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Archive for April, 2011

Disillusioned by Scotland’s political short termism

By Caroline Whymark - 30th April 2011 5:48 pm

Scotland goes to the polls this Thursday (5 May). As well as the referendum on voting, we are also electing the next Scottish Parliament. This time the decision about who to vote for is harder than ever.

Each day for the last three weeks our mail has been infiltrated by an increasing amount of propaganda. Promotional leaflets adorned with smiling happy families, politicians in dire need of photo shopping and instructions on how to do an X flutter through the letterbox, diverse in their style as well as their promises.

Leaflets range from the active (we will cut crime), to the passive (we won’t charge tuition fees), the practical (polling stations open from 7am) to the downright insulting (look for my name and put a cross next to it on the lilac coloured paper). There are the tactical ones describing ‘wasted’ votes, the simple ones with a tick box list of proposed achievements and intellectual looking ones with lots of percentages.

Knowing that women in last century burned their collective bra so that I could have a vote I feel obliged to make an informed decision and place my crosses in well thought out boxes. This is harder than it seems. As in the world of celebrity, the eye catching headlines are rarely what they seem. If we could believe that council tax would stay frozen, innovative ways of properly employing young people would be effected rather than them being manipulated off the jobless count, and that education would be changed to reduce paperwork and allow teachers to teach, then that would be great.

But words are easy; following them up with hard and long-term actions is another kettle of fish. I am reminded of Katie Price ‘finally finding true love’ or Kerry Katona ‘losing 2 stones’ and think ‘here we go again’. I no longer believe what is written. I don’t believe the headline achievements will last past the next issue of the magazine and I’m beginning to feel the same way about vying political parties.

Trust has to be earned. Unless politicians have a code of conduct enforcing them to deliver all that they promised the electorate in their campaigns I will find it hard to trust any party to do what it says on the tin. In all likelihood the promises will merge into one amorphous heap with a minority government or be whittled away tit for tat in a coalition. Cynical? Perhaps, but just like celebrity love and weight loss, no one is in politics for long term benefits. Long term change for the better requires sustained effort and hard work. It involves short term hardship for long term results. It is not easy.

Short term reforms aiming for impact before the next election send us round in circles, chasing our tail with little tangible benefit in the long term.

Perhaps the people with the most to gain on 5 May are school children. Not because the elected government will shape the future they live in, but because they get yet another day off school.

Tags: Election
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English hospitals facing tougher efficiency savings

BBC Health - 1:08 pm

The regulator of NHS foundation trusts in England has warned hospitals must make even bigger efficiency savings than previously thought.

The Department of Health has already said it wants efficiency savings of 4% for each of the next five years.

But the regulator Monitor says it expects savings will be more in the order of 6% to 7%.

Monitor says higher than expected inflation and tougher financial penalties for hospitals are to blame.

Trusts insist on local GPs in out-of-hours overhaul

Pulse - 28th April 2011 10:29 am

GP out-of-hours care is being radically reshaped across England, with PCTs working with consortia to implement ‘local doctor only’ policies or merging services with the government’s new 111 urgent care number.

Trusts are enlisting the support of GP commissioners as they make sweeping changes to out-of-hours care in the wake of the Daniel Ubani case - with more than a third bringing in new rules stipulating that out-of-hours providers must be staffed by local GPs only.

NHS reforms and cuts distract from patient safety

By Mike Broad - 27th April 2011 5:28 pm

Pushing through major NHS reforms at the same time as making significant healthcare savings could damage services, an influential committee of MPs has warned.

The Health and Social Care Bill aims to transform the NHS in England into a highly devolved, market-based model in which local commissioners and providers are freed from central control.

At the same time, the NHS is expected to make £20bn of savings, including a 33% reduction in administrative costs in non front-line organisations, by 2015.

The PAC report says: ‘It was clear from the evidence we took that many critical issues have yet to be resolved. Most important, for instance, the Department of Health has not yet got a framework to deal with failure in the system, be it on the provider side or the commissioning side.’

The reforms require all hospitals to become foundation trusts by 2014 and they will compete with non-NHS providers. PAC is concerned that competition law puts the focus on protecting services rather than providers. ‘This has serious implications for the less competitive NHS hospitals, particularly those with expensive PFI contracts,’ it says. ‘It is imperative that the Department of Health puts in place clear and transparent policies for dealing with failure of commissioners or providers to ensure patients are protected and value for money is assured.’

PAC, which seeks to ensure public money is well spent, wants the government to establishing strong, effective systems of governance and clear lines of assurance and accountability supported by robust flows of information.

The government has estimated the initial cost of the reforms will be a total of £1.4bn, mainly redundancy costs, to be offset by a £1.7bn reduction in administrative spending by 2015. PAC suggests these estimates could change if GP consortia prove reluctant to employ staff from existing NHS commissioning bodies.

Committee chair Margaret Hodge said: “The Department of Health acknowledged the risks associated with this radical shake-up of the NHS.

“Whilst the reforms could complement the imperative of achieving £20bn efficiency gains by 2014/15, the reorganisation might also distract those responsible for making the savings while safeguarding standards of patient care.”

Dr Hamish Meldrum, chair of BMA Council, said: “The Public Accounts Committee is right to highlight the risks posed by such a massive restructuring at a time of financial crisis.

“However, it is not just the timing, but also the direction of travel of these reforms that will cause problems. We share the concerns of the PAC that the consequences of increasing competition in the NHS have not been fully addressed. Market failures in healthcare have far more serious consequences than in other industries - and may have little connection with quality of care, or even patient demand.”

Health secretary Andrew Lansley said the efficiency challenge and reforms were inextricably linked. “Our reforms will help the NHS make savings,” he said.

Read the full report.

Tags: Health policy
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PMI: balancing full fee payment and affordability

By Dr Simon Peck, head of investigations and medical advice at AXA PPP Healthcare - 10:08 am

BMA research suggests that consultants’ income from private practice is declining. The study also reveals that private medical insurers are having greater influence over what consultants charge for their services. Here’s a response from AXA PPP Healthcare, a PMI provider:

As health insurers, we do of course have an essential role to play in helping to contain the cost of doctors’ charges.

We try to pay as many fees in full as we can but we have to balance this with keeping our policies affordable, which can be challenging for an insurance-based system because, at the point of treatment, individual policyholders generally do not seek value for money in the way in which they would if they were paying for this themselves.

Indeed, the (then) Monopoly and Mergers Commission recognised the importance of this issue in its 1994 report Private medical services: a report on agreements and practices relating to charges for the supply of private medical services by NHS consultants, the overview to which states:

‘Consultants enjoy a strong position in the private medical services market. The patient seeking PMS (private medical services) is vulnerable. He is usually insured and so is not greatly interested in prices.

‘It is therefore unsurprising that we have seen no evidence of significant pressure on consultants’ charges exerted by either the patient or the GP in his role as gatekeeper, and virtually no evidence of price competition between consultants. In this situation the countervailing power of the insurers is of crucial importance.’

Our fixed fee schedules are also important for customers as they balance offering a fair remuneration for doctors with ensuring that customers do not run the risk of having a personal shortfall.

Patients cannot reasonably be expected to discuss fees on an equal footing with someone about to treat them and they do not have the knowledge of what is and is not reasonable. We do, and that is why these schedules are an important part of our customer proposition.

Our hospital network policies are an example of our offering customers more choice - not less. Customers, if they wish, can choose a policy that enables them to be treated in any medical facility in UK.

In practice, most elect for the network option for which they pay a lower premium.

Tags: PMI, Private practice
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Reform opposition masking budgetary constraints

By Matthew Shaw, co-founder of Remedy UK - 9:47 am

Remedy UK is pleased to have been invited to be a part of the NHS Future Forum - a special group which the government will consult over improving the Health and Social Care Bill.

We hope that this will be an opportunity for junior doctors to plant a foothold on a secure training structure for the future.

The Health and Social Care Bill creates two particular problems for doctors in training which we would like addressed. Fragmentation of clinical services will make it much harder for doctors to arrange training programmes.

We expect to see a lessening of the role of deaneries, which have always been fatally compromised by their internal conflicts between their educational goals and their SHA paymasters. We are keen to see the Royal Colleges given a stronger voice in maintaining professional standards, and we consider that they can best ensure that doctors-in-training are sent to the most appropriate training units.

We also want mechanisms in place to avoid the hands-off management style which could relegate manpower planning to the whims of market forces. We will be fighting to ensure that universal training structures and standards are preserved and that better mechanisms exist to plan workforce numbers. The government must not wash its hands of this responsibility and apportion blame to someone else if things don’t work out.

Last month Remedy affirmed our view that there is some good in the Health and Social Care Bill, as well as some bad, and we emphasised that the budgetary constraints - NHS chief executive David Nicholson’s challenge of £15bn efficiency savings by 2015 - have been receiving insufficient attention.

The email responses we received unsurprisingly ranged from very positive to very negative (the balance was about 3:2 towards the negative) and we have taken note of these comments. But we firmly believe that that are hard decisions to be made about rationing and constriction of services, and these decisions should be made by doctors. Not by local politicians who are looking for the next vote.

We look forward to taking part in the improvement of the Bill and defending the ability of doctors to get world class training in a new NHS.

Tags: Health policy
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NHS trusts are flouting mixed-sex ward rules

PA - 26th April 2011 6:23 pm

Almost half of NHS acute trusts are still putting patients in mixed-sex accommodation despite facing financial penalties, new figures show.

Data for March revealed 5,446 breaches of mixed-sex rules across England, down from 7,583 in February. As of April, trusts are being fined £250 per patient per day for breaking rules on mixed-sex sleeping on wards.

The data for March, from 287 provider organisations, showed there are still thousands of breaches every month.

Of 146 acute trusts, 48% had sleeping breaches.

The difference between listening and being heard

By Stephen Campion, HCSA chief executive - 2:18 pm

I have been thinking a lot about ‘listening’ recently. The coalition government’s decision to create a breathing space in the Health and Social Care Bill timetable ostensibly lets Andrew Lansley off the hook by giving him the opportunity to reflect on what healthcare professionals and others may be saying about it.

This is not the first time governments have sought to seduce us into believing it will listen to what we have to say. Remember Tony Blair’s Big Conversation? I never got a word in and I doubt many others did either.

Where I live (a conservation area) Sainsbury’s has just received planning approval subject to the Secretary of State’s approval, to a major new store. This went through the planning machinery despite strong and vehement local community protest. Who was listening? Certainly not the Planning Committee chairman whose casting vote determined the application should succeed.

I get really angry when the notion of ‘community engagement’ is trumpeted by politicians as a central platform of listening to what local people have to say. There’s a big difference between being listened to, and being heard. It is rare in the extreme for policy to be changed or abandoned because that is the will of the people. I have therefore to be sceptical about the outcome of the Alternative Vote referendum. I write this before the vote is held - but if the turnout nationally is over 50% I will give a donation to Help the Heroes. Will apathy rule? I think so.

It seems to me that giving the local community the powers to elect its chief police officers, decide whether to retain a prized hospital A&E unit, encourage bus passes for the over 60’s or even decide whether a supermarket should be built on the doorstop is a good principle. But all too often it fails simply because apathy rules. Why? Because governments fall into the trap of believing communities don’t have the right answers. All too often local views are overturned by bigger business of political influences. So why bother?

That reminds me of a true story going back to the 1980’s. NHS trusts were being established all over the place - but only after public consultation. When was a NHS trust not formed through public opposition? These were foregone conclusions.

Which is perhaps why, at a public meeting in the New Forest, the chairmen and chief executives designate of the community, ambulance and acute teaching trusts gathered with their associated public relations personnel and other assorted bag carriers. The venue was the village hall. One person only showed up in the audience. The chairman opened the public meeting offering the attendee a warm welcome, and although no-one else was present thought he should offer the full consultation package.

“Do what you like,” the attendee replied. “I’m the caretaker and the sooner you finish, the sooner I can get home.”

I am not sure much has changed.

Tags: Health policy
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Private practice income declining, survey says

By Mike Broad - 1:58 pm

Consultants’ private practice income is declining, initial findings from a BMA survey suggest.

In 2011, more consultants reported a decline in private practice over the previous year (45%) than when canvassed in 2009 (40%).

Only 15% of consultants reported an increase in private practice income, compared with 17% in 2009.

Furthermore the research - which is based on the opinions of 608 consultants so far - suggests that private medical insurers are gaining more influence over consultant fees.

The proportion of consultants who are setting their fees in accordance with the reimbursement available from PMI providers has doubled in the past two years to 18%.

Those consultants setting their own fees have tumbled from 36% in 2009 to 28% now.

Half of doctors who have responded said they had been challenged by PMI providers about their fees, with 11% threatened with deregulation.

Derek Machin, chair of the BMA’s private practice committee, said that reducing income is a trend over the four biennial surveys conducted to date.

“There was not very much variation in people saying that their income had gone up, but there was a shift from people saying their income was the same to saying it had gone down.”

The Office of Fair Trading is currently examining the private healthcare market amid concerns that competition and patient choice are being stifled. The government body said its initial research suggested the £5.5bn market might not be working well for private healthcare patients.

Doctors’ representatives welcomed the review. They’ve campaigned against private medical insurers’ use of preferred provider networks and fixed fee schedules which they claim compromise patient choice.

Consultants surveyed by the BMA rated insurer WPA most highly (with 58% saying it was good or excellent) and, of the big PMI providers, AXA PPP Healthcare least favourably (with only 29% saying it was good or excellent).

Dr Simon Peck, head of investigations and medical advice at AXA PPP Healthcare, said: “We try to pay as many fees in full as we can but we have to balance this with keeping our policies affordable, which can be challenging for an insurance-based system because, at the point of treatment, individual policyholders generally do not seek value for money in the way in which they would if they were paying for this themselves.”

He added that AXA PPP’s fixed fee schedules were important for customers as they balanced fair remuneration for doctors with protecting customers from a financial shortfall.

Read a blog on the PMI view.

Tags: Private practice
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No cover up of mistakes at Mid-Staffs, new ceo says

BBC Health - 23rd April 2011 11:09 am

The incoming leader of Mid Staffordshire NHS Foundation Trust said there would be no cover up of past mistakes when she took over.

A public inquiry is looking at the role of regulatory bodies after a higher-than-expected number of deaths at Stafford Hospital from 2005 to 2008Lyn Hill-Tout will succeed trust chief executive Anthony Sumara in June whose two-year contract is due to expire.

She said the best tribute to those who died was ensuring changes were made.

“The thing for me, is behind all the questioning and all these really important people poring over their paperwork, that there’s patients and relatives behind all of this,” she added.

“The thing that strikes me out of all of this really, is how this is going to influence, not just care and what we do at Mid Staffordshire hospital, but how this is going to affect the NHS. This is really important,” she said.

Hill-Tout said she wanted to spend regular time at the inquiry to hear what had been going on, so that she could use the knowledge to take the trust forward.