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.
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.
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.
Not much has been happening over the weekend I guess other than the BMA Junior Doctors Conference in London on Saturday which made the news by calling for the resignations of Patricia Hewitt & Lord Hunt.
The motion of no-confidence in the JDC executive was not carried but this was the wrong setting for it anyway. And given that the webcast reminded me of those model UN sessions for high school students, I did not expect much else. I am veering towards the view that the hot-house atmosphere of medical schools & the NHS delays the worldy maturity of a number of medics. But the BMA need to be more responsive as an organisation to their members & also to improve their media strategy.
There is though progress on the legal front with the Remedy UK sponsored challenge listed for hearing in two weeks. Both Dr Grumble & the Ferret Fancier go into this in detail.
The cuts come despite a promise by Lord Hunt, the health minister, that last year’s transfer of £340 million from health authorities’ training funds to a contingency fund to help meet the NHS deficit would be a “one-off”. David Nicholson, the NHS chief executive, had also assured staff that training budgets would be reduced “for one year only”.
But even though Patricia Hewitt, the Health Secretary, claimed earlier this month that the NHS financial problems were now “fixed”, six of England’s 10 strategic health authorities have taken £136 million from dedicated training budgets to store in “investment reserves” that will be used to offset future debts.
Figures compiled by the Conservatives show that the impact is greatest in the south and east. South Central, the strategic health authority covering Berkshire, Buckinghamshire, Hampshire, Oxfordshire, and the Isle of Wight, is to reduce its training budget by 12 per cent, and the East of -England authority (comprising Bedfordshire, Cambridge-shire, Essex, Hertfordshire, Norfolk and Suffolk) by 10 per cent.
The surveillance society comes under attack by the Information Commissioner but I fear that he is fighting a losing battle as too many people are complacent, having no understanding of the risks.
Professor Charles Court-Brown, an orthopaedic surgeon at Edinburgh royal infirmary, who has accused ministers and NHS managers of sacrificing the needs of emergency patients by using scarce resources to meet “artificial†waiting list targets.
“There are increasing numbers of surgeons employed simply to do elective or non-emergency work but very few surgeons are employed only to undertake emergency work.â€
Court-Brown’s criticism, which is sure to embarrass Labour, follows the claim last year by Clive Davis, chairman of the British Medical Association’s Scottish consultants committee, that surgeons had been asked by NHS managers to postpone cancer operations in order to bring down waiting lists for wisdom teeth extractions.
I seem to remember that there is an election due there shortly.
The treatment of AMD continues to get traction in the media as does the policy of some PCTs to exclude people from treatment on the grounds of weight or their smoking status. The decision to exclude people from treatment is not a medical responsibility unless there are overriding grounds to do so for either of the above reasons. This is a decision to be taken on a case by case basis with regards to the health of the patient, not as a matter of policy.
Pat Wood, from Sutton-on-the-Forest in North Yorkshire, was told by North Yorkshire and York Primary Care Trust it would pay for one of the drugs only if she goes blind in one eye and the disease then spreads to her other eye.
Margaret Maslowska, 82, from Eastwood, near Nottingham, is blind in one eye and losing the sight in her second eye due to AMD. Nottinghamshire County Teaching Primary Care Trust is refusing to pay for the medication.
Nottinghamshire County Teaching Primary Care Trust issued a statement saying: “We do not routinely provide treatment that is being investigated by Nice until the final appraisal is published.â€
Not a good enough defence, having already been contradicted by the DoH for one. Are clinicians really going along with this?
“Those decisions are being made by individual doctors all over the country. In a few places doctors have come together collectively through the primary care trusts to put in place guidelines for all of their patients.
“This isn’t a matter for managers or indeed Government ministers to decide who gets what operation - it’s a matter for doctors and always has been.
Really? Would any of these clinicians be willing to defend these restrictions publicly or to their colleagues?
This brings me back to my argument about trying to work with a failing policy in the stated hope that you can influence it for the better from the inside. This is a misguided approach & produces no worthwhile results. What you end up doing is providing cover for others to defend those self-same policies.
According to figures from three-quarters of the way through the 2006-7 financial year, one in three hospitals and primary care trusts, which pay for local services, were not expecting to balance their books.
But NHS bosses have insisted overall the health service will break even.
This is because regional health bosses have built up a contingency fund of £450m from savings made to budgets, such as training and public health, and held back £1.1bn of extra funding.
These are not savings. We need to start calling them by their proper name which is cuts in training & services.
First-round offers are due to be submitted to Citigroup, BUPA’s long-standing adviser, this week. Among those queuing up to bid are some of Britain’s largest private equity groups, including CVC Capital Partners, Cinven and BC Partners. Blackstone, the US house, is also expected to bid.
“The sale begs the question, what’s the role of third-way companies that are not plcs or charities,” says Bryan Sanderson, BUPA’s former chairman who stepped down last November. “BUPA is a provident association. It’s about the patients.”
Bryan Sanderson left the company last November, seven months before his official retirement date at next month’s annual meeting, after a disagreement over plans to sell the portfolio of UK hospitals, a key plank of the business. Sanderson argued that as a provident association one of BUPA’s core activities was to provide the best care for patients, which he felt included providing hospital care.
“I have no quarrel with the board but a watershed had been reached,” Sanderson told The Sunday Telegraph. “You have to think about what a provident association is for. At a time when there is a lot of anxiety about NHS hospitals, is this the right time for BUPA to be exiting? A provident association should exist for its customers, they must come first.”
The board’s decision to sell the hospitals business - even thought it only accounts for 11 per cent of sales - raises the prospect that BUPA’s provident status could eventually change and lead to a break-up of the group. It is understood that BUPA has in recent months rebuffed several offers from private equity groups that valued it at more than £5bn.
Instead, the decision to consider the sale of the hospitals, say supporters of the move, is based primarily on the rationale that the business has greater potential to grow outside of BUPA. It has been unable to expand as fast as it would like, notably blocked by the competition authorities from buying Community Hospitals some seven years ago. It has also sought to win NHS business, for example by providing independent treatment centres.
Selling the hospitals would also put to rest long-running suspicions that BUPA’s position as both the biggest health insurer in the UK and one of the biggest hospital providers is a conflict of interest. Although both businesses are run separately, divided by Chinese walls, suspicions have lingered as to whether BUPA, as an insurer, is always acting in the best interests of subscribers. According to BUPA, some 18 per cent of its subscribers are treated at its hospitals.
Operating on its own would also open up new opportunities for the insurance business. One potentially lucrative area of growth for the private sector is in providing commissioning services for primary care trusts - in effect, how they plan and deliver services - under the Commissioning Framework. BUPA has signalled its interest in bidding for these contracts but as both an insurer and a provider of hospital services it could be accused of a conflict of interest; in other words, if BUPA Insurance ended up commissioning care services, BUPA Hospitals would have to be excluded. Selling the hospitals does away with that conflict.
As I have previously mentioned, it depends on what the vision for BUPA really is. I would prefer it to provide services rather than commissioning them on behalf of the NHS, the necessity for which I do not accept. As has been said before, we are importing the wrong elements of the US healthcare system.
So who is right, the govt which claims that only a few hundred mostly non-clinical staff have been made redundant or the unions who say that the number is over 27,000 people in the last 18 months?
It appears that the unions have their figures right. The Information Centre for Health and Social Care (ICHSC) says that the number of people working in the NHS fell by around 17,000 between September 2005 and September 2006, equivalent to 8,118 full-time equivalent (FTE) staff, when part-time workers are taken into account.
Analysis of the figures shows a drop of 5,826 in the number of qualified nurses working in the NHS between 2005 and 2006. However, this figure includes 3,370 duplicate entries for 2006, leaving an actual fall of 2,456.
Equally, there were 18,342 fewer support workers for clinical staff, with a duplicate entry number of 2,719, leaving an actual drop of 15,243, according to the Department of Health.
There were 2,640 fewer managers and senior managers working in the NHS by September 2006 compared with the previous year, with 76 duplicate entries, leaving an actual drop of 2,564. The numbers of NHS staff in some areas increased over the year, leaving an overall drop of 17,390.
Even these figures are disputed with claims that what are called duplicate entries are not really that.
Peter Carter, general secretary of the Royal College of Nursing said the figures confirmed fears deficits were having a damaging impact.
“When you dig below the surface… the headline increase in nurse numbers is made up of double counting existing nurses working extra shifts.”
“Meanwhile, internationally recruited nurses, who make up a significant number of the extra nurses, now face the prospect of having to leave at the end of their contracts under new immigration laws.â€
That dispute then brings us to the claims about GP pay with the release of a revised set of figures down from 30% to somewhere near 23%. But it looks likely that they will have to come down even further. They have removed the employees NI contribution of 6% from the pay figures but left the 14% employers NI contribution in, thus guaranteeing another round of headlines over pay in a few weeks.
It makes for a good PR strategy though, (it is working), to release information known to be incorrect so that GPs get tagged as greedy profiteers & then to let the truth come out in stages over a long period of time. Does no one remember the recruitment crisis that existed just a few short years ago with juniors talking about going on strike & GPs / Consultants being in very short supply? Was it a mistake agreeing to conflate the very necessary correction in pay that needed to happen with the new contracts demanded by the govt, which is one of the reasons why the media find it easy to over-simplify the argument?
But in the real world, in an example of providers cutting the cloth to suit the budget, dentists are reducing the number of complex or expensive treatments they provide on the NHS to match the limited funding offered.
Patients are being offered cheaper dentures, crowns and bridgework, with dental laboratories reporting that demand for more expensive alternatives has plummeted by up to 90 per cent over the last year.
Critics claimed the plunge has been triggered by a new NHS contract that the Government introduced last year. Dentists are offered three payments: £15.90 for check-ups and minor work, £43.90 for fillings or root-canal work and £194 for crowns, dentures or bridges.
But there are fears that many dentists are using cheaper treatments, such as dentures costing £40, because they will receive the full fee.
David Smith, of the Dental Laboratories’ Association, told a conference in Westminster yesterday that there had been an alarming decline in the amount of complex treatment being offered by NHS dentists.
Derek Watson, chief executive of the Dental Practitioners’ Association, said NHS dentistry was being steadily pared down to a “cheap and cheerful” service that offered a limited range of treatments.
The Dispensing Doctors’ Association (DDA), which represents the interests of about 5,000 family doctors in remote areas who dispense drugs directly to patients rather than through a chemist, says that many doctors resent the new system for adding an extra layer of bureaucracy and cost to their work.
The DDA says that doctors will always put patient safety first, but where identical drugs are available from rival manufacturers, many are opting to prescribe non-Pfizer products.
So while the health gap widens in retirement at the same time as facilities are thrown into chaos with little or no integration of service provision, people are still waiting for diagnostics according to new data. The IS Diagnostics contracts were supposed to have come on stream at the beginning of April to help meet the 18 week target but are already in disarray with the failures in the North West causing the DoH to re-examine its procurement strategy.
As I have said before, resources are being wrongly targeted on political priorities with poor analysis of clinical requirements & little regard for sustainability and results.
But her words did not address the thrust of our paper, which is the new demand by patients to “top up” their NHS care. This is a growing trend; on Wednesday, a new product was launched to provide the latest cancer drugs, not yet available on the NHS to NHS patients.
The questions raised by these developments are not easily resolved, but they are important and should not be ignored - especially as they relate to equity of access to new treatments. One way forward, recommended by the Prime Minister’s recent policy review, might be to start the process of defining an NHS entitlement, to eliminate what is currently a postcode lottery in respect of many treatments and clarify the responsibilities of individuals and government.
All the while, Clostridium Difficile cases rise by 8% a year according to the Health Protection Agency (HPA) data which showed 55,681 cases were reported among over 65s in 2006.
From 2004 to 2005, there was a 17% rise compared to the 8% being reported last year, (though this was from a smaller base & was also the time it came into prominence).
There were 1,542 MRSA bloodstream infections from October to December 2006 - 7% down on the previous quarter.
The HPA does not look at deaths although figures from 2004 show that MRSA was mentioned on over 1,000 death certificates in England and Wales, while C difficile was listed on over 2,000.
Overcrowded hospitals running at close to 100% capacity with staff under stress do not help.
Improvement has to come from the bottom up with individual teams improving their capabilities of service delivery. Centrally mandated programs have a very poor record of actually delivering. People end up thrashing around in a frenzy, trying to meet impossible mutually contrary diktats.
So Polly Toynbee blames it all on unbridled consumerism fuelled by Blair’s ideology of choice. And she thinks that NHS staff have a sullen crew who never had it so good & who cannot be trusted to decide in patient’s best interest.
So Tony Blair has arranged to face the enemy to fight it out over a final reckoning at the King’s Fund. He will confront a host of doctors, managers, nurses and patients’ leaders with his record and hear their verdicts, starting a campaign to win the NHS back for Labour.
NHS morale is always at “rock bottom”, but now it’s in meltdown. Unison barracked a health minister this week over a 1.9% pay offer to nurses. Though nurses’ pay has risen in the last decade by a real 25% for the newly qualified, £19,645 doesn’t get them on the mortgage ladder. Doctors are in a fury at being ordered about, despite massive pay rises, better hours and 32,000 more jobs. Patients have persuaded themselves everything is worse, even though they tell pollsters their local NHS is pretty good. Spending has trebled, heart deaths are falling, waiting times for inpatients are at just an average 6.6 weeks and 90% of hospital patients report that their treatment was “excellent”. By almost every indicator, ask any expert, there is no doubt things are very much better.
What’s his legacy? It’s not yet clear that Blair’s market NHS will work. The Commons health select committee gave a devastating portrait of the inadequacy of primary care trusts to commission services. Staffed by juniors, far from being the commanding heights directing more services into the community they are the weakest link, so money is sucked out of them by hospitals willy-nilly. The dash for all-powerful foundation hospitals and private treatment centres may have fatally unbalanced the market in favour of providers. Consultants have always found a way to run the show, and their power is little diminished, but even that little has made them dangerously incandescent.
Meanwhile, the computer system everyone said could never work hasn’t worked, advice ignored. The junior doctors’ employment system is another case of electronic chaos. Some 50 Save Our Hospital campaigns are doing lethal electoral damage locally: shutting dangerously underspecialised A&Es is the right thing to do, but not at the same time as a savage clampdown on age-old deficits, so everyone thinks closures are cash - not clinically - driven.
More serious problems lie ahead. All but abolishing waiting lists has taken the brakes off NHS rationing. Everyone thinks they have a right to everything they have read about on the internet, right here, right now.
So an inability to publicly recognise the concern that NHS staff feel about the direction of the “reforms” doesn’t stop her from admitting the problems herself. And as pointed out, if staff were merely mercenary, they would not bite the hand that feeds them. As a consultant to the private sector as well as the NHS, I have no reason to annoy my potential client base unless there were serious concerns about the prospects for the future of healthcare in the UK.
But even she has to admit that:
The truth is the NHS is nothing like a market. It is a collective agreement to spend a set amount of money as efficiently and as fairly as possible. It is not open-ended - no health system ever is: private insurers strictly limit treatments according to the policy paid. The NHS has always been a better system, but it relies on a measure of understanding by citizens of the nature of the compact.
The Health Select Committee’s enquiry into the NCRS continues but the transcript is not out yet with just a few outlets covering it. Richard Granger says that consultation led to the delays. What consultation?
Dr. Murrison: To ask the Secretary of State for Health what the projected cost was of the Medical Training Application Service at the instigation of the service; and what the latest estimate is of the cost of the service. [126460]
Ms Rosie Winterton [holding answer 9 March 2007]: The projected cost of the medical training application service at instigation was £5.8 million over five years for an England only service. Expanding to United Kingdom wide coverage and incorporating academic/specialty and general practitioner recruitment into a single, two-round recruitment exercise has slightly increased set-up costs. The projected cost of the service is now expected to be £6.3 million over five years.
Dr. Murrison: To ask the Secretary of State for Health how much has been paid to the Work Psychology Partnership in connection with the medical training application service. [128713]
Ms Rosie Winterton: There is a contract in place between the Department and Work Psychology Partnership for the sum of £92,950 excluding VAT. Work Psychology Partnership are contracted to provide advice and tools to support the recruitment and selection into specialty training programmes, for which the Medical Training Application Service facilitates applications.
Dr. Murrison: To ask the Secretary of State for Health how much has been spent on the Medical Training Application Service (MTAS); and how much has been allocated to MTAS for 2007-08. [128715]
Ms Rosie Winterton: The cost of the Medical Training Application Service (including set up costs) is £1.9 million in 2006-07. The budgets for 2007-08 have not yet been agreed.
So far this fiasco looks like it will cost a lot more.
Mr. Graham Stuart: To ask the Secretary of State for Health whether the Modernising Medical Careers and Medical Training Application Service process has been formally quality assured; and if she will make a statement. [129699]
Ms Rosie Winterton: The Medical Training Application Service (MTAS) processes have been developed following extensive consultation which included both paper based and workshop based reviews within a formal project quality management framework. The MTAS information technology system is provided by an ISO9000 accredited supplier and has been reviewed and found fit to be for purpose.
The Modernising Medical Careers programmes itself has been subject to scrutiny by the Office of Government Commerce Gateway Review process in both 2005 and 2006.
Well, that worked out very well in the end then, didn’t it?
As I have tried repeatedly to impress upon the Department of Health, measures & certifications like OGC Gateway Reviews & ISO 9000 are a very basic form of quality assurance and do not really provide much confidence that the finished product will be satisfactory.
The entire quality assurance strategy of the Commercial Directorate has become subject to the mistaken idea that a satisfactory demonstration of process on paper is adequate to guarantee the quality of the services being procured. This is a fallacy that has been pointed out to them time and again. Process verification is just the very basic first step & the department does the NHS / public no favours by refusing to test its purchases beyond that.
Anyone can register for an MTAS account simply by using an anonymous email account with no further verification required.
Any applicant can see ANY correspondence sent by another candidate or from MTAS to another candidate by just going to his inbox and changing the message number displayed in the url.
You do not even need to log onto the MTAS site. Dr Crippen has just been sent a URL, which ends in four numbers. Put any random four numbers in at the end and you are taken straight to a MTAS reply to a junior doctor offering him/her a job. The recipient is not named, but it is probable he/she could be traced by replying to the hospital who offered the job.
The URL on its own is enough to see the inbox of anyone without any password or log in! It basically means that all correspondence that has taken place is sitting on the Internet completely unprotected, all you need is the URL. Once the inbox URL is known you can even send emails for that person.
Bolting the stable doors after the horse is in the next county appears to be what the DoH do best.
Director general of IT for the NHS, Richard Granger, told a Commons select committee he wished he was running the junior doctors system because then it “might not have gone wrong”.
So Channel 4 call him out on it by claiming that a previous failure occurred on his watch. We are given to understand that this is to do with the personal details of doctors who attended a conference in February organised by Connecting for Health who had their personal information displayed on the CfH site & from where it was only taken down after two weeks. We are told that it is still available in the Google cache for the site.
Jobsite & Methods Consulting ought to have known much much better than to be responsible for this sorry spectacle. And the DoH need to go away and read the guidance from their own colleagues.
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.
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.
In what appears to be an unacceptable & humongous breach of security, the much maligned MTAS website was found to be critically lacking in protection for the personal details including among other things addresses, sexual orientation & phone numbers of hundreds of applicants (Foundation programme applicants) according to Channel 4 news who were made aware of it this afternoon.
They showed footage of the website on the 7 ‘0′ clock news this evening with Jo Hilbourne from the BMA & Matthew Jamieson Evans from Remedy UK onscreen to comment. Andrew Lansley was on air to excoriate the govt who didn’t bother to send anyone to the studio to catch the flak.
“I’m absolutely gob-smacked, I don’t know whether to laugh or cry. I’m not going to be able to laugh because it’s so serious. After I’ve scraped my jaw up off the floor I’ll say that I’m not really surprised - it’s a level of ineptitude that has characterised this whole procecss. It takes the concept of a botched IT job just to a new dimension.”
- Matt Jameson-Evans, Remedy UK
Shadow Health Secretary Andrew Lansley:
There should be redress against anybody who is responsible for such a serious breach of people’s data confidentiality. But frankly, I come back to the point I was making a moment ago. We know that more than a month ago there was a risk to security.
There is an open challenge to the DoH from Jon Snow to send anyone in for an on-air explanation. Patricia Hewitt / Lord Hunt / Andy Burnham / Caroline Flint / anyone?
Throughout the junior doctors’ recruitment saga, we’ve been asking the Health Secretary Patricia Hewitt to appear on the programme, but she’s always declined - and tonight was no exception.
We offer her an open invitation to come on to Channel 4 News.
Who knows for how long the information has been exposed! It has been available for atleast a day. (Channel 4 reported on the 26th that the data had been exposed atleast for 3 days.)
The website was secured late this evening but the flannel put out claiming that it was accessed via an URL not meant to be available to the public is ridiculous. Putting the information on an excel spreadsheet without even a simple password protecting it is not just negligence, it is idiocy. Then placing it on a publicly accessible location is another thing altogether.
I hope that each & every applicant potentially affected by this complains to the Information Commissioner. Fines can & should be levied. (The initial response that there was nothing they could do on the other hand needs explaining by the IC).
And this is a government that claims to be able to secure the massive amounts of information an ID card database or the Electronic Patient Record (Spine) will collect. Show some competence in protecting the data of a few thousand people before attempting to do so for the entire country.
The muppets at Methods Consultingshould not be allowed near a computer again.
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.
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.
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.”
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.
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.
Sir - Recently, I came up against the full might of our proud nation’s new NHS computer system (Letters, April 19). We all, our dear leader tells us, want choice. I was offered “Choose and Book”, which is supposedly a part of the system that is actually beginning to work.
I was given a password and went as instructed to nhs.healthspace.
That was the first problem. I use a browser that is chosen by all who have tried it in preference to the one that comes with the computer. But although the NHS began working on its system in the past century, it is still under construction. The first response I got was that the system could not cope with my decent browser.
So I downloaded the old-fashioned browser. Did that help? Not a lot.
“Choose and book your appointment,” it said on top of the document that I was given at the local surgery. But as soon as I tried, the NHS website went into a sulk from which it never recovered.
Nothing was having any effect. So I resorted to the telephone. A surprisingly cheerful woman explained, as though to a toddler, that I could get no further because there were no appointments.
What none at all? At any of the hospitals within a day’s train ride? None at all. If there is no such thing as an appointment, it was not very polite of the NHS to offer the temptation to try to get an appointment. It hardly seems like £12 billion well spent.
John Ticehurst, Chard, Somerset
The problems do not lie just within the provision of IT services. The integration of information systems into the delivery of healthcare is also one of the largest change management programmes in the world. It has however not been given more than lip service in that direction & any number of lost opportunities litter the field.
IT is an enabler, not an end in itself. Something that appears to have been forgotten by CfH & the people making the decisions.
Rather than Connecting for Health gathering forces for a final push, a limbo is developing. Mr Granger is expected to leave soon yet everyone must maintain the fiction that he is still influential.
PAC chair Edward Leigh wants someone to ‘get a grip’ but there is no clear hand on the tiller during the vital transfer of responsibility to strategic health authorities. It is time the programme, and its pugnacious boss, retired to the sun.
There is more interesting news from the HSJ:
Comparative analysis of patient safety using a set of US indicators has heightened concerns about the quality of NHS trust coding, according to a Dr Foster Intelligence study.
The company had planned to publish trust-by-trust comparison of performance on patient safety against nine of the US Agency for Healthcare Research and Quality indicators. But returns from trusts revealed such variance and lack of confidence in secondary level coding that Dr Foster plans to work with a selection of trusts on a study of how to improve safety reporting.
Something that I have been saying for a while. It is not just the safety data however but also the rest of the data infrastructure. It is not a solid foundation to rely on for the development of an internal NHS economy.
Earlier this year the professional and patient lobby on dermatology got together and warned of a threat to their specialty.
Given that this was the height of the NHS financial crisis, it was tempting to dismiss their letter to The Times as special pleading, except for one important fact: they appear to be right. The law of unintended consequences from payment by results is making itself felt.
At least one hospital trust - Newham University Hospital trust in London - has declared its department financially unviable; others have come close.
The Times letter was signed by 350 dermatologists (that is pretty much all of them, by the way), the Skin Care Campaign, the British Journal of Dermatology and the Royal College of Physicians joint specialty committee.
NHS deficits and the government’s health reforms were damaging the care of people with skin diseases by removing choice, it said. GPs were being forced to treat patients themselves or divert them to services not run by specialists. As a result, specialist teams were being dismantled.
Didn’t Bedford Hospital dismantle it’s dermatology department too? I seem to remember Barry Monk standing for parliament opposing the changes.
In a survey by the British Association of Dermatologists last summer, just over half the 100 consultants surveyed said their primary care trust was setting up a clinical assessment and treatment service for dermatology. These were expected to divert up to 50 per cent of patients; meanwhile PCTs were commissioning fewer referrals from the hospital departments, in some cases slashing the number in half.
A third felt this would lead to financial instability and redundancy was under discussion in a quarter of trusts. As BAD clinical vice president David Shuttleworth put it: ‘Those departments which are unable to demonstrate financial viability in trusts trying to claw back a deficit are particularly at risk.
‘Under PbR a relatively small reduction in referrals may be sufficient to attract the attention of an embattled finance director, who may feel that “outsourcing” dermatology into the community will reduce losses on the balance sheet.’
It is hard to argue with that assessment based on present evidence.
Nor is it just dermatology that is threatened in this way. Rheumatology faces the same pressures, says the British Society for Rheumatology.
Take, for example, BSR president Andrew Bamji. He says he is currently under pressure to reduce his new follow-up ratio from 1:3 to 1:1, a move that is not clinically appropriate, would place him outside professional guidelines and see him discharge nearly half his caseload overnight.
But the tariff is based on an average; divert the simple referrals to a clinical assessment and treatment service or GP with a special interest and it no longer covers the more expensive cases left to the hospital department.
Or, as Dr Holden puts it: ‘That means bankruptcy. You cannot be paid for Minis and build Rolls Royces.’
I would have to agree & that argument has been put forward to oppose the transfer of patients to the ISTC programme as well, only to be ignored by the Department of Health.
NHS Confederation policy director and PbR supporter Nigel Edwards agrees. The idea is in the latest PbR discussion document, although only as an idea. ‘I am concerned that the PbR team’s approach is to unbundle, unbundle and unbundle and put a price on everything,’ he says. ‘They seem to recognise the problem but not do anything about it.’
Things have got to be bad then if the NHS Confederation comes out publicly against it.
‘This is an area where services have to be very carefully designed, where “good enough” will not deliver.’
I concur but I would also extend that statement to the rest of the health service.
Which leads us to the the effects on the wider system:
The Department of Health has drawn up a list of acute trusts that will be closed, merged or broken up because they will not survive under payment by results.
The list follows health secretary Patricia Hewitt’s request earlier this year for strategic health authorities to find ways of salvaging acute trusts struggling under the government’s new financial regime for the NHS, possibly mirroring the take-over of Good Hope Hospital trust by Heart of England foundation trust last month.
Sussex-based Frimley Park foundation trust is exploring whether it could merge with or take over the running of some services from the financially failing Surrey and Sussex Healthcare trust.
Other foundation trusts considering mergers include King’s College Hospital, and Guy’s and St Thomas’ in London, which are understood to be examining whether a takeover of Sidcup’s struggling Queen Mary’s trust is feasible.
HSJ have come out with corrections to the list with strongly worded letters of complaint from the chief execs of the trusts in question.
Forced mergers between organisations with very different circumstances do not work. There is plenty of evidence for that. You only postpone the inevitable.
And you end up with things like this:
The Department of Health has been asked to explain where the ‘missing millions’ that should have been spent on sexual health have gone.
PCTs were given £300m of money to be spent on public health under the Choosing Health white paper, but it was not ringfenced.
So we end up paying more in a few short years.
And there is also trouble out in the community with the BMA advising GP’s to ensure that atleast 70% of savings under Practice Based Commissioning are returned to the practices as promised by the Department of Health. A very good illustration as well of how a minimum level ends up becoming a maximum target very soon.
The British Medical Association’s GPs committee has recommended to members that they do not agree to commission through PBC unless their PCT will guarantee in writing 70 per cent of any savings they may make. The ability to use savings for patient services was announced, as an incentive for GP practices, when PBC was introduced two years ago.
The GPs committee guidance says there is ‘an absolute necessity for practices not to enter into any commissioning arrangements without written and signed confirmation from the PCT, in advance, that they will get their share of freed up resources at the end of the financial year, regardless of the PCT’s financial situation’.
But NHS Confederation PCT network chair David Stout said the BMA’s stance could cause problems for cash-strapped PCTs.
‘PCTs and practice-based commissioners should agree on service redesign but I think the GPC’s suggestion of a contract shows a real lack of trust, although I do think agreements should be documented.’
What trust? You just had all those stories about GPs being overpaid & how the DoH would re-negotiate the contract. Did no one see this coming?
A DoH spokesperson said guidance it published in November last year said it was ‘imperative‘ for practices to be allowed to use a minimum 70 per cent of any freed up resources for reinvestment in care.
The NHS Alliance can’t get away by saying
‘The 70 per cent savings figure is guidance and at the end of the day a statutory duty outweighs guidance.’
Watch out for more of the same.
NHS Employers says there is now no need to employ staff from abroad, following the increase in home-grown healthcare staff, but the Royal College of Nursing said the move was ‘wrong and muddle headed’. The British Medical Association said that while there had been an expansion in doctor training in recent years, ‘that doesn’t necessarily mean there are more doctors than needed’.
I am sorry but there is no workforce planning worth the name in the NHS. And NHS Careers is not really very credible.
Besides, I wonder what the DoH will have to say to that, given the rules on “additionality” which necessitate the employment of non-UK staff only by the various IS providers under the ISTC schemes.
Bill McCarthy, director of policy and strategy, director general of commissioning Duncan Selbie and director general of health and care partnerships Professor Antony Sheehan have all left recently.
Departmental sources denied that any interviews had been carried out for a rumoured new chief medical officer post, dedicated to the NHS and separate from Sir Liam Donaldson’s DoH post.
There is simply very little credibility left in the medical establishment. Recruiting in secret from within that segment of the profession will not be an improvement.
Our experience is common. We are confronted by an almost continual stream of advice, instructions and demands. Almost any external event, such as a front page story, guarantees a new set of instructions. We hear of some initiatives from the media. Often what we are told to do by one part of the NHS clearly conflicts with another; giving the perception that there is no coherence at the management layer above our trust’s. A plan reached after months of negotiations can be only weeks old before it is invalidated by decisions external to our trust.
This conflicts with the experience of successfully managing large complex change programmes. You need clarity of vision - everyone needs to know what they will get as a result of all the effort and upheaval, and it has to be worth it. You need leadership who personify the vision, and have not only the capabilities to deliver the programme but an ability to reach people on an emotional level. And you need clarity in the structures for accountability and responsibility for day-to-day delivery as well as the change programme. I suggest the NHS falls well short on all of these.
Oh dear, someone has strayed off the reservation!
The NHS is managed badly. It has neither the capability nor capacity for the efficient management of so many component sub-organisations, especially during a period of change. Some would add it does not have the right culture either.
Or has he? The remedies he suggests are redolent of a “business focussed approach”. Repeat after me “The health of the public is not a business.” You are not there to improve circumstances just for your organisation alone.
After all, the land of opportunity has its own set of troubles with poor healthcare management, not to mention the fact that UnitedHealth is in the spotlight again.
Hermes, one of the biggest European pension fund managers, has for the first time put forward a proposal requiring a shareholder vote on executive pay at a US company – a move that reflects the increasing activism of foreign shareholders pushing for boardroom reform.
UK-based Hermes plans to introduce its resolution at next month’s annual meeting of shareholders of UnitedHealth Group. The healthcare insurance company has been hit by a stock options backdating scandal.
You might remember the $1.6 billion paid out to the chief exec over the past decade.
Proper public consultation on the National Health Service will be undermined by “vague and woolly” legislation passing through parliament, the Commons Health Committee said today, criticising government proposals to limit public consultation on healthcare changes to “significant” proposals and decisions.
The proposed changes are contained in the Local Government and Public Involvement in Health Bill, which is nearing the end of its passage through parliament.
Consultation on NHS changes, such as the closure of maternity wards, was already a sham in some cases, the committee said. “Elsewhere, NHS bodies have sought to evade their duty to consult entirely,” it added.
“The Department of Health needs to take a lead and make it clear that such behaviour will not be condoned.”
MPs said the planned replacement of the country’s 400 Patient Forums by 150 “Local Involvement Networks” (LINks) only four years after the volunteer-run health watchdogs were created was unnecessarily disruptive, and might push volunteers to leave.
Uncertainty about the role of the new LINks would create “confusion and inactivity”, the MPs said.
The government says the forums, which themselves replaced the 30-year-old network of Community Health Councils, have too narrow a membership.
But the Health Committee said the forums should have been allowed to merge to form the new LINk bodies.
“Once again the Department of Health has embarked on structural reform with inadequate consideration of the disruption it causes,” the committee said.
The MPs said the health secretary — currently Patricia Hewitt — intervened too often in decisions after extensive local consultation, leading to illogical conclusions and undermining public confidence in the consultation process.
The Public Accounts Committee report receives wide coverage in the media.
Mr Edward Leigh added: “Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.
“The programme is not looking good. And, four years down the line, the costs and benefits for the local NHS are unclear.”
Committee member Richard Bacon called for the scrapping of Connecting for Health, the agency responsible for the IT programme.
“It is a nightmare organisation and I think the NHS would be better off without it.”
Health minister Lord Hunt criticised the MPs’ report. “This is based on a National Audit Office (NAO) report that is now a year out of date.
“Since then substantial progress has been made and the NAO recommendations have already been acted on.”
If so release current information. Somehow I do not believe you.
Edward Leigh MP, Chairman of the Committee of Public Accounts, today said: “There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected.
“The Programme is not looking good. The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the Programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear.
“Given that the total cost of this hugely ambitious project is expected to top £12 billion – and who can be confident that even this massive sum will not be surpassed? – the Department of Health is playing for high stakes indeed.
“Resolute action at this stage by the leaders of the Programme can do much to diminish the risks. The Department must get a grip on what it and the NHS are spending. It must thrash out with its suppliers a robust delivery timetable in which everyone, including local NHS organisations, can have more confidence. It must also launch reviews of the ability of the suppliers and local service providers to deliver against their contracts.
“The leaders of the Programme have talked long and loud about the benefits which it will bring to the NHS. The time for talking has ended. If dissident clinicians are to be persuaded, then they will have to see the advanced electronic patient record systems up and running. And if these systems cannot be delivered within the framework of the Programme, then the local NHS should be given greater freedom to look for alternative systems which do work.”
They are miles behind schedule, yet the limited deployment has already caused havoc, with significant delays in providing inoculations to children, waiting list breaches, missing patient records and the inability to report activity statistics. Not to mention the trifling matter of the largest computer crash in NHS history, when 80 hospitals had no access to patient administration systems for four days.
Timetables are fictitious and the programme is now years behind.
Doctors, nurses and hospital managers have been left spitting with rage. Most GPs think the appointment booking system is a joke.
One expert told our committee: “It was like being in a juggernaut lorry going up the M1 and it did not really matter where you went as long as you arrived somewhere on time. Then, when you had arrived somewhere, you would go out and buy a product, but you were not quite sure what you wanted to buy. To be honest, I do not think the people selling it knew what we needed.”
Sounds very familiar, almost as if it was me saying it, though I did not get called.
Their report called for an urgent independent review of the performance of three regional contractors - CSC, Fujitsu and BT. A full audit of their work would detail the multimillion-pound payouts and cash advances they have received, the contractual milestones they have missed and what benefits they have delivered.
BT, CSC and Fujitsu, the current suppliers, hold £5bn worth of contracts but were “clearly struggling to deliver”, the Commons public accounts committee said.
The key recommendation - that other suppliers be allowed in - challenges the structure of the programme where BT, CSC and Fujitsu, the so-called local service providers, are charged with supplying, installing and operating the various components of the programme. They use just two software suppliers, Cerner and iSoft, for the core patient record.
Well, it all becomes clear when you read this. Forcing two very different sets of working practices into one straitjacket that fits neither is a route to disaster.
Meanwhile news from across the pond is that New York is to try giving Medicaid practices free medical software with a 19 million buy.
“We will cover half of all the high-volume Medicaid providers in the city, those where over 30 percent of their patient encounters are Medicaid or the uninsured,†said Farzad Mostashari, an assistant city health commissioner overseeing the project.
Over the next two years, the city’s Department of Health and Mental Hygiene will distribute the software to about 1,500 medical practices, from small neighborhood doctors’ offices to large clinics, including the medical offices at the Rikers Island jail. City officials, and makers of patient records software, said they do not believe any state or large local government has tried such a thing.
The department spent months shopping for an electronic records system before awarding a $19.8 million contract to eClinicalWorks, a Massachusetts company that is a sales leader in the field. The medical practices will have to supply the computers. Some already have the equipment. Others that do not might qualify for a state program that awards grants to upgrade medical technology.
1. The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist. By now almost all acute hospital Trusts should have new NPfIT patient administration systems (PAS) as the essential first step in the introduction of the local Care Record Service. As of June 2006 the actual number was 13 hospitals. In June 2006 the Department wrote to us stating that by October 2006 there would be a further twenty-two. So far as we are aware, up to the end of February 2007 the number has increased by only five acute hospitals. The introduction of clinical as opposed to administrative software has scarcely begun; indeed, essential clinical software development has not been completed. The Department should develop with its suppliers a robust timetable which they are capable of delivering, and communicate it to local NHS organisations who may then have greater confidence as to when systems will be delivered.
There is still an unwillingness to accept the failures inherent in the current approach. an honest re-evaluation is needed.
2. The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion. Total expenditure on the Programme so far is over £2 billion. The Department should publish an annual statement outlining the costs and benefits of the Programme. The statement should include at both a national and local level original and current estimates of total costs and benefits, costs and benefits to date, including both cash savings and service improvements, and any advances made to suppliers.
Hopefully the claims made by Richard Granger that the work done by the suppliers is “at risk” is sound. But as witnessed in the case of Acccenture, getting them to actually pay up is going to be a different matter due to all the cock-ups from CfH.
3. The Department’s investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost. The main justification for the Programme is to improve patient services, and the Department put a financial value on benefits where it could. The Department should also quantify non-financial benefits, even if they are not valued, to better inform decision making and to provide a baseline for work after implementation to ensure that the intended benefits are being fully realised. The Department should commission and publish an independent assessment of the business case for the Programme in the light of the progress and experience to date.
The procurement was truly woeful but not much different from other recent contracts. The quality of purchasing by the DoH is shameful.
4. The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC. The Department should review with suppliers their capacity to deliver, and use the results of this review to engage, or to get suppliers to engage, additional capacity where required. It should also regularly review suppliers’ performance for any signs of financial difficulties potentially affecting their ability or willingness to discharge their obligations. In view of the slippage in the deployment of local systems, the Department should also commission an urgent independent review of the performance of Local Service Providers against their contractual obligations.
I could say a lot about the quality of resourcing by both CfH & the industry but it is a waste of time when people who do not know healthcare IT are running the show. Incompetence is the key word.
5. The Department needs to improve the way it communicates with NHS staff, especially clinicians. The Department has failed to carry an important body of clinical opinion with it. In addition, it is likely that serious problems with systems that have been deployed will be contributing to resistance from clinicians. It should ask the heads of the clinical professions within the Department, such as the Chief Medical Officer, to review the extent of clinical involvement in the specification of the systems, and to report on whether they are satisfied that the systems have been adequately specified to meet the needs of clinicians.
There needs to be a period of re-evaluation. The goals are far too important to be treated like this.
6. We are concerned that leadership of the Programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change. The frequent changes in the leadership of the Department’s work to engage NHS organisations and staff have damaged the Programme and convey that the Department attaches a low priority to this task. The Department should avoid further changes in the leadership of this work, beyond those necessary to improve its links with clinicians, and strengthen the links between the Programme and the improvement of NHS services that the Programme is intended to support.
I would argue for a change of leadership as there is too much sunk capital for them to accept their mistakes.
7. The Department should clarify responsibility and accountability for the local implementation of the Programme. At a time when many changes are taking place in the configuration of the local NHS and a range of other initiatives require implementation, it is essential that Chief Executives and senior managers in the NHS understand the role they need to play in the implementation of the Programme. The Department should make clear to Chief Executives and senior managers their objectives and responsibilities for local implementation, and give them the authority and resources to allow local implementation to take place without adversely affecting patient services.
Local implementation should be governed by strategy, not expedience & there need to be clinical personnel at the helm who understand IT.
8. The use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition. In addition, the fact that the Programme has lost Accenture, Commedica and IDX, three key suppliers, is running late and is having difficulty in meeting its objectives raises doubts over whether the contracts will deliver what is required. The Department should seek to modify the procurement process under the Programme so that secondary care trusts and others can if they wish select from a wider range of patient administration systems and clinical systems than are currently available, provided that these conform to national standards. This approach could have the benefit of speeding up the deployment of new systems and of making it easier to secure the support of clinicians and managers. We are concerned in particular that iSOFT’s flagship software product, ‘Lorenzo’—on which three fifths of the Programme depends—is not yet available despite statements by the company in its 2005 Annual report that the product was available from early 2004.
See comments above about the procurement process & my previous posts about the belief in “big is beautiful”.
9. At the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period. As a matter of urgency the Department must define precisely which elements of functionality originally contracted for from the Local Service Providers will be available for implementation by the end of the contract period and in how many NHS organisations it will be possible to have this functionality fully operational. The Department should then give priority to the development and deployment of those systems of the greatest business benefit to the NHS, such as local administration and clinical systems.
So pretty much nothing I can seriously disagree with. A look at the full report will happen when there is more time.
To readers from far & wide:
The server logs make for interesting reading, telling me just who is visiting the site & the topics that interest you.
So can I invite you to participate in the discussion, by telling me why I am wrong if indeed I am so & generally shedding a little light on this brave new world we inhabit.
It is more fun that way, honestly!
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