In pride of place, the BMA - for being an all-round disappointment, though I must say that the new team is better than the old one by a minute degree. Or maybe not as recounted by Private Eye in their “Medicine balls” column. Brian Butler has been mentioned here before and he is joined by colleagues in the IT & legal departments.
The DoH - for being a mixed bag of contradictory policies but with the worst predominating.
The Royal Colleges - for being asleep on the job & now looking to pass the buck.
The medical establishment, to wit the Deaneries & associated networks including those involved in training - for their callous cynicism.
Connecting for Health - for their singular lack of sense.
I am sure that they will be joined soon by other deserving candidates. I must really add a scoring system to keep a running tally of the level of cluelessness of the above players.
The current controversy surrounding the purchase of Cervirax rather than Gardasil for the NHS immunisation programme against cervical cancer demonstrates just how poorly procurement is understood and practised by most of the public sector. Penny wise, pound foolish might be another way of putting it.
Not to mention the more controversial SAT marking contract with ETS, a company that is now being described as a Powerpoint warrior. And to think the Office of Government Commerce publicised this procurement as a case study in “best practice”. Then there is Northern Rock to consider along with the the ghost of Equitable Life to display the fallacy of the current fashion for light-touch regulation. (Of-course the private sector fares no better, with any number of monuments to failure littering the landscape.)
Value needs to be calculated by looking at the total cost or benefit of a project, not just the rather inadequately defined attributes initially described. There are likely to be broader disadvantages or benefits stemming from a course of action that will need to be considered by decision-makers.
In the healthcare sector, this attention to the full extent of any issue is our raison-d’etre. Unfortunately this is a lesson that most seem determined to ignore.
£91 billion in today’s prices we are told & with interest mounting to over £171 billion over 20 years.
So far that is.
“PFI deals were supposed to give us certainty about the long-term costs of providing public services.
“The reality is different. Benchmarking and market testing of the costs of delivering ongoing services under PFI deals - such as catering and cleaning - have in practice led to increases in prices of up to 14%.”
A third of projects after 2003 attracted no more than two bidders compared with just 15 per cent previously, the Commons public accounts committee reported. Competition was put at risk if a bidder subsequently dropped out or one of the bids was weak, it said.
The committee reported that average tendering time had increased from 33 to 34 months since 2004. Delays to projects had cost the taxpayer at least £67m.
The verdict of the Better Government Initiative, contained in a series of reports to be released over the next few weeks, is damning.
Government departments have “serious deficiencies”; the combined output of Parliament and the executive contain “too many disappointments and failures”; and “emphasis on ‘management’ has led to more bureaucracy at the expense of substance” in the Foreign Office.
“Health, education and the armed services have had constant change, insufficiently discussed and thought through.
“We’ve had nine revolutions within 10 years in the NHS. We’ve gone away from markets, then back to markets. It’s just disruptive and demoralising.”
“What has really damaged the public’s trust in politics is the failure to live up to promises… Ordinary people want the money spent on the NHS to have brought about the improvements it should have done.”
“Teachers, nurses and doctors can see how much micro-management is going on, that makes their job harder and seems to treat them as unintelligent creatures.” There is a similar problem in Whitehall. “Civil servants are not expected to analyse problems and produce intelligible policy,” he says.
“Ministers come up with an idea and expect civil servants just to do it. You can’t just come down on civil servants if they don’t deliver when you haven’t been very precise about what you mean by delivery.”
“Constant change, often couched in impenetrable jargon has had a depressing effect on morale. People feel that they no longer feel they know whether they are coming or going, that they are unappreciated and ignored… This is not management in any real sense, it is certainly not leadership and it undermines the effectiveness of the organisation.”
Hmm, so where does it absolve the authors from responsibility for standing by while all this was happening? Not to mention the very many failures of years past? After all, it is not as if the civil service has clean hands in all this as can be seen below. But I will take allies wherever I can find them.
Sophia Christie in the HSJ punctures a few bubbles relating to the way in which policy seems to be populated by some remarkably persistent ideas that pop up every decade or so in search of believers.
Several weeks later, Lord Darzi announced polyclinics as the solution to primary care capacity in his interim report for Our NHS, Our Future (or the On/Off review).
The last time I remember polyclinics taking centre stage was the late 1980s when Margaret Thatcher sent teams of civil servants overseas to investigate alternative funding for the NHS. They came back from Germany with polyclinics, which at least diverted attention for a while from personal insurance as the answer.
However, the theme of finding community-based activities for hospital consultants is a recurring one. In his London review, Lord Darzi rightly identified a key principle as ‘localise where possible, centralise where necessary’. However in On/Off he also references US achievements in shifting outpatients to community settings. Given the lack of primary care in the US, much of this outpatient activity would have been seen by a GP in the UK anyway.
Meanwhile the many GP fundholding initiatives of inviting consultants to sit in GP surgeries and see a fraction of the patients they could have in a clinic should have been a lesson in both (in)efficiency and inequality.
At-least someone is paying attention & is willing to display a healthy cynicism. Now to help educate the rest of her colleagues.
The 2007 NCEPOD report on the management of trauma is out & makes for uncomfortable reading, especially with the wide variation in performance of what should be standardised responses to presentation at A&E.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
Consultant led trauma teams would be ideal but even one staffed with registrars would be a start.
All patients with severe head injury should be transferred to a neuro-surgical/critical care centre irrespective of the requirement for surgical intervention.
Hmm, this will require a massive increase in neuro-surgical / rehabilitative capacity & a sea-change in attitude.
Making a virtue out of necessity, Mark Britnell appears to have suggested that the Commercial Directorate will be substantially downsized (neutered is the word used). It is hard to see how its performance over the past few years can stand up to scrutiny.
The DoH’s director general of commissioning and system management Mark Britnell said that the ‘commercial directorate will be reduced in size and regionalised and procurement will be localised’.
Sources close to the discussions confirmed that the commercial directorate will be ‘neutered’.
The plans will be contained in the DoH’s operating framework to be published next month.
As always the devil will be in the detail especially with the question of what will happen to ongoing procurements still open, not to mention the proposed primary care contracts.
The National Audit Office was poised on Friday night to investigate the hugely scaled-back programme to buy £700m worth of private-sector care for NHS patients after it emerged ministers had spent more than £100m on the procurement.
The cost of the procurement so far is £84m, the Department of Health admitted on Friday. In addition, it has already paid £8.4m in compensation to private health companies for schemes cancelled at the last minute, ahead of this week’s announcement.
Industry estimates are that the department will have to pay at least another £20m, maybe much more, for the latest round of scrapped deals.
The NAO, the spending watchdog, said it was “very conscious of parliamentary interest” in the issue, and that it was at the “early stages of preliminary inquiries”.
I guess that we will be seeing more about this in the coming weeks.
More about accountability then & I am warming to my theme, what with well argued comments from a number of commentators.
How can you police the competence of a chronically incompetent organisation where the probability of discovery of any single error is very low? Answer: make the consequence of discovery very high. That way you provide the correct incentive to staff and ministers to be competent. They will multiply the probability by the consequence - knowing that it is unlikely that their mistakes will be unearthed, but that if they are unearthed they cannot expect the press and public to be all sweet reason.
I have to agree with this well reasoned opinion from Daniel Finkelstein as also I do with the following from Simon Jenkins.
Who bears responsibility for the deaths of hundreds of Britons from hospital infections, almost certainly the result of the privatisation of cleaning services? Should it be the Tory health ministers who instituted the policy or Labour ministers who failed to reverse it? When should “responsibility” mean resignation?
All we know is that not a week passes without something going wrong somewhere in the public sector and an almighty row ensuing over “whom to blame”. The reason is that the dinosaur’s head is too far from its foot.
The nearer a school, hospital or police force is to its client the easier it is to identify responsibility and thus allocate blame. In the private sector, blame attaches to whoever makes the mistake. The same applies in properly “tiered” democracies. In most cities abroad, a poorly performing school, a corrupt planning decision or a fiscal scandal is accounted to the elected mayor. If the relevant service is provincial, it is to the governor, if national to the minister. Accountability is clean. The franchise bites at each tier.
In Britain nothing bites but an occasional general election. Nobody down the ladder of public administration accepts blame since performance is dictated by Whitehall. The reason why so many police cars crash is that government offers more money the faster that 999 calls are answered. Hospitals are dirty because ministers want cash diverted to lower waiting times. Yet when these policies go awry, the centre pushes blame back down the line.
Continuing with the theme, a local GP has his say in the letters section of the Times.
As a GP representative for 20 years I have never before dealt with such an arrogant hospital management which treated its employees, including consultants, with contempt, some threats and a degree of bullying.
Management styles of the type we have experienced in Maidstone over the past four years should have no place in the NHS. We must never allow any trust in the UK to be run by such a publicly unaccountable and — and in the end — ineffective regime again. Other communities should be on their guard and “whistle-blowers” protected.
GPs who fail to provide out-of-hours services could be penalised if their patients seek treatment elsewhere, a leaked NHS document suggests.
According to the letter, “recharging” would mean surgeries on the General Medical Services (GMS) contract, which has allowed 90 per cent of doctors to opt out of providing out-of-hours care, would be charged if their patients are seen elsewhere.
Just as soon of course, as the GPs also have control of the various other services that would affect their patients health & precipitate an attendance at A&E. After all, they can’t be held responsible for things that are not totally under their control. And then we could disband the PCT & possibly the SHA which would really be an improvement.
Is it time yet to say “I told you so”? Over the past year I have been engaged in a dispute with the Commercial Directorate & the Department of Health over the wishful thinking that has dominated policy. I am glad to see that some difficult decisions have been taken even though it is a year & £84 million later (ok, not all of it was spent in the last year but a large enough sum would have been).
The Director General also advised that a contract for diagnostic services in the West Midlands should be terminated. Poor take-up of the service (5 per cent utilisation to date) meant it could no longer be justified on value for money grounds. Waiting times for diagnostic treatments in the region have fallen dramatically from more than a year to three weeks since the scheme was first proposed and as a result the scheme no longer represents good value for money.
Maybe there never was demand for the service in the first place, after all a proper demand assessment was not carried out. And I do not mean to single out the Care UK deal as it is a common element across most of the contracts that I am aware of excluding certain specialised services such as Renal Dialysis. There is a lot of room for improvement in productivity of existing NHS facilities if management & financial constraints are reduced.
A new forum for independent sector providers to advise the Department on local procurement practice.
Unless membership of this forum is open to all organisations in the healthcare sector & it is not weighted towards the larger providers, is it fair?
I have a question though for the proposals to procure 100 new primary care facilities from the likes of Boots / Asda / Tesco in deprived areas. Can anyone tell me what the criteria used to designate a locality as under-doctored & in need of new private sector facilites are?
Or the case of the incredible conjurors at the DoH. I am surprised as to how the NHS can have a backlog of over 4 billion pounds in essential repairs (note, essential means important stuff, like leaking roofs, dodgy drainage systems etc, the kind that led to Maidstone being in the news with commodes not being fixed for example) and yet be in the black to the tune of 1 billion pounds. This is after the savage cuts to education & training, public health and other vital budgetary areas over the past couple of years and serves to illustrate the lengths the NHS went to in order to save Patricia Hewitt’s job.
Kudos though to the membership of the BMA for their principled stand over the eligibility of non-EEA doctors to continue their training in the UK. I’m glad to see that the BMA has come out with a strong statement though it remains to be seen if it is diluted down when it comes to implementation. After all, there is a lot in the Tooke report that while not exactly a red flag, bears careful watching.
“The thousands of overseas junior doctors currently providing essential services in UK hospitals must not be scapegoated for the government’s poor workforce planning,” said Dr Terry John, chairman of the BMA’s International Committee.
“They came to the UK in good faith and in the honest expectation of training opportunities in the NHS.”
Limiting new entrants to post-grad training might be something to consider but destroying the careers of those already here is unconscionable.
Even the French appear to recognise that the lot of the UK GP is not a happy one with them being very concerned about the future of General Practice in the UK.
“However, 87% were concerned for the future of general practice, second only to the Spanish at 90% and above Germany at 84%, Italy at 83% and France at 79%.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said recent media coverage of GPs was taking its toll.
“There’s a sense that the government doesn’t value general practice highly nor understand what it does and how it responds to need.
“There’s a constant perception being put across that others can do this job just as well.”
Having already made a mess of the provision of Out of Hours cover, does the DoH really want to meddle in General Practice?
And finally, have not seen much publicity about this decision by the Scottish Information Commissioner’s office regarding the release of contracts for PFI facilities. If the argument that there is an overriding public interest is upheld on appeal (to the Court of Session - I suspect that there will be one) then look out for an avalanche of similar applications in England! I might have a few to put in myself, following up on a few of my inquiries over the years. Of course the legislation is different but I do not see the underlying principles being all that dissimilar.
Facts
Ms Docherty requested a copy of the PFI contract relating to the construction, maintenance and provision of support services for the Royal Infirmary of Edinburgh from Lothian NHS Board (NHS Lothian). NHS Lothian responded by informing Ms Docherty that it considered the information to be exempt under section 36(2) of FOISA. Following a review which upheld the initial decision, Ms Docherty remained dissatisfied and applied to the Commissioner for a decision.
NHS Lothian consistently failed, during the course of the investigation, to present an appropriate case for the application of any FOISA exemption. The Commissioner did not accept NHS Lothian’s arguments, raised during the investigation, that the cost of compliance with the request would be excessive. As a result, the Commissioner concluded that the contract in question should be released to Ms Docherty, subject to the removal or redaction of personal data which did not fall within the scope of Ms Docherty’s request.
The Information Commissioner had this to point out:
30. Where an authority seeks to withhold information in response to a FOISA request, it will be the responsibility of the authority alone to apply any appropriate exemption, and the application of any such exemption must therefore be considered fully, carefully and appropriately by that authority.
31. While it may frequently be appropriate for authorities to seek comment and opinion from third parties in relation to information which might, for example, give rise to an actionable breach of confidence if disclosed, this information should be used to inform the authority’s own consideration. In many cases, third parties will argue vigourously for the non-disclosure of such information, but the authority will be required to assess those arguments independently in the context of the relevant FOISA exemption before ultimately deciding whether or not that exemption should be applied.
So just passing on the messages from the third party involved (Consort in this case) will not suffice. More work for the lawyers then! I presume that Allyson Pollock will have a good read. I look forward to her analysis.
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!
Loading ...
