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.
I could be acused of unfairly beating up on HMRC but losing personal data from 7.2 million families (25 million people) is not exactly best practice & it is surprising but honourable that the chairman has resigned. Now those affected could change security details / banks / accounts / cards etc but the distress & confusion caused is substantial. Now just imagine if this was a problem with someone’s medical history, leaked from the Spine due to the poor design of the security policies that everyone & their dog have been warning about. Just how do you go about changing that? An increasing number of GPs seem to agree.
Will someone at CfH listen?
Also known as “making friends & influencing people”.
So how do you try to revive a much criticised project, one that is under fire both for technical shortcomings as well as the quality of its engagement with users?
One of the tried & tested methods available to large organisations disconnected from their user base is to just shout louder hoping that the message will drown out the criticism. We are all quite familiar with the technique, having been on the receiving end of it often enough but it rarely is capable of producing genuine & lasting results, creating instead a feeling of resentment & apathy.
CfH are looking to recruit Clinical Leads, who we are told must be willing to stand up in public & explain why they support the programme. There is nothing wrong with that. But what influence if any will these “Leads” have over the direction or implementation of the programme? Err, none! At-least that is according to a senior clinical source within CfH. So do you really expect there to be a change in attitudes towards the programme?
This when clinicians already working for the programme are having to be very circumspect in what they say & can only bring themselves to call for greater clinical influence. I am not holding my breath.
Perhaps a methodology likely to be more successful in the longer term would be to take the criticism on board, review & implement any changes that might be needed and prove yourself by your results. I’m just saying, it might be worth a try.
A very quick question for Richard Granger (Where is he? Where also is the rest of that self-serving article in CIO magazine that came out a couple of months ago? ).
Given the posturing about the NPfIT procurement exercise & how successful it was, perhaps he would like to tell us why we are now told that Lorenzo will be with us in 2011. I suppose the mass extinction of numerous innovative local software projects was worth the wait. Perhaps he would also like to explain why SHAs are having to migrate GP systems to those provided by the LSP just to avoid penalties. GP Systems of Choice anyone?
The Penfield strategy is the latest in a long-line of plans for delivering Lorenzo that stretch back to 2004, none of which has so far resulted in completion or delivery of the next generation software. One of the procurement principles behind the NHS IT programme, led by NHS Connecting for Health, was claimed to be only buying proven product that had been shown to work after exhaustive expert testing.
Would incompetent contracting be an explanation?
And I am sorry to see the same state of affairs in the US as exists here though there appear to be a few bright spots. Do we have to suffer the same poorly designed crap that passes for software?
The HSJ suggests that the delayed Commissioning Services Framework (ASCC) is finally happening with the official announcement due next week. It will be interesting to see just who made it onto the list but the possibility exists that the contract is not that important anymore due to the change in emphasis at the DoH.
And it looks like Leicester will not be getting a new PFI hospital after all with the collapse of a £921 million scheme.
The University Hospitals of Leicester Trust (UHL) has pulled the plug on its Private Finance Initiative (PFI) after a nine-week review of the project.
The trust had planned to spend £711m developing three sites in Leicester but the review showed costs would increase to an unaffordable £921m.
A total of £23m had already been spent preparing for the PFI scheme.
Atleast they took the decision now rather than going ahead with the plans in a fit a of bravado & saddling the people of Leicester with an unaffordable white elephant. Now to see if other trusts in a similar position gain the courage to do the same.
An interesting argument from a PCT PEC member regarding the importance of diversity assessments while commissioning. I’m glad to see someone applying their mind here instead of just filling in check-boxes. But it is action that is required, not just waffle.
This post from Hospital Phoenix hits the bulls-eye regarding the complicity of the Royal Colleges in dumbing down medical training.
While the midwives go to war.
Something from the BBC & Lancet.
Not to mention this surprising turn of events with Isoft ditching IBA at the altar to elope with Compugroup! Though with CSC having taken over all responsibility for the NPfIT contracts, the relevance to UK healthcare is reduced.
While this is an argument for increasing the priority allocated to sexual health.
And finally the official write-up of the work done by the NHS Service Delivery Organisation (SDO) that was covered here previously describes the importance of continuity of care to eventual outcome even where choice might have initially been seen to have the upper hand in the patients mind.
Patients need help with choosing which service mode and/ or practitioner will suit them best.
As far as I knew, that is what GPs do!
Service developments that make relational continuity less easy to deliver will impair patients’ experience of care, particularly those patients who have more complex problems. For these patients, informational continuity promoted through electronic record systems cannot substitute for relational continuity. And as the structure and range of services becomes more extensive, some patients may find increasing difficulty in negotiating for the aspects of care they prefer. A service is needed that is simple to use and allows for both convenient access and continuity depending on the patient’s preferences and needs.
And regarding the movement of services closer to home, there is a reiteration that not all is as rosy as it seems.
Our review broadly suggests that transferring services from secondary to primary care, and developing strategies to change the referral behaviour of primary care, may be effective in increasing the effectiveness and efficiency of outpatient services.
Relocating specialists in primary care and developing joint working arrangements between
primary and secondary clinicians have been of more doubtful value.
Although the evidence is still limited it does suggest that any initiative to move care closer to
home needs careful design and evaluation, as we cannot simply assume cost-effectiveness and high quality.
Many of the new models of care have been introduced to meet the important objective of improving patient access. However, those responsible for service improvement should be aware that they might face potential trade-offs between the goals of access, cost-effectiveness and quality.
And regarding the fashion for GPSIs, the message appears to be unequivocal.
The most important benefit to patients of GPSI services appears to be in terms of accessibility. The location of a GPSI service is crucial to maximise accessibility and convenience for as many people as possible. In the case of the first study, it appeared to provide care which was more accessible and preferred by patients, with no evidence of difference in clinical outcomes. These benefits were obtained at considerably greater
cost.
I wonder if policy-makers will take this into account, not to mention of course the above-mentioned commissioners?
High dudgeon today as GPs are accused of overprescribing medication & generally being responsible for wasteful supply of medication to the tune of between £85 million to £300 million a year.
A few home truths then for those interested.
Not all generics are created equally. Some might not be suitable for a proportion of patients because of side-effects / efficacy / convenience, being usually atleast a generation older than the medication still on patent.
Using statins as an example, not all patients can be switched to generics from the newer versions due to the significant numbers who develop musculoskeletal problems.
Three cheap pills a day that a patient does not take are not better than the more expensive single pill regimen he or she does comply with.
Patients stockpiling drugs or simply not taking them account for a large proportion of the waste highlighted.
Of course No Free Lunch is pretty important in this effort.
“One in five GPs indicated they felt that pharmaceutical companies have more influence than [the primary care trust] prescribing advisers,”
Perhaps pharmacists might be better used to provide advice on medicines management rather than becoming diagnostic assistants treating patients independently.
A look at Diabetes related illness & the fact that it accounts for 10% of NHS spending.
The Guardian profiles a GP practice that provides an interesting model of midwifery care. But we are told it is too expensive. I wonder if we have our priorities wrong.
Many women see different health professionals throughout their pregnancy, labour and birth, and postnatally, but Oakwood’s women are given a named midwife who carries out nearly all of their antenatal and postnatal appointments and in many cases delivers their baby at home or in hospital.
“This type of service offered by Oakwood is considered too expensive and too demanding for midwives by many in the NHS,” said Newburn, “but if you look at the overall ratios of midwives to women it looks like it could be possible for far, far more women to have this kind of care.”
And I am surprised that there are not more stories like this one.
Despite asking instead if she could stay in the waiting room until someone could come and collect her as she couldn’t afford the £40 taxi fare, she was discharged at 2:30am. Miss Beale, who has no family, then spent six hours on a bench in the hospital grounds before walking into the city in her hospital slippers.
Once upon a time this would have been dealt with sensibly.
I used to work in Manchester around the turn of the millenium & was thankful for the introduction of unbreakable pint glasses there. I can’t believe that there is still a reluctance to introduce them nationally.
The MP John Grogan, chairman of the All-Party Parliamentary Beer Group, said: “We are calling for a sensible approach rather than a blanket ban. Banning glass is the wrong way to attract a wide and diverse set of customers.â€
Nathan Wall, operations director at JD Wetherspoon, who attended the BEDA meeting, said: “There’s a philosophical difference between us and the police. They are of the view that one glass injury is one too many, but ultimately we have to consider that we are punishing the vast majority.â€
Alcohol awareness campaigners claimed recently that a typical glassing incident costs the NHS £184,000 to deal with, before the cost of a police investigation is added to the equation.
Now I am not able to understand the reasoning behind these statements but I guess that I am not qualified to be a connoisseur. What exactly is the punishment? On second thoughts, don’t bother explaining. But aren’t metal tankards more traditional?
A clutch of letters in the papers today with some propounding the view that “Increased spending is not the answer” for the NHS. To me it is part of the answer as the correspondent quoted explains.
The answers are simple and well known within the service. First, the austerity years under the Tories led to a massive backlog in capital expenditure, notably for repairs and rebuilding. Redressing this has soaked up funds with little immediate effect on care outcomes. Secondly, and more importantly, the NHS for 50 years was predicated on the basis of the trust and sacrifice of its workers at a time when vocational commitment meant long hours for little reward. When politicians, in a desperate attempt to find cheap solutions to NHS ills, declined to believe the hidden value of this benevolence, and demanded contractual rigidity and centralised control, they dissipated that goodwill and found to their cost that they had underestimated its contribution severalfold. To their shame they are now engaged in a desperate scramble to reverse their largesse.
And “Choice” is debated as well with a few interesting participants.
So is this realism or undue pessimism?
“Today only 30%, we estimate, of our projects and programmes are successful. Why shouldn’t it be 90% successful?” he said in a speech to this week’s Government UK IT Summit, reported in Computer Weekly. “It’s about improving performance in projects and programmes and our day-to-day services as well as our procurement processes.” Predictable weaknesses such as inadequate requirements were often to blame.
I have to agree & these are not limited just to IT projects. I have raised the same concerns regarding a number of DoH programmes.
Stephen Timms, chief secretary to the Treasury, was more upbeat in a speech to the same conference, brushing aside criticisms of the NHS IT programme, describing the scale of the scheme as “heroic”.
Not sure that I wan’t heroic to be the word used.
A DWP spokesman said the figure Mr Harley quoted came from an independent report with “very narrow criteria”, which was also highly critical of private sector projects. “Only projects which were on time, on budget and exactly to specification were deemed a success. If they never saw the light of day they were deemed a failure. Anything in between - around 63% of the projects - was deemed neither a success nor failure.”
Seems fair to me & not particularly narrow, though details of the report would be welcome.
Not a get out of jail free card this time but better than James Johnson / Carol Black at the very least given that the BMA is haemorrhaging members after its recent shennanigans (700 resigning in just one day). This is unlikely to cut much ice.
As you are aware, the failure of MTAS, the application system into the new ‘MMC’ training programmes has been one of the most negative and destructive events in medical training in recent years and has damaged confidence in those bodies involved. Among those are the Royal Colleges, whose statutory responsibility for training doctors was taken away and transferred to PMETB but who are still perceived by many junior and senior doctors to have failed to intervene – indeed been complicit – in the failures of the last few months. We have been deeply damaged by insistence that “The Royal Colleges’ agreed to these changesâ€. As responsible professionals we have worked with the Department of Health in its wish to train a medical workforce in a way it perceives as appropriate for the NHS for which it has responsibility. We have however repeatedly expressed concerns and caveats that have gone largely unheeded. There has been consultation but little true listening.
Th Royal College of Physicians has been slightly ahead of its compatriots by virtue of having a more switched on PR department & has responded to the concerns of its members. This letter would have received a much stronger welcome a few months ago & the medical establishment needs to learn when to walk away from futile exercises. But they are trying & that is a sign of progress.
Especially curious is the revelation by the Department of Health during the hearings for the judicial review that MTAS was work in progres
The legal team for the Secretary of State for Health presented a second witness statement by Mr Nick Greenfield from the Department of Health.
In it he states that the matching algorithm (that underpins the MTAS computer system) was not, and is not, functional or reliable.
Mr Greenfield states “The decision not to proceed with MTAS for matching candidates to training posts was taken as a result of recent security difficulties and the fact that the Defendant could not be certain that the algorithm necessary to operate the ’single offer system’ would be effective.”
Further, this had been raised with the Review Group in early April. To add insult to injury he concludes “the required algorithm… was a ‘work in progress’”
The judgement is expected in a week or so.
And as for the Tooke inquiry, I will update this later.
The claim that nearly half the A&E departments in the country are under threat has people up in arms.
“Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people.â€
So where does this figure of 450,000 come from?
A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.
Common sense I would have thought.
A Department of Health spokesman said there was no such official guidance from his department. “It is absolute rubbish to suggest that we are demanding the closure of A&E departments.
But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E department in North London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.
There is a difference between densely populated north London (not that I am in possession of detailed knowledge about the area & hence am not commenting on the specific merits of that particular proposal) & the greater geographical spread in Surrey, not just in matters of distance but also in terms of demand for services. Surely decisions at SHA & PCT level do not just parrot “guidance” but involve public health experts & frontline clinicians in the design of services? I have been increasingly concerned at the lack of clinical involvement in these decisions.
The RCS has clarified that it is only asking for major trauma facilities to be concentrated.
Dermot O’Riordan, of the Royal College of Surgeons, said: “Very major trauma cases with multiple injuries like road traffic accidents are more likely to survive at specialist centres, but local emergency departments should stay open to focus on what they do well.”
Yes, but how do you get them there in time? Are we prepared to invest in an increase in HEMS / med-evac helicopter capacity? Or will existing ambulances simply have to travel further? There is a lot more to this & the intemperate closure of existing services without having appropriate validated replacements in place is rather dangerous.
Though the argument is made that time is not an issue.
Ambulance crews are now well-trained paramedics able to stabilise patients and give emergency treatments. Except in rare cases, the time taken to reach hospital is not critical.
“Long ambulance journeys do not lead to more deaths,†said Sir George Alberti, the former national director for emergency access.
Specialist A&E units, fewer in number and therefore farther for most people to travel, would save more lives, the Government asserts.
So do we “scoop and run” or “stabilise and treat”? The fashion varies over the years (the discussion of the treatment recd by Diana Princess of Wales was a case in point) & I am not too sure that members of the ambulance services would claim to be capable of doing what is suggested. Especially since I have highlighted earlier the move to replace one of the paramedics on a two man crew with a driver / technician with 8 weeks training. It is called integration, or one hand knowing what the other is doing.
Yes, we need to be more flexible with ambulance protocols, not just dumping patients at the nearest hospital. But these reconfigurations need to be based on the practical, not a theoretical possibility.
The doctors either disbelieve the claims, or use a more subtle argument to justify retaining an A&E. They say that loss of emergency services risks destabilising the hospital, and reducing its capacity to do other things.
An A&E requires the services of orthopaedic surgeons. Without an A&E, it is harder to sustain the necessary numbers, and the ability of the hospital to do elective orthopaedic operations is diminished. Costs rise, and it becomes uncompetitive. So closure of the A&E can have knock-on effects.
They ask why these clinical arguments for closures have emerged at a time when the NHS is short of money. The coincidence suggests that cash, and not best practice, is driving the changes.
I have to concur.
This was endorsed by the National Leadership Team, a body that advises the Department of Health, and a document produced by a local primary care trust described this as “national guidance”.
Either this is an oversimplification of the output from the advisors (with all caveats removed) or they have become remote from the day to day struggle to provide care & do not any longer represent professional consensus.
The DoH frequently sends out “guidance” of this nature procured from a variety of sources. It is incumbent on PCTs & SHAs to apply their minds to these documents & not take them as gospel. That is the whole reason why the professional component of NHS structures needs to be strengthened.
The proposals in the expected update of the Human Fertilisation and Embryology Act 1990 are highlighted in the BBC with implications for abortion services as previously mentioned.
What palliative care? I would be hard pressed to find many such services.
I have my differences with the hospices as I feel that they give up too easily. Patients are promised visions of personalised inpatient care in clean comfortable facilities if they decide to cease intensive treatment, as compared to the mad bad & dangerous world of acute hospitals.
But my argument is that every patient should be receiving such care, not just the ones at deaths door & hospices should not force patients to make such a choice, especially given the advances in medical treatment. And children’s wards are an idyll compared to adult wards.
The speculation over Isoft’s future takes up more space with questions being asked about IBA’s health.
IBA’s full-year results show very poor conversion of profits into cash. In the year to June 2006, profit after tax was A$15.3m (£6.4m), while cash inflow was just A$421,000. Profits after tax in 2005 were £14.4m, but the company recorded cash inflows of £6m.
I presume that the advisors at both ends earned their money having examined the books in detail but will wait to see what comes out.
A move to Sydney is also mentioned.
The group at the heart of the NHS software upgrade will move to join its suitor, IBA Health, in Sydney after it struck a £233 million deal to create the biggest healthcare IT company outside the United States.
Size isn’t everything. All companies have to start small somewhere & it is their products that determine prospects & reputation. Isoft’s current products are at-least 2 generations old & need to be replaced soon.
Especially as the BMJ highlights the dangerous state of information systems currently.
One hospital IT manager told researchers: “It’s been urgent that [the system] is replaced all the time I’ve been here, which is about three and a half years … It is a clinical risk.” Another said the system still being used at his hospital was “not just obsolescent, it’s obsolete”. The trust had had to buy computer parts on eBay and get them shipped from the US.
The last four years have been a distraction & a disappointment. But trusts have put off any IT plans since at-least 2001 with the expectation that the DoH would deliver, strangling any innovation in their own backyards in the meantime. This is a failure not just of CfH but also of business planning at the various trusts themselves.
The expected public sector summer of discontent comes closer to reality as the RCN vote to ballot their members for strike action as promised at their annual conference.
The RCN met on Wednesday to discuss their options after an emergency motion passed unanimously at the RCN conference in April called on the government to implement a full 2.5% pay rise as recommended by the independent pay review body.
The Royal College of Nursing ballot will ask NHS members whether they want to be balloted on what would be the first ever national industrial action.
The first move to coordinate strike action was announced yesterday when Dave Prentis, general secretary of Unison, the country’s second biggest union, released a letter saying it and the Public and Commercial Services Union (PCSU) should coordinate industrial action in hospitals, health centres, Whitehall departments, jobcentres, courts, museums, art galleries and the coastguard service.
The PCSU conference voted unanimously to escalate strike and industrial action in Whitehall. There have already been two one-day strikes, with the Cabinet Office acknowledging that 119,000 people took part in the last action on May 1, which hit jobcentres, tax offices, driving tests, courts and museums and art galleries.
And what of medical training, with the second day of the judicial review scheduled for today in the High Court?
Thomas de la Mare, representing Remedy in the High Court, said key decisions with a direct and serious impact on doctors were being made “without any form of notice or consultation”.
In a court packed with junior doctors and their supporters, he said MTAS was now “so conspicuously unfair as to amount to an abuse of power”.
And he said it was mystifying why the British Medical Association, the doctors’ trade union body, was not supporting its call.
Ah, but the BMA & the Academy of Medical Royal Colleges are busy brown-nosing.
We restate our support for the Chief Medical Officer and his role in improving junior doctors’ training. He pioneered the principles underlying the reform programme. Serious though they have been, it would be a far-reaching shame if those principles were obscured by recent problems with the online application system.
The problems with the applications were just the tip of the iceberg. Unvalidated educational theory is being forced down an unwilling profession in the form of the current implementation of MMC. Yes, it would be nice for example to cut the period of postgraduate training from 12 years to eight but to do so without increasing the educational content of those eight years is not realistic & can only deliver decreased standards. First show concrete proposals to improve the quality of training & then we can talk about cutting the time required.
There are a number of letters related to healthcare in the Telegraph today with Monitor coming on board to defend it’s handling of the Royal Brompton.
The application from the Royal Brompton and Harefield NHS Trust is being dealt with in exactly the same way as is any other applicant’s, and the standards required of it are no different. The assessment is in process and no decision has been made.
William Moyes, Executive Chairman, Monitor, London SW1
MTAS & budgets get a mention too.
Sir - You report (May 16) that the notorious online application process for junior doctors is to be scrapped. Unfortunately, as you imply, this will do nothing to alleviate the present crisis. The appointments of doctors to thousands of posts, due to start on August 1, have yet to be made.
This week, doctors are being called for interview with no more than 48 hours’ notice. Indeed, I know of candidates being telephoned abroad to attend for interview the next day. Regrettably, this callous approach by administrative staff to dedicated young men and women has prevailed in the NHS for some years now.
Thousands of doctors will have less than two months to prepare for their next job. Many will have to move considerable distances to find new homes, with consequent serious effects on their spouses’ careers and family life. Other well-trained physicians and surgeons will simply be unemployed.
Professor Robert Rubens, London SW19
Immediately after Mr Prescott, Patricia Hewitt came to the Dispatch Box to answer an emergency question about junior doctors put down by the Tories. Miss Hewitt was, if possible, even more useless than Mr Prescott.
She is another member of the doomed and discredited crew who no longer even pretend to have any kind of control over the ship of state.
The day developed a theme. Before the debate on Home Information Packs, the Speaker allowed an Urgent Question on Patricia Hewitt. The question was: “Why on earth is she still Minister of Health?” I thought the answer was obvious but Andrew Lansley muddied the waters sufficiently to let her escape into the murk.
The computer isn’t that important to the doctors’ training places fiasco. The first rule of computing is: sewage in, sewage out. It isn’t the computer saying that one failed interview prevents you ever becoming a consultant.
No, it’s Mrs Hewitt saying that, or someone very like her. It is she who should pick up the can of sewage and carry it outside, closing the door behind her.
As mentioned a couple of days ago, the 2006 Patient Survey results were published today by the Healthcare Commission. The Guardian
The Healthcare Commission found 30% of inpatients have to share bathrooms or shower areas with the opposite sex, in spite of government guidance that the practice is upsetting, particularly to women.
It identified a handful of trusts where most patients have to wash in mixed-sex facilities, which rarely exist in public buildings outside the health service and which ministers claimed to have eradicated. At St Mary’s teaching hospital in central London, 59% of patients shared mixed-sex bathrooms.
The commission’s huge survey of 80,000 inpatients’ experiences also found that 20% of people who could not eat without assistance said they did get enough help.
The target culture is of no benefit whatsoever in producing real improvement.
The commission praised the NHS for achieving persistently high levels of patient satisfaction. The survey, conducted last autumn, found 90% rated the overall standard of care as excellent or good, with only 2% saying it was poor.
But after drilling down into the details of patients’ experiences, it found many hospitals failed “to get the basics right”.
You can give a building that is in disrepair a new coat of paint but that does not fix the structural problems.
British Medical Association consultants’ committee chairman Dr Jonathan Fielden said: “It is gratifying that this survey reflects the immense efforts from doctors to improve the quality and experience of care for their patients despite the financial pressures placed upon the health service.”
“It is the political meddling that gets in the way, diverts attention and leads to so much of the waste.”
The Guardian goes on to suggest a path for Gordon Brown to follow.
Compare now the patients’ views about what the NHS is really like with opinion polls showing what the public thinks about the government’s handling of the service. While the inspectorate was questioning patients last autumn, an ICM poll for the Guardian found only 25% of voters thought the NHS had improved since Labour came to power in 1997, compared with 30% who said it had got worse and 39% who said Labour had made little difference. In spite of all the extra billions that Brown, as chancellor, poured into health, Labour has been trailing behind the Conservatives on territory that it used to dominate.
Brown’s advisers must ask why the NHS’s reputation is so bad when its service is regarded by users as so good. Perhaps the most plausible reason is the persistent bad-mouthing of the NHS by its staff and by the media. A service with 1.3 million employees, including many of the most trusted professionals in the land, ought to have 1.3 million goodwill ambassadors. Instead they are, for the most part, disgruntled and fearful that their service is on a slippery slope towards privatisation. In spite of substantial pay rises over recent years and recruitment of extra staff that should have reduced work pressures, the mood of optimism that greeted the NHS plan in 2000 has dissipated.
The disregard shown towards staff is being repaid in full.
Every health minister I can remember has gone on a listening tour, or held an expensive consultation exercise, round and round the roundabout, and they got the same answer: patients want shorter waiting lists, a GP who will visit them, an A&E reasonably near by. Health service staff want more pay and fewer reorganisations. Who do you listen to?
Quite often what patients want & what staff advocate are not too different, within the realms of the possible of course. There will always be a few quibbles.
We have had new types of hospital and a far wider use by the NHS of private treatment centres, walk-in centres and NHS Direct. Everyone has had new contracts, with nurses taking on greater responsibilities, consultants taking on extra money and GPs devolving responsibility for out-of-hours services to others (while taking on extra money). There has, generally, been a public consensus supporting all of this. Taxes have risen a little to fund it.
And then Patricia Hewitt came along, brandishing a Bold Reform Agenda that encompassed closing down much-loved hospitals across the country in the name of “care closer to homeâ€, greater efficiency and super A&Es not yet established. At the same time the Treasury cracked down on previously hidden debts and, hey presto, like a too busy consultant magicking a private appointment out of his diary, the Government magicked defeat out of triumph. Its ratings on the NHS have plummeted and with them trust in the Government, and the Tories have taken the lead – despite having no health policies to speak of at all.
Masterful inactivity has something to be said for it after all.
After all, just how does one re-negotiate a contract signed just three years ago?
The Health Select Committee has looked at hearing aid provision but there is more to come.
Paul Hodgkin who runs Patient Opinion evangelises the benefits of a two way conversation in the Guardian.
The NHS concentrates on efficacy and efficiency but these are aesthetic aspects of care. Questions such as: were you included in decisions? Did staff make you feel precious or worthless? are just as important. Too small to be dealt with by formal contracts, they gain some bite by being voiced on the public space of the web. Add comments from patient groups, and feed these conversations back to hospitals and primary care trusts, and the small voice of the individual can become the kernel of real change.
Again, paying attention to the requirement for basic care might be an idea.
It looks like IBA Health have finally bought Isoft for £140 million along with liability for debts to the tune of £89 million. Let us hope that they have rather more luck with Lorenzo.
Update:
It appears though that CSC has still not given its blessing.
IBA had come close to abandoning a combination with iSoft less than two months ago after becoming frustrated at CSC’s position. A number of other potential bidders for iSoft - which has been in talks with a string of suitors for seven months - are understood to have lost interest soon after talking to CSC.
So in this game of hardball, I imagine that CSC is having to satisfy CfH of the fitness of IBA to complete the deal.
More crystal balls in evidence at the Independent with its own version of Gordon Brown’s plans:
THE NHS
Said by allies to be his “number one priority”. Labour has lost its lead over the Tories on the health service, despite spending billions on reform. Mr Brown is said to be “appalled” at nurses being sacked and plans to call a halt to the expansion of private health care in services by hospital trusts. That will be hailed as a victory by unions who have been mounting a vigorous campaign against the Government over the “privatisation” of the health service which could prove highly damaging in the approach to the next general election.
But it will alarm some who fear he is turning the clock back. This is denied by Mr Brown’s allies who believe that the NHS hospital trusts wasted taxpayers’ money by paying the private health sector to do its work, including expensive agency nurses while home-produced nurses were denied jobs.
Mr Brown is not halting other NHS reforms. Tomorrow Andy Burnham, the Minister of State for Health, is expected to call for private companies to be offered the chance to run family doctor services in 30 “under-doctored” areas. That may seem to contradict Mr Brown’s approach, but his defenders say GPs are already private contractors and bringing in companies to run services will “put a rocket up them”.
Well, we have a few weeks to wait.
A question proposed for the GMC consultation about consent out later this month:
“Does withholding of information about treatments that might be in a patient’s best interest but are available only either in the private sector or abroad constitute a contravening of GMC guidance?”
It will be interesting to see what the consensus is on that one.
More on Romania from the Independent with it being used to show the pitfalls of rationing.
If the British Medical Association is serious about rationing treatments on the NHS, it might care to examine what is happening in Romania.
In a report to be published this morning, the BMA will launch its plan for the future of the NHS in England. It will say that despite the billions of pounds poured into the health service over the past six years, there is still not enough cash to pay for everything. We must, therefore, kiss goodbye to the idea of a universal service available, free to all on the basis of need, and accept that some of what the NHS does it must cease doing.
This is a conclusion the Romanian government reached last year when it took radical action to curb health spending. In September, it eliminated medical oncology as a separate specialty, slashing at a stroke one of the high-cost areas of medicine, on the grounds that cancer patients are not economically productive. In future, oncology services will be provided as part of the broader specialty of internal medicine, reducing expertise and limiting access to treatment. Yesterday, the decision brought some of the country’s 370,000 cancer sufferers on to the streets of Bucharest in protest.
The BMA’s thinking seems to be that cuts hurt, but they hurt less if they are self-inflicted.
I have to agree with the thrust of the analysis. The savings to be made as minimal & just what is the BMA doing anyway? Rationing is a consequence of available funds against public priorities & while the BMA can & should call for an open debate about rationing, it should not be setting itself up as an interested party calling for rationing to be introduced.
Isoft moves closer to being sold with IBA Health seeking to raise funds.
The Australian stock exchange agreed to a four-day suspension to allow IBA Health to seek extra capital from institutional shareholders. ISoft said it had joined talks between shareholders and IBA as both companies sought an agreed deal.
IBA Health is asking for a debt facility of £82m to fund the proposed all-share offer for iSoft. It has also reached agreement with investment bank ABN Amro for new debt facilities of £130m for the combined group. It is understood further debt-raising was necessary to refinance iSoft’s crippling borrowing commitments.
Now that the future looks more secure, I hope that Lorenzo is delivered according to requirements.
While the Telegraph highlights Computer Weekly’s report on “major incidents” in the NPfIT.
Hospitals have been hit by 200 “major incidents” in four months because of breakdowns in the NHS’s £12 billion computer system, a report claims today.
The Independent looks at who can claim credit for the reduction in deaths from cardiovascular disease in light of the report yesterday that the fall has been worldwide.
Across more than a dozen countries, deaths among patients admitted to hospital with severe heart attacks almost halved in six years - from 8.4 per cent to 4.5 per cent. The University of Edinburgh study was the largest of its kind. It covered 113 hospitals in 14 countries and involved nearly 45,000 patients.
Chase Farm hospital in Enfield should be downgraded in spite of a vociferous campaign to save it by Joan Ryan, a junior Home Office minister according to Sir George Alberti, the NHS national director for emergency access.
Ms Ryan had been supporting constituents in her Enfield North seat who wanted to retain a complete set of medical services at Chase Farm. But after a two-month review, Prof Alberti decided there were too many A&E departments in north London and too few senior doctors to ensure patient safety.
He backed proposals from local NHS managers to switch A&E and maternity services to Barnet and North Middlesex hospitals. “Put starkly, it is evident that high quality modern care cannot be provided for all specialities in all three acute hospitals in the area. There are insufficient doctors, particularly at senior level, buildings are inadequate and resources are finite.”
I have a feeling that there are senior doctors available if trusts are prepared to pay for them (the promised consultant expansion has not taken place) and the only real reason is the lack of resources. It is funny then that so much money is being diverted into non-essential projects. NPfIT / CFISSA anyone?
And we heard recently that health visitor numbers were falling with one job lost every day. So who exactly will be providing teenage mothers with “minders”? Not that I think that it is a bad idea, I don’t. I just want it to be resourced properly.
Not exactly a medical issue except peripherally as births & deaths do have to be registered but is it unrealistic to expect any IT system to work properly?
Hundreds of register offices across the country have been ordered to abandon a new online system for recording births, deaths and marriages in the latest IT fiasco to hit the government.
The Times has learnt that the huge £6 million IT project has met with “complete system failure†and online registration has been suspended in half the 3,000 offices.
Registrars have been told that a long-term solution will take “many months†and in the meantime those affected should revert to the old computer system, even though that means none of the hundreds of births, deaths and marriages that occur each day will be centrally recorded.
Design by numbers does not work. Will the people using it move on, please!
And Lord Warner on Channel 4 news yesterday claimed that productivity was not up as expected in the NHS due to a lack of patient centeredness. Can I point out to him that it is the policies he championed while minister that bear a large part of the responsibility? I have banged the drum about integration for long enough.
For example, do walk in centres really reduce GP or A&E workload? Not according to this survey just published.
The response rate was 69% (33,602/48,883). Over the five year period 16% (5223/33602) 95%CI (15.9 to 16.1) of respondents had an unscheduled episode in the previous four weeks and this remained stable over time (p=0.170). There was an increased use of telephone help lines over the five years, reflecting the change in service provision (p=0.008). However, there was no change in use of traditional services over this time period. Respondents were most likely to seek help from general practitioners (GPs), family and friends, and pharmacists, used by 9.0%, 7.2% and 6.3% respectively of the 5815 respondents in 2002. Most episodes involved contact with a single service only: 7.0% (2363/33,602) of the population had one contact and 2% (662/33602) had three or more contacts per episode. GPs were the most frequent point of first contact with services.
Conclusions
Introducing new services to the provision of unscheduled care did not affect the use of traditional services. A large majority of the population continued to turn to their GP for unscheduled health care.
A reminder that Panorama is tonight.
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