Monthly Archives: June 2014

eflection on the 2003 reforms and “foundation” trusts

Jo Revell in The Observer 28th September 2003 reportsed: £2.5m cost of hospital reform ‘spin’

So what value have we the patients had from this reorganisation? How has anything changed? This was an example of bureaucracy at its worst, and is a lesson on what not to do. The perverse incentive to become a “foundation” trust, put patients second to managerial ambition.

Move increases opposition of MPs to two-tier health system

More than £2.5 million of NHS money is being spent on glossy documents and public consultations by the country’s top-performing hospitals in their bid to become foundation trusts.

Ministers have set aside special funds from a central government budget to help hospitals with the cost of having to consult hundreds of thousands of staff, patients and members of the public about their plans to become more independent.

The revelation that the process will cost so much will fuel opposition to the Government’s controversial proposals that the best-performing hospitals should be given more freedom from Whitehall and allowed to borrow and keep their surpluses.

A resolution at this week’s Labour Party conference in Bournemouth is expected to reject the idea of foundation trusts, as many delegates fear it will lead to a two-tier health system. But the Government intends to push ahead with the plan, seeing it as one of the key planks of its health reforms. The 25 trusts applying for foundation status next April have to consult their patients and staff, as well as local residents.

For large hospitals, this involves compiling enormous electoral databases and sending out consultation papers to more than a million people. They have to invite people to become members of the trust, and to vote or to stand as representatives on members’ councils, taking the place of the NHS boards.

The Observer has learnt that each trust can apply for up to £100,000 from a central budget to help with the costs of the consultation.

A Department of Health spokesman said: ‘When you are creating a membership organisation, it does cost money and there are inherent start-up costs in the preliminary phase of the application process. There is a recognition that you have to help from the centre, [given] the scale of the change.’

But the financial aid has angered those most opposed to the foundation plans, such as former Health Secretary Frank Dobson.

‘I would have thought that most people would like to see this money spent on operations instead of a lot of PR and spin,’ he said last night. ‘But the £100,000 they are getting is probably chickenfeed compared with the real cost of having to put together an electoral list. They have to include everyone who’s ever been a patient as well as all the local residents.’

He is hoping the Health and Social Care Bill, the legislation under which foundation trusts would be set up, will be defeated in the Lords in two weeks’ time. However, it seems likely that the peers will back an amendment calling for the scheme to be piloted properly for at least two years before it is finally introduced.

Hospitals are already sending out consultation documents on their plans to become foundations. The document from University College London Hospitals argues that foundation status ‘can provide even better services, drive up standards of care and create a state-of-the-art environment of which we can all be proud’.

According to the brochure, the new status will allow them to ‘gain a reputation for developing staff and a “can-do”culture’, and to apply the new employment conditions and pay for staff earlier than the rest of the NHS.

Last week the leader of Britain’s 120,000 doctors said the proposal threatened the fundamental principles on which the health service was founded.

‘We should aim to level up the standard of care, not introduce changes that could enable our top hospitals to widen the gap,’ said Dr Jim Johnson, BMA chairman.

Call to halve target for added sugar

James Gallagher for BBC news 26th June 2014 reports: Call to halve target for added sugar

We dont trust the pharmaceutical industry, the tobacco industry or the finance industry to self regulate. So why should we trust the agricultural or the food industries any more? Reducing sugar intake would be a major improvement in diet, and could lead to reductions in obesity, diabetes, coronary heart disease, strokes and arthritis…

Morecambe Bay NHS Foundation Trust placed in special measures

BBC News reports 26th June: Morecambe Bay NHS Foundation Trust placed in special measures

A failing health trust has been placed in special measures, meaning all Cumbria hospital trusts are now getting extra help to boost performance.

University Hospitals of Morecambe Bay NHS Foundation Trust was rated as inadequate in an inspection by the Care Quality Commission (CQC).

It said the Royal Lancaster Infirmary and Furness General Hospital in Barrow needed to improve the quality of care.

The trust said it was “part-way through a process of significant improvement”.

Last year, a separate trust covering the north of the county, North Cumbria University Hospitals Trust, was one of 11 put into special measures after the Keogh review found higher-than-expected mortality rates.

‘History of concern’

The CQC inspection took place in February and while inspectors said care in services such as maternity and A&E had improved since previous checks, they added other areas of concern had not been addressed.

Medical care in one part of the Royal Lancaster was said to be “of particular concern”.

The overall recruitment of nurses and doctors was identified as a “fundamental” worry with “too much reliance” on temporary staff.

The chief inspector of hospitals, Professor Sir Mike Richards, said: “There is a long history of concern with the quality of service provided by the trust, so it is disappointing to report that a number of the issues that have been identified in the past remain unresolved.

“I do not believe that the trust is likely to resolve its challenges without external support.”

As well as the hospitals in Barrow and Lancaster, inspectors also visited the Westmorland General Hospital, near Kendal, which was said to be providing a good service overall.

The trust’s chief executive, Jackie Daniel said: “The reports reflect the fact we are part-way through a process of significant improvement which is still going to take a number of years to complete.

“It isn’t an overnight job to change the culture of a large, complex organisation.”

Full reports of the inspection have been published on the CQC website.

Have you made recent use of a hospital covered by the trust? What was your experience of the care given? You can email your comments to haveyoursay@bbc.co.uk, using the subject ‘Morecambe Bay NHS’.

Savile and the abuse of absolute power

Janice Turner in The \times 28th \june 2014 opines: Savile and the abuse of absolute power

A freelance despot, Savile befriended both high and low in the NHS. In return, they helped him commit his crimes

Steve Bell 26.06.2014

In the whole 253-page report into Jimmy Savile’s activities at Leeds General Infirmary there is just one instance where he troubles hospital bosses. Doctors complain that, although only a volunteer porter, he is plonking his vast Rolls-Royce in the consultants’ car park, filling two bays.

Savile skulking the wards in the dead of night; his access to nurses’ quarters and mortuary alike; the near-universal disgust felt for him by female staff — and, of course, his copious crimes — were not under their purview.

For a study in absolute power — how to win and exercise it; how to create useful allies and deflect would-be enemies; how to indulge undetected your taste for violence, humiliation and sexual depravity; how to steal trophies from the dead and the innocence from children and yet be garlanded with honours — forget Machiavelli. Read the Leeds and Broadmoor hospital Savile reports. Not every despot needs a nation; some go freelance.

The first principle of Savile’s modus operandi was: sort out the top and the bottom, then the middle will neither care nor dare. So at Leeds he first befriends night porters, dropping in for late-night chats, buying TVs for their seedy hospital bolt holes where they drank, played cards and entertained women. All against the rules, but Savile wouldn’t tell if they kept his secrets, too.

We never learn the names of men who note that Jimmy, viewing the board where portering jobs were chalked up, always bagged patients from the women’s or children’s wards. Nor do we know his accomplices, who, after his victims had been assaulted in linen cupboards or side-rooms, suddenly appeared to lead them away. “No one knew” is the Savile refrain. But they saw, they heard, they knew.

Besides keeping sweet the lowliest men, Savile ingratiated himself with the most powerful. At Leeds he befriended the chief governor; in Broadmoor he actually chose him, after Edwina Currie bizarrely trusted his judgment in heading up a task force to change hospital culture. He promised the minister he’d win officers’ compliance by threatening to expose their overtime fiddling to The Sun. He never did; conscious, no doubt, of what they had on him.

In Broadmoor, he didn’t need the slapdash security guards to lend him keys, to slip him in without question as he had in Leeds. The governor gave him, along with an office and a house near the grounds, a whole set of his own. This not only afforded him a back route to the women’s wards, but guaranteed nurses never challenged what he was allowed to see. Some were uncomfortable as Savile watched the female patients bathe, commenting on their “nice Bristols”. But they knew he had the power to have them sacked.

Nurses mainly feared and loathed Savile: scuttling out of the canteen or into their station when he showed up. The senior ones knew “You don’t get too close”; that it was dangerous to leave him alone with a student, especially one who looked young for her years. They found him a hindrance on the wards, hated dodging his groping hands. They had an idea what he was doing to patients, since he relentlessly tried the same on them.

Moreover, as several in the Leeds report point out, this was the reign of the Yorkshire Ripper. If police could not keep women safe from a serial killer, why would they bother about Jimmy Savile? So the nurses mostly shut up and watched their backs.

But not all. The only heartening moments in the report are when Savile is challenged. A senior nurse turns on him and says she doesn’t want the self-styled “chief cheerer-upper” dropping in whenever he feels like it. A grandmother, seeing her granddaughter being felt up beneath blankets, screams. And instead of confrontation, Savile
melts away.

In Broadmoor, he avoided the wards run by the sternest custodians, those who wouldn’t bend rules because it’s “just Jimmy”, the governor’s best pal. Savile used his customary greeting — kissing the length of a woman’s arm — to “scope” for malleable staff: homing in on the gigglers, sidestepping those who recoiled in disgust.

These reports are a cure for nostalgia, especially about the NHS’s supposed golden age. It is hard to feel sentimental about porters and consultants alike being drunk, while a single student nurse is left in sole charge of a ward all night.

Savile could not operate with such impunity today.

And yet the female Broadmoor patient who is written off as troublesome after complaining about abuse reminds me of girls in the recent Oxford grooming case. When they complained to police and social workers about the men who raped, drugged and tortured them, they were dismissed as child prostitutes who had made a “lifestyle choice”.

Meanwhile on the very day of the Savile reports, Ofsted admitted that its inspections into Stanbridge Earls School had failed to pick up a culture that enabled the rape and sexual assault of pupils. Closed institutions are still problematic worlds.

But at least the Savile reports may quell your fury about the annoyances of modern life: swipe card security, CRB checks and the professionalisation of menial jobs such as portering. And you may conclude that we don’t live in a dirty-minded age that imagines paedophiles around every corner, but one that has learnt, over decades and after many grave mistakes to protect little girls on hospital trolleys from roaming eccentrics with squeaky clown noses.

The Guardian 26th June reports: Those who shielded Jimmy Savile are still silent

Given the evidence from dozens of witnesses, how did Savile, a child molester and sex pest,
escape attention?

Don’t tell me the mental health system isn’t in crisis – I’ve been in it

Johnny Benjamin in The Guardian writes 27th June 2014: Don’t tell me the mental health system isn’t in crisis – I’ve been in it

The most rationed part of the Regional Health Services is Mental \Health: and thats because we the public, and the professionals, and the media, let the politicians and administrators get away with it.

The mental health system is in crisis. It’s a car crash waiting to happen.

That’s according to Prof Sue Bailey, the outgoing president of the Royal College of Psychiatrists, in an interview earlier this week. Her comments came a day before the British Medical Association’s annual meeting, where delegates were told that cuts to mental health services are resulting in avoidable deaths and suicides. Sadly, neither of these stories told me anything I didn’t already know. I’ve seen at first-hand how the mental health system is failing vulnerable people. For many of us dealing with mental illness, the car crash has already happened.

In fact, my experiences of mental health care were so bad that a few years ago I completely gave up on trying to get support. I’d been going through a period of severe anxiety and had waited for months to see a therapist. But after a few sessions, she told me she was being transferred. I’d have to go back on the waiting list and start all over again.

The Observer: Crisis grows in mental health care
Services for the mentally ill are facing a growing crisis across Britain due to soaring staffing costs and accelerating numbers of young patients.

 

Jeremy Vine discuses saving the NHS on radio two, 26th June 2014

On Thursday 26th June Jeremy Vine asked GPs and Health professionals to ring him and give their views. Rationing was not discussed.. Too complex for Radio 2, or would Mr Vine be disciplined for raising the subject overtly?

Jeremy discussed Wonga chasing debts from its customers using made-up law firms, how new charities can undermine existing charities, saving the NHS money and drinking water.

 

 

GP A&E Triage – would be a good idea if we had planned for the numbers needed. We have not.. and GP partnership and continuity of care is in decline

Despite a lack of evidence, some CCGs are allocating scarce resources  to GP A&E Triage. Sofia Lind reports in GP Magazine 26th June 2014: CCG plows further half a million into PM’s seven-day opening model despite uncertainty over A&E impact

GP A&E Triage would be a good idea if we had planned for the numbers needed. We have not.. My old trainer used to say “every patient deserves and examination” as well as “if you do n’t put your finger in you put your foot in”. The risks of litigation increases by not examining the patient. Those doctors who are good at emergency medicine, as well as as triage, and GP primary care will be the “polished” and much desired doctors of the future… This does not necessarily mean they will be GP partners… and continuity of care will be in decline. This will mean more demand for private care in affluent areas, and more importance for working integrated IT systems (which don’t yet exist). The perverse incentive to reduce quality of continuing care is in conflict with the need to ration emergency care services within budget.

David Millett reports for GP Magazine 26th June 2014: GPs should not provide front-line A&E triage, says former GPC leader

In Cornwall, since 2012 GPs have been involved in A&E Triage. Observer article prompts big changes at Cornwall Regional, reported by DONNA HUSSEY-WHYTE Sunday Observer so there should be some evidence…. West Cornwall Hospital still has a skeleton GP manned service, but it seems to be adequate, with no increase in mortality or morbidity..

There is no plan. The lunatics are running the asylum – and we are condemned to a “managed decline”. (by our politicians)

NHS faces crisis in litigation as well as A&E. Introduce no fault compensation (NFC)?