£1.4Billion (Count those zeros)

 

So the Ubermeister of NHS management thinks money spent on paying managers could be better spent!  Employing the managers for our PCTs and SHAs costs us taxpayers  £1.4bn a year. (God alone knows how much managers in hospital trusts and the DOH itself cost)

That's right £1.4 billion which is £1400 million or even more impressively  £1,400,000,000 on paying managers. In a moment 0f Paulian revelation David Nicholson, our beloved NHS Chief executive, has said this is too much. Not much gets past him does it? Give that man another gong.

Truly truly astonishing……

Public Consultation

The NHS is big on public consultation. Nothing can be done and no major decisions taken without consulting “key stakeholders” and the wider public. This is the theory in any case. In practice we know that policy is decided, plans put in place and then the motions of consultation are gone through.

In my patch we had a “public consultation exercise” on the new Darzi clinics. NOT to decide if they were wanted at all but to decide on the sites and services to be provided.  To say it was akin to one of Joseph Stalin's show trials would be an understatement. The PCT made their decision and then hundreds of thousands of pounds were spent on glossy brochures and radio adverts . A series of public meetings (attended by 2 or 3 people and a few dogs) and then the decision was made to proceed as originally intended. A truly remarkable exercise in duplicity and going through the motions.

It seems this may have been in breech of the law –Camden PCT have been forced to back down on its plans to award a Darzi centre contract to a private firm and to ask patients if they want the new service at all.

Got that – not what new services the public want the clinics to provide but if they want them at all.

This has major implications for the national rollout. I fear it is too late for my patch – the clinic are up and running and patients can get antibiotics and painkillers on demand  whenever they like but hopefully this will stop the madness in other areas.

Cherry Picking

Shock of the century! Who would have thought it?  Completely unpredictable and not at all obvious !

What is this this mysterious and unthinkable event that no one in the DOH or Government thought possible? What could possibly have escaped the attention of the sharp minded apparatchiks of the downing street health policy unit.

Wait for it….

independent sector treatment centres do not provide value for money and cherry pick patients.

Research has shown that those patients (aka walking cash machines) they do see need fewer diagnoses and procedures. In other words only simple and straightforward cases (aka walking pay packets) are taken and those with complex problems, multiple pathologies and higher needs are left to the NHS to sort out.

Well bugger me! Private enterprises cherry picking simple cases, fleecing the tax payer and pouring the money into the pockets of their directors and shareholders. This could almost be called capitalism couldn’t it? Surely this is the market in action and only to be expected. Surely this was what the opening up of health providers was obviously going to achieve. Who could possibly be surprised at this?

Wait until the Darzi practices and polyclinics are evaluated and also found to be overfunded and underperforming.

Who will be held accountable for this colossal waste of our money? No one of course. A few internal reorganisations, rebranding of job roles and team building away days and the management gravy train will continue to steam ahead.

When is a target not a target ?

So Gordon Brown and Andy Burham are moving away from the target culture ? At his monthly press conference the PM has announced 3 new health policies.

• A  free health check to all those over 45 – announced repeatedly by Gordon as a new policy over the last 3 years and has always been available to anyone who wants it through your GP anyway.
• The right to see a cancer specialist within two weeks of diagnosis.  Diagnosis by who ? ( a cancer specialist perhaps). How will this be measured unless a target is attached?
• The right to treatment of cancer within eighteen weeks.  Why 18 weeks? What is cancer treatment in this context -initial biopsy/ excision?  Control of symptoms? Definitive surgery? Start of chemotherapy? How can this possibly be measured without requiring more form filling and tick boxes.

So more targets not less. Characteristically the PM then went on to argue black is white, up is down and left really does mean right by saying

"It is part of a move away from a target-led approach”

Obesity Epidemic

Another triumph for government policy!

It official - The Obesity Time Bomb ( © Liam Donaldson 2002) has stopped ticking. It seems that all the talk of Armageddon and the nation drowning in a sea of lard or suffocating under the weight of enormous children was a tad over the top. Really -who would have doubted the predictions of this government ?

The forecast was for one million obese children gallumping across the land reeking havoc with car suspensions, getting blocked in doorways and crushing toilets with their huge weight. It was a greater threat than global warning and cost the health service untold billions we were informed ( what about obese management consultants I wonder – how much do they drain the NHS?)

Well praise be to the DOH the forecast has been downgraded .

The new figures suggest that by 2020 the proportion of boys aged 2-11 who will be overweight or obese will be 30% - not 42% as previously predicted and for girls the prediction is now 27% - down from 48%.

Wait for the government spin machine to warm up and claim this is all as  a result of health policy and shows that New Labour is tough on obesity and tough on the causes of obesity.

Only of course this is complete bollocks. The original predictions were utter rubbish and wildly inaccurate  but fed into the prevailing zeitgeist that everything in Britain is crap that is the constant sermon from the Daily Mail. It was jumped upon by ministers and tabloid editors as an excuse to berate, belittle and humiliate the nations children – not only are they all drug taking muggers and layabouts but they are fat as well.

Will we get an apology for the inaccuracy of the original predications or will it be self congratulatory clap trap from politicians saying they are “winning the war against obesity”.

I think I know which.

Donaldson where's your trousers?

I listened and couldn’t quite believe it so I listened again - “Sir” Liam Donaldson, the chief medical officer, was defending the government in sacking Professor Nutt from his role as chairman of the drug advisory committee. Professor Nutt’s crime was to believe that policy would be informed by impartial scientific advice rather than ignored completely when it failed to agree with the prevailing views of the Daily Mail (“All drugs are evil and all drug users are evil hoodie wearing immigrant dropouts who mug old ladies and defraud the benefits system”)

Liam Donaldson commenting on Professors Nutt’s assessment of the risk of drugs said

“Broad-based comparisons between the respective risks of drugs and alcohol are not helpful in making policy.“You cannot just look at it comparatively. Each of these risks are risk in their own right,”

This is staggering coming from someone responsible for public health policy. He is saying that under no circumstances should comparisons of risk be made and all decisions should be taken using absolute risk figures. On this logic putting trousers on in the morning  -which causes on average 5 fatal falls a year -should be treated with the same seriousness as smoking  which causes 100,000 deaths a year. As it is “not helpful” to make comparative risk assessments why are trousers not banned? Surely government must act to outlaw this menace. Legislation to ban trouser wearing in public places and a public health campaign to warn the public of the dangers should be just the first step. A custodial sentence for possession of trousers should be mandatory with a minimum of 10 years for those intending to supply.

I believe at one time Liam Donaldson trained as a doctor and had some basic grounding in scientific methods and risk assessment. These days he is the perfect government “expert” – tell them what they want to hear and do as they say and the elevation to the Lords is a certainty.

He has sunk to new depths in defending government policy over and above  objective scientific evidence and the impartiality of expert advice. Sadly no one in the medical community will be in the least surprised.    

A FAILURE OF LEADERSHIP, CULTURE AND PRIORITIES

In a parallel universe far away from NHS-land known as the real world a report into the tragic and devastating failures in safety checking and quality within the armed forces has been published. This makes for difficult and grim reading and is relentless in its criticism of management, politicians and the structures in place.

Particular mention is made of the role of the governments drive to cut costs through “efficiency savings” which led to financial targets and budget balancing being the only priority for managers and the sole criteria that success or failure was judged on. To quote verbatim

"Financial pressures and cuts drove a cascade of multifarious organisational changes, which led to a dilution of the airworthiness regime and culture within the MOD, and distraction from safety and airworthiness issues as the top priority. There was a shift in culture and priorities in the MOD towards ‘business’ and financial targets, at the expense of functional values such as safety and airworthiness."

Now substitute “NHS” for “MOD” and “patient safety” or “quality of service” for “airworthiness” and read that paragraph again. Anyone who provides clinical services will recognise this is exactly the culture that has been imposed on the NHS – financial targets, tick boxes and checklists as a substitute for caring and compassion and a crushing of professional values under the jackboot of “modernisation” and “service reform”.

Bob Ainsworth – the hapless and floundering Defence Secretary said in Parliament

"We are working hard to ensure we capture lessons from incidents and inquiries to improve our safety. As an organisation the MOD is changing its culture and approach to put safety first."

How many of us have heard successive Health Secretaries say exactly the same words following major failures in NHS provision? The only thing that happens is more financial targets are imposed so there is more distortion of clinical priorities, more marketisation occurs and longer “checklists of quality” with even more tick boxes are produced.

When will the NHS get its own Haddon-Cave review?