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?
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.
So what are we to believe?
That Blair regrets the wasted earlier years during which he took cautious steps to change matters (which the public feel happy with)?
And that the ideologically driven current “reforms” have made the NHS “much healthier now” (opposed by most of the public)? Funny how he can be so out of touch with the public.
Lord Falconer, the Lord Chancellor, and one of Mr Blair’s closest cabinet aides, told the Guardian that up to three years after the 1997 Labour victory were marred by slow reforms in areas such as health, education and welfare.
The Prime Minister’s own assessment of his time in office is markedly different to the views of voters as reflected in today’s Telegraph YouGov poll, in which two thirds of respondents said Mr Blair had been proved wrong in his election slogan “Things can only get better”.
While, in his own view, the Prime Minister’s increasingly aggressive policy will form a strong and positive component of his legacy, the Telegraph poll shows that voters take the opposite perspective, judging that Mr Blair started well and ended “mediocre or worse”.
Short term gains have been prioritised over thoughtful analysis & considered improvements. The predominant mood in the NHS is one of frustration.
Todays speech at the Kings Fund highlighted reduced waiting lists, “huge” investment in staff and 154 new or planned hospitals as proof Labour had “saved the NHS”.
On Monday the prime minister presented reports on progress in four areas - cardiac care, cancer treatment, emergency services and mental health.
Mr Blair, who warned voters in 1997 they had “24 hours to save the NHS”, used the event organised by the King’s Fund think tank to set out why he feels he has been successful.
“Ten years on, high quality care on the NHS is no longer the preserve of the lucky or the well-connected but genuinely universal, still free at the point of use and focused on those who need it most,” he said.
“We have ended the era of uniform, monolithic provision in the NHS. We have put new incentives into the system and devolved power to the front-line and communities to continue accelerating progress.”
The increased money was welcome. No one denies that there have been improvements. What did not help however was the orgy of unnecessary changes that came along with it. That these are likely to cause long term damage to the NHS is the whole point everyone is making.
The dental contract comes under more scrutiny.
Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract.
Some dentists face repayments of tens of thousands of pounds, and in a few cases more than £100,000. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.
Many dentists – nobody yet knows how many – have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid.
One dentist said that the contract had turned him into “a UDA factoryâ€, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.
A survey by the British Dental Association (BDA) found that 61 per cent of practices expected to miss their targets. There are about 20,000 NHS dentists, so as many as 12,000 could face financial penalties. In practice the number is likely to be smaller, because as long as a dentist achieves 96 per cent or more of the target, the money owing can be paid off in the next year.
The BDA figures are backed by a smaller survey by Denplan, a company that provides dental payment plans. This found that 53 per cent of the 122 dentists that it approached expected to miss their targets by enough for their PCTs to insist on “clawing back†money, and that they would receive a smaller contract next year. Another 13 per cent said that they expected to be asked to return money, but to be given the same contract.
“There is a huge potential for supervised neglect.â€
The BDA has told the Government that alternative ways of monitoring dental contracts must be found. “UDAs are fundamentally unfit for purpose,†Lester Ellman, chairman of the BDA general dental practice committee, said in a letter to the chief dental officer for England, Barry Cockroft.
A blueprint for a shake-up of the NHS in England when Tony Blair’s successor takes over as prime minister in the summer has been provided by Labour in its campaign for this week’s elections.
Plans for full health checks for all men at 40 and free vaccination for girls against cervical cancer are among a dozen new policies in the party’s programme for Scotland.
They are strikingly different from policies being pursued in England by Patricia Hewitt, who is not expected to remain as health secretary if Gordon Brown becomes prime minister. Her successor will need fresh ideas to erode a Conservative lead in opinion polls on the NHS.
The policies include reform of prescription charges and hospital car parking tariffs, salaries for student nurses, speedy access for all patients needing chiropody, physiotherapy or clinical psychology, and a crackdown on shopkeepers selling alcohol or cigarettes to children.
The chancellor has not allowed his friends and advisers to speak about the health policy changes he might make during his first 100 days in No 10. They have privately met leaders of the NHS in England, but only to listen to their views and not to test reaction to Mr Brown’s ideas.
We have had enough of ideas imposed from on high with little consultation. Can we have a change from that please!
The Guardian continues reporting on Isoft with a statement this morning that talks over a possible takeover have reached an “advanced” stage.
It revealed today that discussions with potential buyers had taken longer than expected, due to concerns over its role in the National Programme for IT (NPfIT), but insisted that a deal was close.
“Discussions are well advanced with several parties, both trade and private equity, and the company will make a statement about the outcome as soon as is appropriate,” said iSoft.
ISoft also admitted that it must still address its long-term financing. Its current credit facilities are due for renewal on November 14, and it said today that it should be able to operate as normal until that point.
Matthew Jamieson Evans from Remedy UK guest blogs on Sky news.
If anyone had approached me to write an online blog a few months ago I’d have probably answered with something unprintable. In fact today I can already feel a level of embarrassment that I’m going to have to do my best to control over the next few days.
Deep breaths Matthew, it shall pass.
The Health Select Committee has published the written evidence received by it regarding the Summary Care Record service. This can also be read online.
There is too much to precis but it boils down to an overambitious and oversold plan, insufficient definition of the specs, inadequate consultation during planning, a botched tendering process, poor engagement with users and the public & finally a lack of understanding of working practices & software design among those charged with implementing the solution. So pretty much everything. Too much of a reliance on a group think mentality & freezing out dissenting voices did not help either.
It appears that the Public Accounts Committee isn’t about to let go either.
Speaking in the Commons on 19 April, Edward Leigh, chair of the PAC, said: The Government should not use the excuse of saying that although a particular report is fine and that they agree with it entirely, it is based on a National Audit Office report that was published nine months or a year ago and therefore all the excellent recommendations are already being implemented—when, on certain occasions, the Government, or rather accounting officers and their civil servants, have delayed the whole process. The process relies on the National Audit Office reports being agreed between the National Audit Office and the Department and there is often a long period of negotiation.
That was particularly apparent in the recent important report on the NHS computer system—a system that is worth about £12 billion. I notice that the Government’s response this week says, “Well, excellent report by the PAC, but we’re doing all this—it’s an out-of-date report.” I am going to call the Government’s bluff. I have talked to the Comptroller and Auditor General about the matter and, following my encouragement, we are to have another NAO report on the NHS computer in the next year so that we can have an update to check whether all the excellent recommendations of the NAO and the PAC on this £12 billion computer system—that amount is equivalent to the entire cost of the Olympic games—are being carried out.
The General Medical Council, Information Commissioner and the Department of Health have agreed a joint statement to ensure that all those who have access to patient information in the course of their work are clear about what is expected of them.
A bit weak & lacking in specifics with very little focus on informing patients but it is a start.
Maybe there is a reason why the govt wants to ban all consultations on healthcare reconfiguration proposals other than those with a substantial impact. They wouldn’t then have to deal with pesky pensioners making trouble, when after all the DoH know best. (I did not say that it was a good reason, pay attention!)
Pensioners led by Donald Giddings, a 78-year-old heart patient, are challenging the way in which the decision to downgrade health services in the Hertfordshire town of Hemel Hempstead was made.
This week, the High Court in London set a date for a judicial review that will examine claims by the Dacorum Hospital Action Group that the views of the public were “misrepresented” during the consultation over the proposed changes.
The group, represented by Matrix, the law chambers of which Cherie Booth, the Prime Minister’s wife, is a member, claim that their views were ignored during a consultation led by John Underwood, a former Labour spin doctor hired by West Hertfordshire Hospitals NHS Trust last July.
The consultation failed to ask them about plans to close Hemel Hempstead General Hospital’s accident and emergency department, which had already been discussed alongside plans to build a large hospital elsewhere in the county.
None the less, thousands of members of the public told the trust that they did not want to lose their casualty department. However, when health chiefs admitted last November that they could not afford to build the new hospital, they said that Hemel Hempstead would still be stripped of most of its services.
“Cooked” surveys & consultation exercises which aim to produce a report supporting policy goals desired by those in charge can easily be recognised and are not worth much. Accusations of politically driven policy are already being thrown around.
I will admit that I am teetotal & therefore can be accused of wanting to force my opinions on people who are merely enjoying themselves by supporting a ban on the advertising of alcopops. If Patricia Hewitt does really go ahead with this, I will count it as one of her more sensible interventions. ‘Why do I feel this way?’, you are entitled to ask. Years of exposure to completely wasted teens & pre-teens during my time in A&E along with a feeling of horror that the harm done to thousands of babies is not being recognised. The Telegraph highlights the dangers of foetal alcohol syndrome.
Foetal Alcohol Spectrum Disorder (FASD) is the umbrella term for a range of disorders caused by a mother drinking alcohol while pregnant.
With 750,000 live births each year in this country, it is a condition that affects 7,500 children annually - more than the combined number of babies born with muscular dystrophy, spina bifida, HIV and Down’s syndrome.
A recent study indicated that 61 per cent of women don’t cut down at all, and a survey carried out by St George’s hospital in London revealed that just under 50 per cent of mothers visiting the teenage antenatal clinic drank more than four units on a single occasion and 27 per cent admitted to at times “getting drunk”.
In Britain, teenage drinking is much more widespread among girls than boys, with almost 30 per cent of under 20-year-olds confessing to drinking to excess at least three times a month.
And as for smoking, I won’t be shedding too many tears about this either.
The sale of packs of 10 cigarettes - attractive to teenagers because they are cheaper - would be banned and cigarettes kept out of sight in shops.
The proposals, contained in a report from the British Medical Association, also include plans to compel retailers to obtain licences to sell tobacco, to outlaw tobacco vending machines and impose regular and above-inflation price increases to try to cut demand.
Accusations of supporting the nanny state bother me not a tad.
And this intervention sounds like it has the right combination of solid theory & practical implementation to make it work. I await details of the MEND programme with interest.
Time and motion studies make a comeback
The NHS Institute for Innovation and Improvement, a Government agency set up to improve efficiency asked staff at four hospitals to track the amount of time their colleagues spent on different tasks. Particular problems, such as the way mealtimes were organised, were videoed so that staff could suggest ways to speed it up.
A reasonable method as long as not taken to extremes.
Nurses spend less than four hours in 10 treating patients, because of the demands of paperwork and poor hospital layout. They spend a quarter of their time hunting for equipment and drugs or, because of poor design, walking around the ward. Almost as much time was lost to paperwork and handovers between staff changing shifts.
The findings come as a separate survey of 1,300 nurses by Nursing Times revealed that nine out of 10 blamed a lack of time for poor patient care. Almost half had to leave the wards “unacceptably” often, in order to pick up missing equipment or supplies, while more than 40 per cent said they had to take on portering duties too often. Three quarters described themselves as frustrated.
Plenty of us can sympathise.
Liz Ward, a nurse manager at Barnsley Hospital in South Yorkshire, one of the hospitals involved, said that the study showed that technology distanced staff from patients, with records held on computers at hubs, rather than on paper by the beds. Her ward is piloting a return to the traditional system.
“A paper system by the bed means the nurse is actually with the patient when she is taking the notes,” she said.
I wonder how much notice is going to be taken of this example!
The Independent (which is becoming more of a tabloid with its idiotic crusade about mobile phones & Wi-Fi) covers the problems caused by the increasing problem with obesity.
Unison warns on the eve of its conference in Brighton that other healthcare professionals might go on strike unless an improved pay offer is made.
Unison national officer Karen Jennings outlined this stance before the start of its health workers conference.
“I think a strike is certain if we can’t get the government to come back to the table and talk”, she said.
“Our members are extremely angry and this is going to be very, very clear from conference when we leave it - what course of action we’ll be taking and this will be on the back of a range of other health organisations who are also very, very angry.”
Hilary Benn has been heckled at the conference for parroting New Labour talking points.
After speaking at the conference about the role of unions and the government in helping people in poorer countries, Mr Benn took questions from delegates.
One asked: “Why doesn’t the government continue to provide an example to the rest of the world on how to deliver health care and keep the NHS going, rather than going down the road of following the American method of putting greed before need?“
Mr Benn responded saying the NHS had 85,000 more nurses in the past decade, adding there would also be a 10% increase in the funding available to the NHS.
A fact that this correspondent to the Telegraph’s letters pages illustrates:
Sir - On my way back to the ward today from life-support training, given by a disgruntled paramedic, I bumped into a tearful pharmacist whose pay had just been slashed by “Agenda for Change”.
Then, on passing the doctors’ mess, I waved to two of my colleagues who are leaving medicine before being forced into unemployment, and entered the ward only to interrupt the nursing handover, where industrial action and ward closures were being discussed angrily.
Luckily, I didn’t meet any jobless physiotherapists or overworked midwives en route or I might have become rather depressed myself.
Well done, Patricia Hewitt; as the Secretary of State for Health, you have successfully managed to destroy any staff morale left in the NHS across almost every specialty. Do you really think it will be long before patient care suffers?
Dr Graham Robertson, Glasgow
An intriguing mention in the Guardian of the proposed launch of an insurance policy from WPA guaranteeing the availability of chemotherapy if diagnosed with cancer.
The policy gives access to the most modern and expensive cancer drugs for less than £100 a year. Patients covered by a WPA policy would be treated on the NHS, but the cost of the drugs prescribed would be underwritten.
Speaking of cancer, the Scottish Cervical Call-Recall System (SCCRS) is back in trouble. The earlier concerns were to do with security but it appears that the IT teams north of the border have not learnt from the difficulties CfH has faced. The Herald & the Scotsman cover it prominently.
A new computerised cancer screening system planned for Scotland is unreliable and “dangerous to patient care“, according to GPs.
Doctors are calling for the cervical cancer screening system, which is due to be launched in Scotland on May 28, to be delayed so technical issues can be ironed out.
Hundreds of staff members have taken a two-hour training course to learn how to use the software for the system, but they say there are issues with the equipment and no way to revert to the paper system if the software fails.
The NHS National Services in Scotland, however, insisted the software is “state of the art”, and that, in the event of isolated IT problems, surgeries could revert to the paper system.
GP Jim O’Neil, a member of Glasgow medical committee, said: “We do not have a problem with a national call and recall system, which is a great idea. Our concern is with the additional things they insist happen that are not friendly to the way practices work and we think are probably dangerous to patient care.”
A delay is a lot more palatable than an embarassing failure I would have thought. Or is listening to critical users a sign of weakness?
And finally, an interesting strategy seems to be behind the Terra Firma / Wellcome Trust bid for Boots. The Telegraph & the Times each have a different take on it with some mild spinning against the bid in the Guardian.
Guy Hands is trying to build an international healthcare empire that would combine BUPA’s hospitals with chemist chain Alliance Boots under an umbrella brand of “Wellness”.
Terra Firm is plotting a joint bid with Macquarie for BUPA’s 26 hospitals and is due to meet Alliance Boots’ management on Tuesday morning to discuss its indicative £11.26p a share for the retailer.
If successful Hands would merge the two businesses in a move that would see him shift Alliance Boots’ focus away from pharmaceutical wholesaling and on to NHS support services and other personal healthcare initiatives.
Sources say Terra Firma and its co-bidder for Alliance Boots medical charity the Wellcome Trust see massive strategic potential in the local pharmacies, following a pilot National Health Service initiative to tender out the running of GP surgeries to private companies.
Meanwhile KKR’s strategy has emerged as wholly different. It is thought the US private equity house plans to make a raft of large acquisitions of wholesale companies around the world. It has already identified two major wholesalers in South America and has its eye on dozens of others around the world.
It is also considering moving into the healthcare insurance market, through a tie-up with a company such as Pru Health.
Terra Firma faces several handicaps in trying to buy Alliance Boots. The healthcare group has agreed to pay an 11p-a-share “break fee†if the board withdraws its support for the £10.6 billion offer already made by the private-equity firm KKR.
And Alliance Boots has agreed that KKR will be given the details of any new bid from a rival if it considers switching its support to the newcomer. In effect, KKR will then have the option to top any competing offer.
I came across this in the letters page of the Telegraph today:
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.
The HSJ for one is asking for Richard Granger to go.
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.
Which brings us to Payment by Results:
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.
As has been stated before, the underpinnings of the tariff are based on little more than myth.
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.
Which brings us to the shake-up in the Department of Health:
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.
One trust chief exec explains what life is like for his trust:
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.
Oh dear, more trouble:
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.
Wasn’t there a Department of Health report just recently urging better consultation?
Does one hand know what the other is doing?
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