23rd June 2011

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Right and wrong

News and Comment from Roy Lilley
PPA 'Columnist of the Year' - Finalist


What's your take on the Future Forum Report?  The DH responded; how quickly did they do that! Perhaps they started first? 


The thinly disguised retreat was really about Mad-Dog Monitor's threat to 'dismember' the NHS, treat it like a utility company and get a salary of close on �300k for doing it (Isn't that more than the PM?).  So, the bit in the report that deals with choice and competition warrants a special look.


The group charged with this work comprised: Sir Stephen Bubb, Association of Chief Executives of Voluntary Organisations; Lord Victor Adebowale, Turning Point; Paul Farmer, Mind ; Peter Hay, Birmingham City; Thomas Hughes-Hallett, Marie Curie; Joanna Killian, Essex County Council; Bill McCarthy Yorkshire and Humber SHA; Anthony McKeever, Bexley Care Trust; Mr Dermot O'Riordan, Medical Director and Surgeon;  Dr Niti Pall GP;  Professor Jimmy Steele, Oral Health Services Research; Professor Terence Stephenson, Royal College of Paediatrics.


Have you noticed?  Do you see what I see?  There is no one from the private sector.  They are all public or third sector.  Given that the whole debate was about Monitor carving up the NHS and feeding it to the sharks from the private sector - where were the sharks?   


This group watches the world through the lens of Macmillan, Mind, the British Heart Foundation and the Terrence Higgins Trust.  The Emperors of the third sector, the Barons of public sector; established, competent and providing great services.  Their report says; "There is a wealth of talent and untapped resource in our country's third sector which can benefit the NHS."  Well, they would say that.


Where are Southern Cross, Hips-Are-Us Plc, and Bing-Bong-yer-Bunion's-Gone Ltd?


Where's the bit that says: "The private sector have a legitimate purpose; to promote the interests of their shareholders by widening the margin between costs and price and this gives rise to concerns".  Where's the bit that says; "Diabetes is for life and not a three year contract and on that basis contracting with the private sector requires a high level of care and extra assurances".


I have no axe to grind about the private sector; I have spent most of my working life in businesses.  I understand its purpose, advantages and frailties.  Perhaps that's why I can say these things.  A business is designed around a profit opportunity and will give great service for as long as it is profitable - there is no point otherwise.  Right now managerial uncertainties, the downward pressure on tariff, the quest for �20bn savings and no volume guarantees makes the NHS a no-no for any business with a brain.


If a private company does do a good job for a year or two and leaves honourably, who does the longitudinal follow-up and revisions when a calamity arises beyond the life of the contract?


A study by Ellen de Rooij (Stratix Amsterdam) indicates the average life expectancy of a company, regardless of size, in Europe is only 12.5 years.  Remember, that's an average. 

This Group said; "We have also heard how competition can drive more choice and raise quality."  'Heard'? Where? What is the evidence?  Indeed, there might be good evidence to the contrary.


They misunderstand choice.  Supermarkets sell Andrex, PG Tips and Hobnobs.  They price to reflect each other.  There are only three things that really matter; location, location and location.  Put your shop in the right place.  Convenience is the big driver for customers and, I suggest, patients. 


Choice carries a risk.  Search for a special occasion, scarlet, one-shoulder, sash-sweep satin-chiffon evening dress.  Does your our bum didn't look big in it?  Not in the shop, but when you get home; different story.  No harm done.  Choice is the freedom to risk getting it wrong. 


To help us chose they want to bury us under an avalanche of outcome data, but 'Is the hospital easy for visitors to come', 'Does the car-park costs less than �2,000 an hour' and 'Can they do my operation next week' is about all I want to know.


This section of the FF report is written by the wrong people and arrives at the wrong conclusions.  It is just plain wrong.  Worse, it is naive.


But, they did get this bit right: "The National Commissioning Board should [not] lose connections to the local level. ........the Board may want to develop mechanisms that allow a presence closer to consortia." 


That'll be the District Health Authority, then? Right........

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Much needed and an excellent guide.

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-------------------------Formal Response to 'Listening'.

Full document here.  Make for page 4 and the summary.


>>  Does the NHS pay too much - OECD report says we pay GPs twice as much as French counterparts.  Surely not?  Lovely-Jubbly!

>>  Breast feeding rates - on the rise.

>>  How many will lose sickness benefit - Guardian take.

>>  Hip fracture patients given a low priority - age discrimination?

>>  Plans to tackle ageism - about time too.

>>  The Big Beast - on timetables, reform and 328 consortia (!)

>>  Patients have to shake a tambourine - to attract the attention of the nurses.  You couldn't make it up!

>>  Bristol - could happen again.

>>  Gt Ormond St - cover up over Baby-P?  All that is protecting the management team is their reputation.  Interesting story in the Indy.

>>  Cut costs,stop the Go-Johnnies - This is a very interesting piece from the award winning US Huffington Post.  The US is struggling with medi-costs, just as we and the rest of the developed world are.  Writers Merton & Bernstein highlight a McKinsey report that shows, repeatedly, that doctors with financial interests in procedures prescribe them more frequently than less expensive alternatives.  There is nothing the the proposed Bill to stop it happening here.  Indeed some GPs are already making arrangements to set up treatment boutiques to refer their own patients to.  Lovely-Jubbly.  This is a must read.  If we do not pay attention to this it will happen here.  Is it what we want?

>>  DH IT boss - quits.  Groan.  She's achieve next to zilch but it is an important signal.  Getting out whilst the going's good.  NHS IT is still in a terminal state of indecision and it is , probably, the one thing that would speed modernisation above everything else.

>>  Health Bill - tight time-table.  Have a look at the complexity of the bits they are revisiting and the ones they are not.  I am left with the impression that Labour is right.  The Bill should be considered in the round and start again.  The problem with that is the Parliamentary timetable is congested and they want the reforms in and working by the time of the next election.  I think we all know they won't, will they?

>>  Estates conundrum - Sky blog. 

>>  Nicholson and Farrar lock horns - this is in the HSJ, so I hope the link stays open (Subscribe to the HSJ and you get good stuff on line).  Farrar is saying management cost cuts are 'dangerous'.  The Big-Beast is full of the usual Bull-S%$t.  I think Farrar will take over from the Beast.  Pop into the bookies and have a fiver on it.  He's the manager's choice.