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.
Inadequately specified & poorly designed programmes forced through by functionaries remote from the coalface will not work. Accenture left early & now Fujitsu have exited the programme. CSC & BT have made a number of promises but have failed to deliver and I wonder just how long they have left.
Will this serve as a warning for other similar programmes in the healthcare space? Going by past experience, I am not holding my breath.
Consultancy services provided by us will aim to advise the client of the most appropriate strategy / service to fit their expressed need. This applies also to third-parties claiming to “understand” what the client wants when there have been no demonstrable instructions to that effect and that supposed “understanding” is denied by the client. We will not act in a manner contrary to our judgement & expertise.
FrontPoint Systems is in dispute with Methods Consulting over services contracted to be delivered to Eastern and Coastal Kent Primary Care Trust.
There has been plenty of assertion / anecdotal evidence to suggest that continuity of care matters. Now there is more hard evidence to show that there is a benefit to patients seeing their own GP instead of walk-in centres & A&E departments. This is in addition to plenty of US research which shows the same.
After adjusting for measures of medical need, demographic characteristics and other covariates, we found that increased emergency department use by elderly patients was associated with lack of a primary physician, lower continuity of care with the primary physician, low overall use of primary care services and residence in a region with more general practitioners per 1000 population. Furthermore, lower continuity of care and low overall use of primary care services appeared to have a stronger effect on emergency department use among urban than among rural residents, whereas absence of a primary physician had a stronger effect among rural residents.
A much bigger & more robust study then than the British one.
Something to consider when commissioning services perhaps?
£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.
I pity the poor civil servant who has to implement this if indeed it comes to pass.
Britons travelling abroad for health care, ranging from dental work to open heart surgery, will have their treatment funded by the NHS.
They will simply have to pay their travel and accommodation costs, plus any top-up fees if charges in the foreign hospital are higher than NHS costs.
So a trip to Belgium for bariatric surgery perhaps, to Eastern Europe for dental treatment or the Scandinavian nations for infertility treatment that patients might theoretically be eligible for has the potential to wreck PCT budgets as well as strategy.
The plans say that patients should not be given drugs or treatments that their own state system does not fund, and that where there are waiting lists, domestic patients should have priority over foreign patients. Beyond that, EU residents would be free to travel for non-emergency care in any of its 27 countries.
Next week’s directive is an attempt to catch up with a series of European court rulings over the past decade which have ruled that there should be an open market in health care across Europe.
Just how is a hospital abroad supposed to decipher the availability of treatments in every PCT when it is not so clear to doctors within a few miles? A central clearing-house for such information with a clearly codified list of available treatments instead of the juggling of priorities that PCTs have to manage today? If indeed the proposals are accurately described, the devising of a solution to this would be a challenge to relish.
The surroundings were plush. I pushed through a large front door just off ……………………, to find a beautifully decorated room with sunken, red leather sofas, plasma screens showing videos of patients’ success stories, huge windows and fresh flowers on the tables. Everybody was friendly, polite and professional.
Or
………………… was a trek to get to, perched in some industrial estate in north London. No sofas or Tatler here. Just the radio.
Perhaps patient satisfaction questionnaires filled in immediately post attendance are not such a good idea then, do I have agreement?
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 first practices are expected to open to patients in a year’s time and will be funded from the £250 million access fund announced last month. The access fund will also provide at least 150 GP-led health centres across the country.
And if the procurement is to be run by the Commercial Directorate, will they take into account the dossier that the GPC has been collecting as well as the complaints from Third Sector organisations about the way they are being indirectly excluded from the contracts?
The full list of PCTs are: Manchester, Barking and Dagenham, Knowsley, Sandwell,Wolverhampton City, Heywood, Middleton and Rochdale, Liverpool, Sunderland Teaching, Birmingham East and North, Halton and St Helens, Heart of Birmingham Teaching, Barnsley, Leicester City, Oldham, Blackburn with Darwen, Stoke on Trent, Hounslow, Hull, Nottingham City, Blackpool, Ashton, Leigh and Wigan, Dudley, Bolton, Greenwich Teaching, Sefton, Medway Teaching, Salford, Hartlepool, Tameside and Glossop, Walsall Teaching, Newcastle, Redcar and Cleveland, South Tyneside, Calderdale, North Lancashire, Luton Teaching, Havering and Hammersmith and Fulham.
I guess that there will be more batches to follow. Though there has been no definition of an under-doctored area & the criteria by which these practices were selected, in addition to which there has been no explanation of whether these contracts will be available via APMS only or open to PMS & GMS providers as well.
The Department of Health will hold a national conference on Thursday 13 Dec in London for commissioners and providers to discuss advancing plans for increased numbers of GP surgeries and GP led health centres.
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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