HCSA

The Hospital Consultants and Specialists Association (HCSA) is a trade union that represents the interests of senior hospital and medical staff

Goodwill to be biggest casualty of NHS cuts

By Stephen Campion - 10th February 2010 5:10 pm

Two news items caught my blogging eye this week. Number one concerned a leaked document prepared by the Foundation Trust Network that shows beyond doubt (if there ever was any doubt) how the boom years have turned to bust.

Call it ‘strategic financial re-alignment’ or ‘savage cuts’, the fact is that the NHS, its patients and staff are all in for a hard time in the coming years.

Yet we see the absurd spectacle of NHS ministers fuelling public expectations in the run up to a general election, while behind closed doors their NHS managers are trying to figure out which services and staff they must savage to balance the books.

What makes me so angry is that the NHS Foundation Trust Network appears to be riding roughshod over the very terms and conditions that its political lords and masters agreed with staff representatives. I may not be a keen supporter of the 2003 consultant contract but that does not mean I can ignore it! But that is precisely what appears to be the case here.

Secret meetings discussing redundancies, the plundering of pensions, the tearing up of national agreements and other consequences of financial crisis hardly suggest health service personnel are valued, far from it. The NHS has always depended on the goodwill of its staff. But that goodwill may well be the biggest casualty of the cost cutting knife.   

Irritant number two was directed towards the appalling abuse of power and trust by a senior police commander, Ali Dizaei. I wondered whether four years in jail was sufficient. His actions were grossly unacceptable, let down the people he was appointed to serve, brought his profession into disrepute and demonstrated a total lack of accountability.

The judge had his own reasons for imposing the jail sentence but I could not help but wonder whether he should not have turned to precedent when another senior public servant was also found guilty of an abuse of power. Surely the least the judge could have done was to call for a complete overhaul of the way the profession polices itself, and introduce relicensing, revalidation, appraisal and the appointment of Responsible Officers.

It may be hugely bureaucratic, costly, time-consuming and tiresome, but at least we will be reassured that nothing like this can ever, ever, happen again - can’t we?

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Time to answer the West Lothian question

By Stephen Campion, HCSA chief executive - 15th January 2010 4:38 pm

What price devolution? The ‘West Lothian question’, whether Scottish MP’s in Westminster should have the right to vote on legislation that only affects England, has yet to be satisfactorily answered.

But the controversy sparked by a member of the Scottish parliament with a petulant bee in his bonnet about wanting to do away with rewarding excellence in medical practice, saw Nicola Sturgeon, Scottish health secretary quoted as saying: “CEAs are outdated and should be reformed on a four-country basis to avoid undermining the competitiveness of any one country when recruiting consultants.”

I simply cannot follow that logic. Why is it then that Scotland has decided social care should be free in that country, but not advocated it on a “four country” basis? Why is it that Wales has abandoned car parking charges whilst others in the UK are forced to pay punitive fees to visit their local hospital? Is that really fair on a “four country basis”?

And, incidentally, why is it that Wales decided to amend the “old” contract rather than adopt the one in place in the other three countries - albeit with minor differences? Many in the other three countries are now wishing they could do the same. Even though the Wales contact is not perfect, it is less open to the flagrant abuses that are being seen elsewhere in the UK.   

Either a policy that is good enough for one country should be applied across the UK - or we have genuine devolution where devolved parliaments do what they believe is right for that country and, crucially, be accountable to those they represent for whatever legislation they introduce.

Come on! Politicians can’t have it both ways! If the Scottish health secretary really wants to antagonise consultants in Scotland then that is her decision - and risk the consequences. But to hide behind the cloak of saying that to do so would undermine the competitiveness of her own country, and should therefore be a UK initiative, makes the concept of devolution a mockery.

If Nicola Sturgeon really believes she is onto a winner then that is her decision, but why should England, Wales and Northern Ireland carry her political risk?

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Impassable roads no excuse for bean counters

By Stephen Campion, HCSA chief executive - 8th January 2010 7:08 pm

Did you hear about the consultant this week who set off for work only to be stopped by the police and told to abandon his journey because the road was closed due to adverse weather conditions?

“I don’t care if you are a doctor sir - the road is closed!” So the law abiding doctor did just that, and was then told by his trust that unless he agreed to repay the time lost his absence would be dealt with by higher authority!

Other stories of NHS staff fighting their way to work during recent days (and some staying nights on end to maintain patient care) quite rightly hit the headlines and deservedly so. The NHS is magnificent when the chips are down. That is what professionalism is all about - genuinely putting the care of patients above self-interest and preservation.  

I wish the same could be true of those not directly providing care but charged with supporting those who do. The next few months will test this to the full.

The New Year has already seen too many trusts signaling financial failure and implementing panic measures. Desperate times may call for desperate measures but unlike the consultant stuck in his car, accountants have many roads to travel. But the road to patient care lies with healthcare professionals and they deserve to be treated better than this!

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Happy Christmas and a determined New Year

By Stephen Campion, HCSA chief executive - 16th December 2009 8:06 pm

Somehow it does not seem quite right to post my last blog for the ‘naughties’ with the words: “Have a happy Christmas and prosperous New Year.”

I am prepared to nail my colours to the mast and hope that the true meaning of Christmas shines through the busyness and commercialism at this time of the year. So the “Happy Christmas” bit of the greeting gives me no problem.

The bit that seems at odds with the traditional words looking forward to 2010 are the words “a prosperous New Year.” A leading public health doctor has called on the profession to take a lower wage in order to improve the health of those less well off. The government has announced that all NHS staff will in effect take a pay cut as it seeks to bail the country of its worst financial crisis in peacetime. And this comes at a time when many staff may well find themselves out of a job as NHS budgets are cut to the bone.

Pressures on ‘productivity’ will only increase. Budgets will decrease. We are destined for austere times and a prosperous New Year seems an ambitious target, political or otherwise.

So what words of greeting can I offer as a substitute? A ‘pleasant’ New Year is pretty bland, although might perhaps be achievable. A ‘relaxing’ New Year hardly sounds promising, and a ‘determined’ New Year would not be appropriate for those keen to get away from it all by flying British Airways.

Whatever alternative greeting is used is fraught with difficulty. What would you use? I have struggled with this one and then came across this quote by H.L. Mencken written in 1949 in his book Chrestomathy. “Puritanism. The haunting fear that someone, somewhere may be happy.”

Perhaps wishing you all a prosperous New Year is not so bad after all. So have a good one!

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Whatever happened to straight talking?

By Stephen Campion, chief executive of HCSA - 10th December 2009 9:08 am

In the past few weeks, the word ‘accountability’ seems to have raised its head above the parapet yet again.

Questions of NHS regulation and performance hit the headlines with the unexpected resignation of Baroness Young as chair of the Care Quality Commission. The public (and I count myself in that number) remain confused about how Basildon found itself between being both a good and bad hospital at the same time. How much confidence do we have in the quality of regulation and the ability of ministers to accept accountability?

That is not just a question for the NHS. It affects all government departments; and their response when things go horribly wrong provides a good insight into damage limitation and the marvels of political spin. Sometimes it is difficult to know where the buck starts, let alone stops!

Take this example. I was in the car on Tuesday evening listening with ever increasing incredulity to a classic performance of “how not to answer the question” on Radio 4’s PM programme. The subject? Not the NHS this time, but an interview with David Lammy, Minister in charge of our universities responding to a damning report on the Student Loan Company. If you have a moment it is worth listening to.

You might think that the answer to Eddie Mair’s simple question: “Is the person who was in charge of the Student Loan Company at the time of this fiasco still in charge of the Company?” would be a simple yes or no. Far from it. The reply was this: “The Chair has said that he is looking to strengthen and re-organise the senior management of the team and it is right that I allow them to do that with the due process that you would expect to take place.”

Eddie Mair tried again to elicit a simple answer: “But the person who was in place when it all went wrong remains in charge?” Answer: “There will be changes to strengthen and re-organise the senior management of the team but I am also making clear that it is not for me, as a minister, to determine the outcome of that. I look to the Board to do that and it’s right that they follow due process in doing that and in employment law.”

Not for the first time, I lost the will to live listening to such obfuscation. The words yes or no seem to escape those charged with running our public services. But the minister has done his colleagues a huge favour. His interview provides the perfect template for any government minister, permanent secretary or quango chief to use when things go wrong. They would do well to keep this reply on file. But I can’t help feeling that for proper accountability to work the better answer is a simple yes or no!

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I’m one year wiser, while the NHS is none the wiser

By Stephen Campion - 25th November 2009 1:55 pm

I woke up on Tuesday morning with the realisation that a further year had been added to my age. The next form I fill in will no doubt make me say “no surely that can’t be right” as I begrudgingly supply the required details.

But as I drove to a meeting outside Northampton I had time to reflect on the ageing process and suddenly realised how lucky I am. Compared to the NHS whose age is marginally older than my own, I counted myself fortunate that I have not needed cosmetic surgery to keep going, whilst the NHS has endured countless operations under the guise of service reconfigurations, organisational restructuring, strategic re-alignment or indeed performance management.

But if human beings get wiser with age, I wondered whether that also applied to the NHS? By the time I arrived at my destination I had worked out that we, mere mortals, do get wiser because we learn from experience. I wish the same could be said of the NHS. The NHS is a modern marvel when it comes to technology and its ability to promote scientific advance. But has it matured with experience?

If anything, the NHS is becoming less experienced as it gets older. Medical training is a case in point. Trainees’ hours in the log book are considerably less than a few years ago - that is not because there is less to learn, far from it.

Consultants are spending less time working in the wider interest of the NHS because trusts are fixed on short-term targets, blind to the longer term benefits consultants can bring to the NHS by active participation with their royal colleges.

There are few chief executives who can claim to have been in post for more than five years; and when it comes to NHS monitoring and quality standards the goal posts seem to move every season.

Getting older is no bad thing if we learn from our experiences, use them to shape the future and share them with those following on behind. But, as the NHS gets older, I worry that those following on will have no-one to learn from.

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How important is foundation trust status really?

By Stephen Campion, HCSA chief executive - 6th November 2009 5:52 pm

Catching up on some late night reading (my contract requires me to work as many hours as needed to get the work done and makes no reference to SPA’s or flexible sessions) I could not help but marvel at press attention to foundation trusts.

A leaked memo from one foundation trust chairman to colleagues in Essex accuses Monitor - the foundation trust regulator - of being “unfair” and “intimidatory”.

In another story, the number of voters for the election of foundation trust governors has slumped. Then there was a report on how Dorset County Hospital appears to be yet another in an all too depressing, yet familiar, catalogue of trusts failing to meet the requirements of effectiveness, efficiency and economy.

Chairmen, chief executives turnover at an alarming rate; senior managers struggle to keep the foundation ship afloat, and medical staff find it difficult to reconcile the promised benefits of foundation status with swingeing cuts imposed in order for too many trusts to correct multi-million pound budget deficits.

So there was a lot to read, but not much news. We have heard it all before. I dozed off, thinking about the magic words of financial freedoms, accountability, value for money and public engagement.

I woke up realising that not much has changed since ordinary NHS trusts were introduced in the late 80’s and early 90’s. Even back then directly managed units were clamouring to achieve trust status, subject to an apparent show of consultation and public support.

I remembered one particular consultation exercise in the New Forest. Three separate trust applications led by three chairmen, chief executive designate and lots of senior bag carriers, of which I was one. There was one single person in the audience when the meeting was called to order - and he was the caretaker.

 Not a lot has changed really. But, what would happen if the meeting was called to close A&E?

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Think carefully before calling in the fraud squad

By Stephen Campion, HCSA chief executive - 27th October 2009 6:36 pm

“Does your wife, or anyone else, drive your car doctor?” was, I thought, a strange question to be asked of a consultant by a clinical director.

But apparently someone - motive as yet unclear - thought his job plan meant he should have been somewhere else other than the local private hospital. So, rather than the trust first simply checking his diary and the job plan, officers of the NHS Fraud Squad instead spent months trying to get pictures of his car parked at the aforementioned private hospital.

They only succeeded in getting four pictures. Goodness knows how much time they spent hiding in the rosebushes waiting to take pictures of the car that “did not attend”.  

What a waste of money! That it was parked there was never going to be a contested issue. Just how much is being paid by way of covert surveillance, and how far are we from becoming a ‘stitch up’ society?  

Few would argue that fraud, when uncovered, means the perpetuator should be bought to account. But I would also like to think that we are living in a fair society and that the NHS should only revert to secret-service style tactics after very careful thought.

This is by no means the first occasion that I have encountered consultants being subject to such scrutiny and they might never find out if they have, if the fraud squad decides that there is insufficient evidence to proceed.

I was involved in one case where the NHS Fraud Squad involved the Crown Prosecution Service who determined there was no basis to proceed; but the trust went ahead anyway because the lesser burden of proof was in its favour. More often than not these Fraud Squad activities take place with the ‘suspect’ completely unaware of what is going on.

My point is that if the employer suspects infringement of the rules, is it right to go straight to the world of hidden cameras and enforcement officers hiding in the hedgerows at vast public expense? Or would it be better if a quiet word was first spoken in the ear?

Clearly much will depend on the severity of what is being investigated; and whether the source of the information is credible as opposed to malicious - and there are far too many of those. But I just worry that the fraud squad is becoming a weapon of first rather than last resort. Either way it saddens me that spy cameras seem as much part of the NHS, as speed cameras are to local authority revenue streams. 

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Did trusts teach Sir Thomas Legg a thing or two?

By Stephen Campion, HCSA chief executive - 16th October 2009 5:51 pm

A week is a long time in politics and so too can it be for the NHS.

In between listening to a medical director lecture a consultant that whatever his employment contract might say if he did not work all the hours required to satisfy the accountants his job would be on the line, and wondering just how the NHS would really benefit from levying a hefty fine on, or even closing, the Royal Cornwall Hospital, it dawned on me how brilliant Sir Thomas Legg has been.

Sir Thomas has reviewed all expenses submitted by our MP’s. He has concluded that whatever the rules may have been at the time they were inadequate and should not have been followed. So MPs who claimed their entitlement now have to pay some of the money back. The brilliance of this approach is that Legg has not only recovered money for the Treasury but has succeeded in changing the relationship between the public and its MPs.

Before the summer recess the public was in hanging mood, ready then to draw and quarter MPs who had abused the system; and, as we know, shares in duck house manufacturers and moat cleaning firms took a nosedive.

But now even the public is beginning to realise that changing the rules retrospectively to suit political ends is unfair. MPs may not be held in the highest esteem but our tendency to fair play offers at least a modicum of sympathy for people who acted within the rules but find, years later, that those rules should not apply.

I wonder if Sir Thomas came to this view after close study of the NHS? Too many trusts are saying that they simply do not care what was agreed between the Department of Health and the BMA in 2003.

Even though they were hailed and endorsed by the government, too many trusts are adopting the ‘Sir Thomas’ approach. “We don’t like the rules and as the game is played on our pitch we will decide how the game is to be played.” Like MPs doctors are entitled to ask whether this is fair.

Perhaps we should agree a new set of rules. My rules would not result in consultants being paid in units of Programmed Activities of four hours each, calculated to the third or fourth decimal point. My rules would recognise that doctors are professionals who resent this time sheet approach. My rules would recognise the value consultants bring. My rules would be work sensitive; not time sensitive.

Who wants to play?

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Tories offer deal that doctors should probably take

By Stephen Campion, HCSA chief executive - 9th October 2009 12:01 pm

Late last evening I received a text. The message from a friend of mine simply asked: “What did I think of David Cameron’s speech?”

I have not yet replied because the real answer is that I simply do not know what to make of it. Certainly the promise to end the target culture was encouraging - and indeed not surprising. Targets have done much to destroy the doctor/patient relationship.

We have consistently argued to government and the opposition that the competing priorities between clinical need and political targets have led to a dilemma for doctors almost impossible to reconcile. So, well done David Cameron.

But the flip side is that doctors will be asked to trade-off the target culture against a new measure of patient satisfaction, and greater patient choice. The concept of patient satisfaction is in itself no bad thing. If you don’t like the service from the bank, then change bank.

As the Royal Mail is finding to its cost, if you don’t like the service then change to a different courier or use the electronic technology now available.

But how does a patient assess the quality of medical care and treatment? No matter how good the doctor, prognosis and treatment are not necessarily indices of success. And the environment is not one necessarily controlled by the doctor alone; the doctor may lead the team but health outcome is governed by a complex combination of factors often outside the doctor’s influence.

If we have to work through these issues as a price for losing the dreaded target culture it seems to me that is a price worth paying. I think I will reply to my friend’s text as follows: “Speech encouraging - the devil will be in the detail!”

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