Posts Tagged ‘NHS’

Jeremy Hunt’s response to Francis will penalise patients while protecting the bureaucrats who cover up abuses

21/11/2013, 03:20:56 PM

by Sam Fowles

I really miss the days when the worst we thought Jeremy Hunt could do to the NHS was privatise it. At least you knew what you were getting with privatisation. But what Mr Hunt is doing, incredibly, manages to be worse. It is an act of legislative contortion which would have done credit to Mitt Romney on his most pliable days: In an (apparent) attempt to “get tough” on standards and ensure the high quality of the NHS, Mr Hunt has made certain that it cannot possibly offer anything but a substandard service.

At least one can see a logical argument of privatising the NHS. It may be exceptionally wrongheaded, but the case has a logical progression: Competing providers will force standards up as a result of their competition for consumers. The problem with this is, of course, that demand for healthcare is inherently almost completely elastic. As such, the impact of market forces on quality and price of provision will only ever be exceptionally limited, leading to monopolistic tendencies and, inevitably, substandard service. But at least there is a justification based on some sort of reasoned analysis.

Mr Hunt’s response to the Francis Report is a masterclass in irrationality.

One of the central issues in the report was poor patient care. Beds were not changed, patients were not fed; essentially the care and attention necessary for a decent quality of existence were absent. Unless the nurses at Mid Staffs spent their days playing scrabble and watching repeats of Monarch of the Glen (in my experience, pretty much the only thing on hospital television) one might perhaps assume that neglect is a function of understaffing. Stunningly this was also one of the conclusions of the Francis review.

Much of the review focused on governance issues, particularly regarding oversight organisations and community engagement (which Mr Hunt’s substantive proposals have singularly failed to address). Those sections which concentrated on the day to day running of wards recommended a more labour and resource intensive model. This is hardly surprising. One doesn’t have to be an expert in healthcare management to realise that if, as a patient, you get more focused attention more of the time, you’re going to have a better experience. The logical corollary of this is that, if everyone is to have more focused attention more of the time then the hospital might need to employ more people to provide it.

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NHS: demotivating workers risks lives

30/07/2013, 02:05:52 PM

by Sarah Rabbitts

On Thursday 11 July, the axe of Jeremy Hunt, the Tory Health Secretary, fell on yet another A&E. In an impromptu announcement to the House, Hunt confirmed cuts to Trafford General Hospital which even took Kate Green MP by surprise. The Independent Reconfiguration Panel (IRP), Hunt explained, had finally chosen to downgrade Trafford A&E services to an urgent care centre that will be closed from midnight to 8am everyday.

Labour supporters will always be protective of the NHS. Labour created it in 1946, and it’s one of the most formidable successes of a British Labour government. It’s an even greater success if you look at the backlash Obama faced enforcing public healthcare in the US – despite being popular in his first term.

However, this is not just about protecting something that Labour established. The issue is that reducing the wrong healthcare services puts people’s lives at risk, and no one in Britain really wants to live in a country in which we invoice the under-privileged £150,000 for cancer treatment because they can’t afford healthcare insurance. That’s the reality if we don’t protect the NHS.

Under this government, Lambeth’s funding has been cut by 45% in total. This is damaging local authority provided services, like social care and leisure – the services which help the council keep people healthy and out of hospital. In addition, the government has scrapped minimum nutrition standards in schools leading many “free” schools and academies to feed their pupils junk worsening a health crisis that’s already putting a burden on our NHS.

Lambeth’s NHS specific budget cuts have inevitably lead to longer waits, fewer nurses and midwives. In addition, Hunt approved the closure of Lewisham Hospital’s A&E, despite a passionate local campaign. This is now putting massive pressure on King’s College Hospital in Lambeth, who are accepting more patients.

I have advised a number of companies on employee engagement during periods of organisational change. I’m confident that taking away annual salary increases and intensive training will de-motivate workers and will probably jeopardise employee performance in the NHS, and inevitably patient care. Recent reports, for instance, that Healthcare Assistants are being trained with DVD tutorials are also worrying, especially if it is right that these workers will be expected to take on greater responsibilities.

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Ed’s right, small state socialism can still be radical – but Labour needs to govern better next time

02/07/2013, 07:00:11 AM

by Kevin Meagher

Whisper it, but governing is the boring part of politics. Ironic, really, given so many would-be ministers would scramble over broken glass on their hands and knees for the sniff of a chance of becoming a parliamentary under-secretary for paperclips and sustainable date-stamps.

It’s not that governing – sitting behind a desk and running things – is pointless or unrewarding; it’s just that it’s hard and time-consuming and politicians are easily distracted by the thrill of the chase. Tony Blair, of course, famously did sofas rather than desks. So Labour’s approach to government for 13 years was, crudely, to announce things then throw money at officials and assume change had been made. Job done.

This approach was tested to destruction. For public services to improve, more state spending was always needed. To make them improve a lot, spend a lot. As a result, ministers often overspent and over-legislated, but, paradoxically, under-governed too. Of course you have to put money into the Whitehall fruit machine to make the lights come on, but you still need to know which buttons to press. That’s what governing is all about.

When the buzz of the press launch has faded and the television cameras have gone away, all that is left is the spadework of navigating bills through parliament, rolling-out new programmes, retraining staff to implement the changes to policy (which invariably takes a fiendishly long time), listening to the gripes of one lobby group or another and sitting in meetings. Lots of meetings. All this slog takes time and commitment and, frankly, a few Labour ministers found themselves bewitched by the Age of Spin last time around and didn’t do the hard work that real change demands.

Take the police. Measurable crime halved under Labour (for a variety of reasons, not least the longest unbroken spell of economic growth in 200 years) but anti-social behaviour, the bureaucratic term for describing thoughtlessness and thugishness, flourished. Police numbers also swelled, while Parliament passed twenty odd pieces of criminal justice legislation.  Although the police had everything they could possibly need from Labour ministers, they still barely made a dent in tackling anti-social behaviour.

Not enough was demanded from them. In fact, unlike other public services, police performance targets were actually scrapped, apart for the single watery invocation to ‘raise public confidence’. Yet ministers didn’t ask why there had been a catastrophic loss of public trust in the first place. No chief constables were sacked for poor performance. The focus, especially after 9/11 was on security and no-one much bothered what the plod was doing – or not doing – on other fronts. It’s only now we get a sense of the rottenness at the heart of parts of our police force.

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What is One Nation Labour?

09/05/2013, 07:00:14 AM

by Peter Watt

One Nation Labour, what exactly is it?  Well according to Ed Miliband on the Labour party website:

“Today, our country risks becoming two nations, with a million young people out of work, the gap between the richest and everyone else getting worse, and hard work not rewarded.  My core belief is in leaving this country a better place than I found it, and that when people join together, we can overcome any odds. We did it during the second world war and we did it when rebuilding the country afterwards. That is the spirit Britain needs today.”

I have quite a bit of sympathy for this.  We certainly needed to refresh our thinking and move on from new Labour which for much of the public had become tainted by ‘spin’.  With the Tories appearing to lack any sort of central purpose or vision other than deficit reduction, it was good to see the Labour Party trying to develop a fresh single organising thought.  The Party wanted a new sense of purpose and Ed’s espousal of One Nation Labour seemed really promising.

Over the last few months there has been some welcome associated rhetoric around challenging vested interests that threaten the living conditions of hardworking families.  So energy companies are challenged to reduce their prices.  Payday lenders are rightly targeted and there is talk of giving local people a bigger say in shaping their high-streets (I’m not quite sure what this means but I think if I did that I would support it!).  Certainly banks and some bankers had become greedy and there is a tiny percentage of the population that has got very rich and who seem very good at avoiding paying tax.  So far so good for ONL.

But then I get a little sceptical.  Firstly there is the fact that the One Nation rhetoric actually seems to divide the nation into three nations.  Of course there is the really rich ‘nation’ that Labour has a lot to say about; and it generally seems to be about taxing them and their bonuses more and then spending the receipts several times.  Then there is the really poor ‘nation’ who need support that Labour has a lot to say about; and it generally seems to involve opposing any reform of the welfare system.  And finally there is the everyone else ‘nation’ – the hard working lot that, as Ed points out, are not being rewarded very well and who feel a bit let down and put-upon.  And One Nation Labour doesn’t actually seem to say much about them at all.

And then there is this whole issue of challenging vested interests; of stepping in ‘when capitalism clearly isn’t working’ for families already struggling.  So banks, energy companies, pay day lenders and so on are all in the firing line.

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Our political parties need to be honest about NHS rationing

21/02/2013, 07:00:40 AM

by Peter Watt

Yesterday saw the publication by NICE of their latest guidance on the use of IVF by the NHS.  It said that women should be able to access IVF quicker (ie younger) and also that the upper range of women able to access the treatment rises from 39-42 in England and Wales.  This has to be seen as a good thing, a reflection of the continued advances in medical treatment.  What was in the past impossible becomes possible.

Except read the small print.  What NICE are doing is providing advice to NHS Trusts as to what they can do if they choose to.  As Dr Sue Avery from the British Fertility Society told the BBC:

“It’s good that there’s the possibility there, but the funding does not match. I can’t see any prospect of it happening immediately. Our biggest concern is hanging on to the funding we’ve got.”

Now quick declaration of interest here; my wife Vilma and I underwent IVF.  Initially we had treatment on the NHS and then went privately.  We were successful and have a beautiful daughter as a result.  But at the time we were incredibly lucky that where we lived was still offering treatment on the NHS.  Plenty of others no longer did or offered a much more limited service.  Because the reality of the NHS is that on a whole variety of fronts it rations treatment.

On Tuesday there was a story about a man who had had a gastric band on the NHS but who was left with large amounts of excessive abdominal skin.  His local health service had refused to pay for his apronectomy and he was facing a bill of some £15-20,000.

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After Mid Staffs, Labour must be brave and take on the cult of the NHS

14/02/2013, 07:00:40 AM

by Peter Watt

Imagine for a minute if there was a terrible accident that claimed a hundred lives; it would dominate the news for weeks.  Or the outbreak of food poisoning caused by some poor hygiene in a major food distributor that made some people ill and perhaps a few poor vulnerable souls to die; it would be a huge story.  The horsemeat scandal has been front page news for days and it’s not (yet) a public health concern.  And yet 1200 people are allowed to die unnecessarily in a NHS hospital and no one seems to notice!  The Francis report into failings at the Mid Staffs hospital was news for a day – and on some outlets it didn’t even top the news schedule for the whole day.  Up to ten other hospitals are now being looked at as their mortality rates are worryingly high.  What is going on?

It really is bizarre; no matter how many times we read about those unable to help themselves being left in wet or soiled beds or left to starve in one of our hospitals it seems to make no difference.  There is an attitude about the NHS that makes it all but un-challengeable.  Politicians in particular are scared of the NHS.  The Tories decided to ring-fence the NHS budget when they were busy slashing virtually every other departmental budget so scared were they of being seen as anti-NHS.  Labour wraps itself in the NHS flag at every opportunity.  Labour politicians who’ve tried to tinker with it are castigated – Alan Milburn and John Reid still have the scars.  We say things like “the NHS is the envy of the world.”  And seem to actually believe it!  The truth is that virtually no other country has copied it as a model.

What is true is that many countries rightly envy the fact that we have universal free health care, they don’t though envy the way that we have chosen to deliver it.  Yes there are some incredible people working for the NHS that provide a great quality of care.  And yes, many of these people work hard and, often under great pressure care for patients with skill and compassion.  But every time anyone criticises the NHS as a model of health care delivery, people tell stories of amazing care and lives saved.  We remember the care that we had when we or a loved one needed it.  We remember that we, and our children were born in NHS hospitals and look with fear at the health care system in the States.  Those criticising are branded as anti-NHS and people back off.

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Labour’s opposition to regional pay in the NHS is intellectually dishonest

08/11/2012, 07:00:55 AM

by Peter Watt

There was a debate yesterday instigated by Labour on the introduction of regional pay into the NHS.  Labour’s argument is clear, that by allowing the introduction of regional pay into the NHS the government risks breaking it up.  Of particular focus for criticism were the group of twenty trusts in the south west, the south west consortium.  They are seeking to opt out of the national agenda for Change framework for pay and conditions as an element of their plans to achieve their required cost reductions.  As Andy Burnham said in the debate:

“National pay is part of the glue of a national health service, part of what holds it together, and in turn the NHS is part of what holds our country together.

A one nation service bridging the social and economic divides of our country, uniting east and west, north and south. The N in NHS should be cherished, but instead it is coming under ideological attack.”

Powerful stuff and you may think hard to disagree with.  But Labour has some form in this area, in both government and opposition, which makes their position a little tenuous.  It may well be that there is a perfectly good reason for this apparent inconsistency but you can be sure that this inconsistency will be exploited by opponents.

First, in government it was Labour that introduced the very flexibilities and freedoms that allow NHS trusts to make decisions that ensure their responsiveness to local needs.  And rightly so; as commissioners agree local priorities it was important that the local providers were able to operate flexibly and choose what they did in order to deliver on these priorities.

This didn’t mean an end to national pay and conditions but it did mean that if needed trusts could be flexible.  So for instance, if there was a need for one particular service to be expanded in an area where attracting the right staff was difficult, then a trust could respond.

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Labour needs to be honest about tough spending choices in the NHS

19/07/2012, 07:00:28 AM

by Peter Watt

It has been a particularly tough few months in the NHS.  Setting aside the impact of the NHS and Social Care Act (2012), the impact of the freezing of budgets is being well and truly felt.  Every week sees another story of a hospital or a patient group in crisis or expressing concern.

July seems to have been particularly difficult.  Early in the month we saw the South London Healthcare NHS Trust being put into administration.  The Trust consists of three hospitals – Princess Royal in Orpington, Queen Mary’s in Sidcup and the Queen Elizabeth in Woolwich and serves more than one million people.

And then this week the South West Pay, Terms and Conditions Consortium, a group of 19 hospitals in the south west, were shown to be planning to cut the pay and conditions of up to 60,000 staff in order to balance tight budgets.  The headlines all warned of doctors and nurses being sacked and of pay and conditions being cut.  I had a special interest as one of the hospitals in the consortium, Poole, was where I nursed and I still have friends there.

According to their project initiation document, the consortium has come together in order to:

“…assist Trusts across the South West in modernising  pay, terms and conditions to ensure that they  are ‘fit for purpose’ going forward.”

In other words they are hoping to challenge national pay and conditions for their staff as a way of bearing down on their staffing costs.  Specifically they are exploring a number of options such as reducing anti-social hour’s payments, some degree of reward for performance for incremental progression, reducing holiday entitlement, increasing hours and reductions in pay for staff on over £21,000.

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If Labour wants to save the NHS it must change it

16/02/2012, 07:30:58 AM

by Peter Watt

Almost everybody agrees that the NHS bill is dangerous. Except, probably, the health secretary Andrew Lansley. Patients groups, trade unions and most of the royal colleges are seemingly all united in their condemnation. And opinion polls indicate a sceptical public. The legislation is so dangerous that the end of the NHS is apparently nigh if you listen to the most hysterical opponents of the legislation.

And increasing numbers of Tory MPs allegedly think that the bill is bad for their political health. If the economy is Labour’s weakness, then they know that the NHS is theirs.  Much of the public may not yet have caught up with the reforms, but they fear that they will soon.

Up until now the government has successfully blamed all of the country’s ills on the last Labour government. It has been easy, and on the whole very successful. But they know that between now and the election, every winter crisis, unclean ward or staff shortage is an opportunity for Labour to blame them and their NHS legislation. And that risks their seats and may just put the outcome of the next election, which up until now they were feeling optimistic about, in some doubt. (more…)

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In defence of bankers and Fred the shred

02/02/2012, 08:00:09 AM

by Peter Watt

If you are the Tories then you know that in general voters are wary of what you might do with the NHS, given half-a-chance. It is a political weakness for them. No matter what they say many people assume that their instincts are anti that most beloved of national institutions.

It is why David Cameron invested so much time and effort in trying to persuade people that his intentions towards the NHS were honourable in the run up to the general election. It is why he pledged, ridiculously, to protect NHS budgets when all others were being cut. He knew he couldn’t win on the NHS, but he hoped he could stop it being a negative for him. Now of course all of this has been blown out of the water by Lansley’s ineptitude, and the NHS is once again an electoral vulnerability for the government. A degree of trust so hard fought for so easily lost.

In contrast, the Labour Party is trusted by voters on the NHS.  It means that they could get away with reforming the NHS, maybe even make mistakes, and would still on balance be trusted. (more…)

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