economy.
Earlier this year the professional and patient lobby on dermatology got together and warned of a threat to their specialty.
Given that this was the height of the NHS financial crisis, it was tempting to dismiss their letter to The Times as special pleading, except for one important fact: they appear to be right. The law of unintended consequences from payment by results is making itself felt.
At least one hospital trust - Newham University Hospital trust in London - has declared its department financially unviable; others have come close.
The Times letter was signed by 350 dermatologists (that is pretty much all of them, by the way), the Skin Care Campaign, the British Journal of Dermatology and the Royal College of Physicians joint specialty committee.
NHS deficits and the government’s health reforms were damaging the care of people with skin diseases by removing choice, it said. GPs were being forced to treat patients themselves or divert them to services not run by specialists. As a result, specialist teams were being dismantled.
Didn’t Bedford Hospital dismantle it’s dermatology department too? I seem to remember Barry Monk standing for parliament opposing the changes.
In a survey by the British Association of Dermatologists last summer, just over half the 100 consultants surveyed said their primary care trust was setting up a clinical assessment and treatment service for dermatology. These were expected to divert up to 50 per cent of patients; meanwhile PCTs were commissioning fewer referrals from the hospital departments, in some cases slashing the number in half.
A third felt this would lead to financial instability and redundancy was under discussion in a quarter of trusts. As BAD clinical vice president David Shuttleworth put it: ‘Those departments which are unable to demonstrate financial viability in trusts trying to claw back a deficit are particularly at risk.
‘Under PbR a relatively small reduction in referrals may be sufficient to attract the attention of an embattled finance director, who may feel that “outsourcing” dermatology into the community will reduce losses on the balance sheet.’
It is hard to argue with that assessment based on present evidence.
Nor is it just dermatology that is threatened in this way. Rheumatology faces the same pressures, says the British Society for Rheumatology.
Take, for example, BSR president Andrew Bamji. He says he is currently under pressure to reduce his new follow-up ratio from 1:3 to 1:1, a move that is not clinically appropriate, would place him outside professional guidelines and see him discharge nearly half his caseload overnight.
But the tariff is based on an average; divert the simple referrals to a clinical assessment and treatment service or GP with a special interest and it no longer covers the more expensive cases left to the hospital department.
Or, as Dr Holden puts it: ‘That means bankruptcy. You cannot be paid for Minis and build Rolls Royces.’
I would have to agree & that argument has been put forward to oppose the transfer of patients to the ISTC programme as well, only to be ignored by the Department of Health.
NHS Confederation policy director and PbR supporter Nigel Edwards agrees. The idea is in the latest PbR discussion document, although only as an idea. ‘I am concerned that the PbR team’s approach is to unbundle, unbundle and unbundle and put a price on everything,’ he says. ‘They seem to recognise the problem but not do anything about it.’
Things have got to be bad then if the NHS Confederation comes out publicly against it.
‘This is an area where services have to be very carefully designed, where “good enough” will not deliver.’
I concur but I would also extend that statement to the rest of the health service.
Which leads us to the the effects on the wider system:
The Department of Health has drawn up a list of acute trusts that will be closed, merged or broken up because they will not survive under payment by results.
The list follows health secretary Patricia Hewitt’s request earlier this year for strategic health authorities to find ways of salvaging acute trusts struggling under the government’s new financial regime for the NHS, possibly mirroring the take-over of Good Hope Hospital trust by Heart of England foundation trust last month.
Sussex-based Frimley Park foundation trust is exploring whether it could merge with or take over the running of some services from the financially failing Surrey and Sussex Healthcare trust.
Other foundation trusts considering mergers include King’s College Hospital, and Guy’s and St Thomas’ in London, which are understood to be examining whether a takeover of Sidcup’s struggling Queen Mary’s trust is feasible.
HSJ have come out with corrections to the list with strongly worded letters of complaint from the chief execs of the trusts in question.
Forced mergers between organisations with very different circumstances do not work. There is plenty of evidence for that. You only postpone the inevitable.
And you end up with things like this:
The Department of Health has been asked to explain where the ‘missing millions’ that should have been spent on sexual health have gone.
PCTs were given £300m of money to be spent on public health under the Choosing Health white paper, but it was not ringfenced.
So we end up paying more in a few short years.
And there is also trouble out in the community with the BMA advising GP’s to ensure that atleast 70% of savings under Practice Based Commissioning are returned to the practices as promised by the Department of Health. A very good illustration as well of how a minimum level ends up becoming a maximum target very soon.
The British Medical Association’s GPs committee has recommended to members that they do not agree to commission through PBC unless their PCT will guarantee in writing 70 per cent of any savings they may make. The ability to use savings for patient services was announced, as an incentive for GP practices, when PBC was introduced two years ago.
The GPs committee guidance says there is ‘an absolute necessity for practices not to enter into any commissioning arrangements without written and signed confirmation from the PCT, in advance, that they will get their share of freed up resources at the end of the financial year, regardless of the PCT’s financial situation’.
But NHS Confederation PCT network chair David Stout said the BMA’s stance could cause problems for cash-strapped PCTs.
‘PCTs and practice-based commissioners should agree on service redesign but I think the GPC’s suggestion of a contract shows a real lack of trust, although I do think agreements should be documented.’
What trust? You just had all those stories about GPs being overpaid & how the DoH would re-negotiate the contract. Did no one see this coming?
A DoH spokesperson said guidance it published in November last year said it was ‘imperative‘ for practices to be allowed to use a minimum 70 per cent of any freed up resources for reinvestment in care.
The NHS Alliance can’t get away by saying
‘The 70 per cent savings figure is guidance and at the end of the day a statutory duty outweighs guidance.’
Watch out for more of the same.
NHS Employers says there is now no need to employ staff from abroad, following the increase in home-grown healthcare staff, but the Royal College of Nursing said the move was ‘wrong and muddle headed’. The British Medical Association said that while there had been an expansion in doctor training in recent years, ‘that doesn’t necessarily mean there are more doctors than needed’.
I am sorry but there is no workforce planning worth the name in the NHS. And NHS Careers is not really very credible.
Besides, I wonder what the DoH will have to say to that, given the rules on “additionality” which necessitate the employment of non-UK staff only by the various IS providers under the ISTC schemes.
Bill McCarthy, director of policy and strategy, director general of commissioning Duncan Selbie and director general of health and care partnerships Professor Antony Sheehan have all left recently.
Departmental sources denied that any interviews had been carried out for a rumoured new chief medical officer post, dedicated to the NHS and separate from Sir Liam Donaldson’s DoH post.
There is simply very little credibility left in the medical establishment. Recruiting in secret from within that segment of the profession will not be an improvement.
Our experience is common. We are confronted by an almost continual stream of advice, instructions and demands. Almost any external event, such as a front page story, guarantees a new set of instructions. We hear of some initiatives from the media. Often what we are told to do by one part of the NHS clearly conflicts with another; giving the perception that there is no coherence at the management layer above our trust’s. A plan reached after months of negotiations can be only weeks old before it is invalidated by decisions external to our trust.
This conflicts with the experience of successfully managing large complex change programmes. You need clarity of vision - everyone needs to know what they will get as a result of all the effort and upheaval, and it has to be worth it. You need leadership who personify the vision, and have not only the capabilities to deliver the programme but an ability to reach people on an emotional level. And you need clarity in the structures for accountability and responsibility for day-to-day delivery as well as the change programme. I suggest the NHS falls well short on all of these.
Oh dear, someone has strayed off the reservation!
The NHS is managed badly. It has neither the capability nor capacity for the efficient management of so many component sub-organisations, especially during a period of change. Some would add it does not have the right culture either.
Or has he? The remedies he suggests are redolent of a “business focussed approach”. Repeat after me “The health of the public is not a business.” You are not there to improve circumstances just for your organisation alone.
After all, the land of opportunity has its own set of troubles with poor healthcare management, not to mention the fact that UnitedHealth is in the spotlight again.
Hermes, one of the biggest European pension fund managers, has for the first time put forward a proposal requiring a shareholder vote on executive pay at a US company – a move that reflects the increasing activism of foreign shareholders pushing for boardroom reform.
UK-based Hermes plans to introduce its resolution at next month’s annual meeting of shareholders of UnitedHealth Group. The healthcare insurance company has been hit by a stock options backdating scandal.
You might remember the $1.6 billion paid out to the chief exec over the past decade.
Proper public consultation on the National Health Service will be undermined by “vague and woolly” legislation passing through parliament, the Commons Health Committee said today, criticising government proposals to limit public consultation on healthcare changes to “significant” proposals and decisions.
The proposed changes are contained in the Local Government and Public Involvement in Health Bill, which is nearing the end of its passage through parliament.
Consultation on NHS changes, such as the closure of maternity wards, was already a sham in some cases, the committee said. “Elsewhere, NHS bodies have sought to evade their duty to consult entirely,” it added.
“The Department of Health needs to take a lead and make it clear that such behaviour will not be condoned.”
MPs said the planned replacement of the country’s 400 Patient Forums by 150 “Local Involvement Networks” (LINks) only four years after the volunteer-run health watchdogs were created was unnecessarily disruptive, and might push volunteers to leave.
Uncertainty about the role of the new LINks would create “confusion and inactivity”, the MPs said.
The government says the forums, which themselves replaced the 30-year-old network of Community Health Councils, have too narrow a membership.
But the Health Committee said the forums should have been allowed to merge to form the new LINk bodies.
“Once again the Department of Health has embarked on structural reform with inadequate consideration of the disruption it causes,” the committee said.
The MPs said the health secretary — currently Patricia Hewitt — intervened too often in decisions after extensive local consultation, leading to illogical conclusions and undermining public confidence in the consultation process.
You might want to ask her about MMC or MTAS. You might even want to ask her about the “reforms” or the “best year for the NHS”. Let us see what gems she comes up with next.
You could if you were so minded ask her whether she believed that consultants & GPs were spending time on the golf course when they should have been seeing patients. I seem to recall that being the staple of the spin during the negotiations on the new contracts.
The contract, agreed in 2003, cost £715 million in the first three years — £150 million more than the Department of Health estimated. In that time the average consultant’s pay rose to £110,000 a year while the average number of hours worked fell from 51.6 a week to 50.2.
In negotiating the contract, the department used out-of-date information on the hours that consultants actually worked. In spite of evidence that the average was between 50 and 52 hours a week, the department worked on the assumption that it was 47 hours.
It then agreed a contract with the British Medical Association that was based on an average of 43 hours a week. In fact, consultants continued to work much longer hours than these, and under the new contract were paid for them.
The National Audit Office said a revised contract - approved by John Reid when health secretary in 2003 - was supposed to give hospital managers more control over how 32,000 consultants organised their time.
But the government greatly underestimated the amount of extra work the consultants had previously provided without any financial reward. The revised contract paid them for this hidden labour, causing a £150m overspend and contributing to the NHS’s deficit.
In the first year of the contract, they agreed job plans with individual consultants that provided hospitals with more hours of work than they had budgeted to fund. In subsequent years, they tried to reduce the hours. But consultants who benefited from a pay bonanza in the first year became disgruntled when some of the benefits were withdrawn. “As a result of the reduction in contracted hours, some consultants told us they are reluctantly developing a clockwatching attitude to their work,” the NAO said.
The NAO also said the contract has cost at least £715m.
It added that the government had underestimated the amount of work consultants did, and NHS trust managers had failed to keep within budget.
The watchdog said NHS trusts needed to improve job planning to improve access to service, while consultants should become more engaged with managers.
Listening to doctors might be a start.
Let us be clear about this.
As with the GP contract, the Dept of Health underestimated the quality of work already being done by consultants. We were subjected to pernicious whispering campaigns & claims of consultants spending time on the golf course instead of seeing patients.
Well, the govt insisted on verifying the hours worked & imposed strict controls on local arrangements. They have sacrificed any goodwill extant & will have to muddle out of this on their own.
But the situation is going to get worse because the current reforms still pretend that staff are not working to capacity. They will come a cropper but by then the culprits will have moved on.
Even a usually rabid Blairite like Michael White, political editor of the Guardian has to agree:
Who is to blame? Certainly not the British Medical Association, Britain’s toughest trade union since the miners’ defeat. Their negotiators, led by a smart transplant surgeon called Nizam Mamode, told the management side, the employers NHS Confederation and senior Whitehall officials, that hospital trusts were under-estimating the long hours their members worked.
Management didn’t believe it: as a result they overpaid them and trusts are only now trying to extract productivity gains and better working practices in return, doing ops on Saturdays, for instance. Change is notoriously hard in the NHS.
The long-stalled new contract was signed at the start of bullish John Reid’s stint at health (2003-05), too impatiently, say some. But Reid’s Labour-ish cultural suspicion of consultants - arrogance, inflexibility, golf - was shared by Frank Dobson (1997-99) and by arch-NHS moderniser, Alan Milburn (1999-2003).
He still hasn’t given up, cheering the supposed breaking of the
BMA stranglehold over the numbers of consultants entering the trade.
That golf course claim makes an appearance again as well:
As the old guard heads for the Last Golf Course, so NHS managers will be able to extract more efficient working.
God save us from a deluded political class & their hangers on.
Instead we get suggestions that Indian hospitals might be better than the NHS. I would be the first to agree that India has a number of world class hospitals but the average public hospital is not of the same calibre, though they are not likely to be used by visitors or even the middle or upper echelons of Indian society. This does not detract however from the fact that standards in the NHS are low.
The 2007 congress was the time and the place where nurses announced to the world that the rules of the game have changed.
Nurses made that historic announcement because they have reached their limit.
About a third admitted that they had delayed for more than two weeks before carrying out a pregnancy test.
Once they were certain, half of the women took more than a week to decide what to do — often because of concerns about the procedure and disagreements with partners.
Another delay came when the women saw their doctor. Almost two thirds said that a significant period elapsed between their requesting an abortion and having it, even though medical guidelines emphasise the need for urgency at this stage.
Two in five waited for two weeks, and nearly a quarter waited three weeks. The main reason for delay was confusion among GPs over where late abortions could be carried out.
Investment in services has been heavily concentrated in early “chemical†abortions for women up to nine weeks pregnant, which are available widely in hospitals and clinics.
Late abortion services have almost all been contracted out.
An extensive study published by the University of Southampton and the University of Kent, of women who had abortions between 13 and 24 weeks found that half did not know they were pregnant for at least two months, and a further quarter only discovered their pregnancy at three months or later. Two in five said that their periods had continued.
Ramsay operates more than 70 hospitals and day care centres in Australia, plus a further three in Indonesia. It would act as a strategic partner providing management expertise to its financial backer.
Ramsay is understood to have held preliminary talks with several potential backers, including Macquarie, the Australian investment bank.
Ramsay Health Care was founded in 1964 and has been expanding fast in recent years. The group listed on the Australian Stock Exchange in 1997 and has since increased annual revenues from about A$200 million (£83 million) to more than A$2 billion last year. In 2006 total core net profits increased 69 per cent to A$93 million.
Ramsay said last year that it was seeking further opportunities to “expand the Ramsay hospital franchise offshoreâ€. This month Pat Grier, its managing director, predicted that within five years overseas operations would represent “at least 30 to 40 per cent†of its business.
A range of other private equity firms, including Black-stone, Cinven and CVC, are also thought to be interested in bidding for BUPA’s hospitals.
I guess BUPA’s plans to invest in care homes instead might make financial sense for them though I still think that the hospitals division is strategically important.
Shares in Southern Cross Healthcare, Britain’s biggest nursing home operator, have risen by 60 per cent since January, providing the best single return among London’s 1,600 fully listed companies. The wider market rose by just 5 per cent over the same period.
The excitement for investors lies in the company’s ability to capitalise on two powerful trends: an ageing population and fewer NHS beds. Most of its fees come from local authorities, who are reliable payers, while soaring property prices have caused a shortage of supply: smaller operators have typically sold their land to housebuilders.
This means that Southern Cross’s homes are more than 90 per cent full: a figure that would make an hotelier blush. With nationwide demand predicted to grow by 14,000 beds a year, the company can raise its fees at more than the rate of inflation.
Not according to a poll conducted by Hospital doctor & Medix with 14,000 doctors responding. Two thirds say they wouldn’t recommend it.
More than half of the 14,000 doctors who responded said they felt morale at work was “poor” and in the case of junior doctors “terrible”.
Government reforms, targets and the central NHS computer system were all given as reasons for low morale. The catastrophic introduction of a new job applications system for junior doctors - the Medical Training Application Service - was also a cause.
The survey asked doctors if they agreed with Patricia Hewitt, the Health Secretary, when she said 2006 had been the best year for the NHS. Nearly 90 per cent disagreed.
One doctor told the survey: “As more hospitals try to balance books by sacking staff, the remaining staff are having to pick up the slack, resulting in more mistakes being made. Morale is at an all-time low and getting worse.”
Don’t look to hard for steps being taken to remedy the situation. After all, everything is hunky-dory according to the DoH.
A spokesman for the Department of Health said the Healthcare Commission’s latest NHS staff survey indicated that staff remained “generally satisfied”.
Is anything guaranteed to be more nauseating than the mindless drivel that passes for PR?
Pulse magazine found 19 out of 50 primary care organisations it surveyed had replaced doctors with cheaper alternatives in some areas.
The survey found another 10 organisations were considering cuts to the number of doctors they employed out-of-hours.
It found some organisations had cut doctor numbers by as much as 50%. Instead, they were increasingly relying on nurses, and emergency care practitioners, who are trained in paramedic skills, to provide the service.
Both the Times & the Telegraph report on the distribution of NHS funds with the claim that 85% of new NHS cash has gone to Labour voting areas.
Of every pound spent by the Government on building hospitals since 1997, 85p has been spent in Labour constituencies.
New figures show that constituencies held by Conservative and Liberal Democrat MPs have missed out on Labour’s hospital-building programme. Of 46 hospitals built by Labour since it came to power, 33 are in seats that are held by Labour MPs, Andrew Lansley, the Shadow Health Secretary, established through a question in Parliament.
Before the 2005 general election, when most of the decisions were made, 36 of the new hospitals were in seats held by Labour MPs, with only 8 being built in the constituencies of Conservative MPs.
The total capital value of the new hospitals is £4.1 billion, of which £3.5 billion (85p in every £1) has gone to Labour areas.
Yesterday the Government announced that it is to spend £50 million on community hospitals and super-surgeries. All but one of the ten schemes for new or refurbished community hospitals is in a Labour-held constituency. The exception is Hornsey, held by a Lib Dem.
Mr Lansley said: “Four in every five of Labour’s new hospitals have been built in the constituencies of their own MPs. Meanwhile, ministers are holding secret meetings with Labour Party officials to target up to 60 hospital cutbacks on the constituencies of Conservative and Lib Dem MPs.
“These figures confirm what we suspected when Patricia Hewitt went against the advice of health experts and ordered a hospital to be built in a Labour constituency in South London.
“Last year Patricia Hewitt launched a policy dictating that care should be provided at home and not in hospitals. Patients in Conservative and Lib Dem areas will be wondering why it is their hospitals that have to close, while patients in Labour areas benefit from virtually all the spending Labour is committing to new hospitals.â€
Labour holds 54 per cent of the constituencies in England, so the balance of spending is disproportionate.
There is however a rebuttal from the govt:
Andy Burnham, the health minister, angrily denied the claims and said that the needs of patients determined where hospitals were built.
“The Tories slashed capital spending in the early 1990s and left the fabric of the NHS in an appalling state, in many cases in the most deprived areas. Now they are having a go at us for putting things right.
“Over 100 major new hospital projects worth more than £10 billion have either already opened or have started construction since 1997 as we rectify years of under-investment.
“Patient need, not party politics, drives the building of new NHS hospitals. I would defend each and every single one of these schemes.”
Hospitals are falling down all over the country, so there is need for more than the 100 claimed. It is just a question of the geographical distribution of priorities & I don’t think anyone claimed that unnecessary hospitals were being built. So a masterly political reply?
The Department of Health denies any political interference. It says that bids for local hospitals come from local NHS, and are not dictated centrally by ministers. Patient need, not party politics, determines spending.
Labour also represents many disadvantaged areas, where the health needs are greater. Allocation of NHS resources is designed to reflect health needs, though it does so rather imprecisely. So spending heavily in Labour areas is evidence not of political interference but of need, ministers argue.
But while they may defend a preponderance of spending on acute hospitals in Labour areas simply on the ground that many big hospitals are located in cities — where Labour dominates — the same defence can hardly be used of community hospitals, which are more often found in rural areas.
In one sense though the areas that missed out can consider themselves lucky. £10 billion spent has become £50 billion to be paid out by the end of term under the PFI agreements that finance the bulk of the new schemes. Let us see how affordable the bills are in a few short years.
In an effort to repair the damage caused by the last week of stories repudiating her maternity policy, Patricia Hewitt writes in the Guardian today. Let’s see how her claims stack up.
Your article claims the NHS has “too few midwives to achieve even the basic levels of care for families” (Birth care promise is unattainable, April 7). This is untrue.
The UK remains one of the safest countries in the world in which to have a baby, and 80% of women are satisfied with the maternity care they receive. Of course, more needs to be done if we are going to deliver our manifesto commitment that, by the end of 2009, every woman will have choice over where she gives birth and what pain relief to use, supported by a named midwife throughout her pregnancy. That’s why last week we set out how, for the first time, women and their partners will be guaranteed this choice.
I am sorry but please specify which part of that statement you claim to be untrue. Can you provide the numbers to back it up? I would like to see the numbers of staff required to provide safe care as per RCOG / RCM norms & the actual numbers extant.
Your piece quoted selectively from research, suggesting that “more women want midwives they can trust than wish to be able to make choices about their care”. Of course mothers-to-be want doctors and midwives they trust. But we also know they want to be given a say over the care they receive. Women want a range of options - from consultant-led care in hospitals, to midwife-led units and home births - and their choice will depend on what’s best for them and their baby.
Not being disputed here. But do you disagree with the statement?
We know that more women would choose home births if the choice were available. Where the NHS locally employs enough midwives to support genuine choice, 10-12% of women choose a home birth compared with only 2-3% nationally. That’s a lot of women currently denied the option they would prefer.
See, the operative phrase is “where the NHS employs enough”. Diverting staff from inadequately resourced maternity units is of no benefit to anyone.
High-quality services that support genuine choice must not be the sole preserve of the articulate middle classes. That’s why tackling inequalities in maternity care is at the heart of our approach. We know that providing more ante- and post-natal services in the community, including through Sure Start and Children’s Centres, helps improve access to care - and outcomes such as low birth weight - among hard-to-reach communities.
