NHS fees are only way ‘to save service’ & Hospitals ‘bury the truth’ about poor patient care

Chris Smyth reports in The Times 3rd April 2014: NHS fees are only way ‘to save service’ Rationing by co-payments is just one option. The knee jerk response is the most likely, as politicians don’t debate philosophy and ethics these days…. But NHSreality has some ideas on rationing and models… Needless to say they don’t work if politicians are involved!

NHS charges and pensioner taxes need to be considered to fix the fracture between the health service and councils which condemns the elderly to confusing and chaotic care, a report for a respected think tank urges.

Britain faces an unpalatable choice between higher taxes, charges for GP appointments, A&E and other services, or continuing with a failing system, a panel of experts said. “None of these things are nice, so the question is which of the not-nice things do you want,” said Kate Barker, the economist who chaired an independent commission set up by the King’s Fund…… (read Chris Smyth here: (NHS fees are only way…)

Chris Smyth in The Times reports 3rd April 2014: Hospitals ‘bury the truth’ about poor patient care

The NHS has “buried the truth” about the huge variation in standards of care out of misguided loyalty to the ideal of a universal health service, its chief regulator has said.

Patients needed to know that neighbouring hospitals could differ so wildly that it could mean the difference between life and death, said David Prior, chairman of the Care Quality Commission (CQC).

About 30 hospitals in England were likely to be offering “crap care” while about 10-20 were outstanding, Mr Prior said after the first round of a revamped inspection regime that he promises will give patients the truth about their local hospital.

Good leaders were the difference between a successful hospital and a failing one, he said.

“The one irrefutable finding from our first inspection reports is the extraordinary level of variation, and sometimes this can be a hospital an hour away from another hospital where the quality of care is just so radically different,” Mr Prior said. “It is the difference between life and death at its most extreme.”

Even within hospitals, there could be an enormous difference between departments, he said. “So you have a really good orthopaedic department and a very poor diabetes department. What the inspections show is it always comes down to leadership. It comes down to clinical leadership at a specialty level, ward sister leadership at a ward level and organisational leadership at the board and chief executive level.”

The CQC was overhauled after the Stafford Hospital scandal amid sustained criticism that it was incapable of spotting poor care. Mr Prior said this reflected a wider cultural problem in the NHS.

“Too often in the NHS we’ve buried the truth deep, deep down because it’s just too difficult, ‘don’t want to go there’. So I think you need to have absolute honesty about the situation,” he said. “I think there is a feeling that the truth is uncomfortable and that by revealing it you might erode public confidence in the NHS, and therefore it’s in the overall interest of the NHS to keep it unsaid. And I think that was profoundly mistaken.”

Mr Prior said that the majority of hospitals fell between “requires improvement” and “good” and added that it was his job to push all to improve by publishing these kind of ratings from later in the year. But he said that relying on patient choice to force hospitals to improve was unlikely to work. “The reality is that for most people with most conditions, there is no choice. You’ve got to go your local hospital,” he said. “If you’re old and frail and ill and tired and depressed you’re not a strong consumer, so I think we have to stand in for that and give them a voice.”

Doctors and nurses who were engaged with running a hospital, bosses who listened to complaints and “an open and just culture in which all members of staff feel they can raise concerns and not be victimised as a result” were crucial signs of a well-run hospital, he said. “The NHS employs in clinical positions some of the most talented people in the country. Some of them, surely will have an interest in managing the system better,” he said.

Mike Smith, chairman of the Patients Association, said the findings were worrying, adding: “Patients who have experienced poor care in hospital have generally not been subject to the whim of an individual but have been let down by a team who have either failed to notice the actions of one of their colleagues or have turned a blind eye to unacceptable practice.”

Mark Porter, chairman of the British Medical Association, said “a culture of control, fear and blame” had held staff back from raising concerns about poor care.

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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