Bob Bury

How the brave new NHS world will look …

A little snapshot for you this week. It will give you a foretaste of how life will be in the new improved NHS, following the forthcoming injection of expertise and altruism from the private sector.

I’m sitting at a radiology PACS workstation, doing my locum session of plain film reporting which, post retirement, provides my pocket money – just enough to cover the odd pint of stout and my class A drugs. This is in the nuclear medicine department and in the background I can hear a colleague quietly tearing his hair out.

The PET/CT scanner has broken down for the umpteenth time in the past couple of months, and he’s trying to get someone to take the recurrent problem seriously. They are frantically trying to get it going again, while at the same time dealing with the anxieties of patients who have already been injected with radiopharmaceutical and who will probably not now get their scan. One of those patients has already been re-booked once, because his blood sugar was too high the first time round. Another patient has informed my colleague that he is a close acquaintance of the editor of one of the national broadsheets, and will be contacting his chum concerning his experiences at the trust’s hands.

He, the patient, will not have appreciated the background to the PET/CT service. Although the scanner is located in an NHS department, it is a cuckoo in the nest. The national PET/CT procurement programme was instituted by the previous government, and, as good socialists, they insisted that the new nationwide service must be provided by the private sector. So, contracts were awarded, and our chosen provider asked the radiologists to assess the equipment available and decide which was the best scanner. They did this, and the company concerned then purchased a cheaper one which, needless to say had not been at, or near, the top of the radiologists’ list.

The contract has now been running for three years or so, and an enormous amount of NHS staff time has been spent trouble-shooting the service in various ways, not least in picking up the pieces when the scanner breaks down and dealing with issues around the booking of scans. The apparent belief of both major parties that the private sector is more efficient than the public would not survive long if they spent some time in NHS departments like this one.

Of course, I can’t say with any certainty that if the radiologists had been provided with the scanner they wanted, it would have broken down less frequently. I would simply observe that with expensive medical equipment, as with most things, you get what you pay for. What I do know is that if the Labour government had just given us the money to buy the scanner and run it ourselves instead of throwing cash into a contract which appears to contain no enforceable quality criteria, we could have had a better service. But of course, the capital outlay for equipment would have impacted on Gordon Brown’s bottom line, whereas the eventually much larger revenue costs of buying the service from the private sector can be hidden. Just like PF bloody I.

And if our disgruntled patient goes to the press, as promised, it will be the trust and the NHS in general which is pilloried in the headlines, with tales of cancer patients denied a timely diagnosis and treatment. I wouldn’t even be surprised if the story used the perceived shortcomings of the PET/CT service to reinforce the case for NHS ‘reform’.

But of course, all that Andrew Lansley’s Health Act will do is to potentially reproduce this unhappy scenario by increasing the number of private concerns taking on NHS work. Providers with an eye to the main chance will be queuing up with the cheapest kit and the smallest number of staff with the minimum qualifications necessary to run their service, and no doubt relying on the NHS to cover up for their corner-cutting.

But perhaps this department has just been unlucky, and everywhere else in the NHS these private/public partnerships are working just fine.

Well?… Examples please?

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6 Responses to “How the brave new NHS world will look …”

  1. Paul says:

    Dear Bob,

    I’ve asked this before but never got a sensible answer. Maybe this will be the time.

    Since all doctors who work in the NHS love it (in the sense of agreeing with its principles) and want it to work well by definition, why would GPs, when they control commissioning, commission things so badly? Being in control of commissioning doesn’t mean just accepting the lowest price, it means specifying what you actually want, making sure that that is what the contract says, and then making sure that the supplier delivers it.

    You may want to listen to before replying to hear both bad and good examples of public sector commissioning. If commissioning can be done well and take into account wider public interests in Wales (if I remember correctly) why will GPs do it so badly? Maybe it will be all the consultants on forums like this (and nurses) who have forced the Government to include their representatives on CCG boards who are going to force the GPs to blindly accept the lowest cost bids?

  2. Bob Bury says:

    Paul – I’d be perfectly happy for GPs to commission services. i would hope they would involve secondary care doctors too, because I wouldn’t expect GPs to know much about the role of (e.g.) PET/CT in the staging of particular cancers (to choose an example from my own area of interest). I would also expect them to need a lot of support from people with knowledge of the commissioning process (i.e. the people who have been doing it in the PCTs), because I wouldn’t expect GPs to know much more about the nitty-gritty of commissioning than I do.

    I also wonder how GPs will find the time to do all of this, but if they tell me they can, that’s fine. But of course, the issue is that this could all have been achieved by simply increasing the clinical input to the PCT system. Instead, the wheel has been re-invented, people have been sacked and then (some of them) re-employed. And once it’s all up and running, Mr Lansley tells us that the commissioning process will be hived-off to the private sector. I don’t know how much influence the GPs on the groups will have once that happens, and i hope I will be favourably surprised.

    My opposition to the HSCB is not centred on GP commissioning, it’s the unnecessary upheaval and the blind insistence on increasing the input of the private sector. I don’t trust commercial providers to put quality above the bottom line, and all of my experience in the imaging field in recent years is that they won’t.

    In short, I have never suggested that GPs will ‘commission things so badly’. I just don’t think they’ll be allowed to commission them well.

  3. Tom Goodfellow says:

    To be devil’s advocate (a role which I love). My Trust has PET CT – but outwith the national programe. We are PFI and it is the company which has provided the kit.

    It has been very successful!

  4. Bob Bury says:

    That’s precisely what this unit wanted to do Tom, but it was not allowed. You must have been lucky, and got in just in time, before the Labour government insisted that all PET/CT had to be provided through their ‘initiative’.

    There’a also a lovely new PFI cancer unit with a five room nuclear medicine department and two room PET suite (although they’ve had to dig up the surface outside the main entrance because the block paving was adopting an undulating contour, and the automatic entrance doors keep malfunctioning) – it’s just that it will cost so much that my grandchildren will still be paying for it.

  5. Iain Stewart says:

    I’ ll join Dr Goodfellow in being a devils advocate.
    The statement
    “contract which appears to contain no enforceable quality criteria” says it all. Who signed the contract ? NHS “managers” ?.
    Wouldn’t muppets be a better description?

    “private sector is more efficient than the public” It is , it is . The private sector screwed the NHS again (see ITSC’s).Very efficient capitalists

  6. Bob Bury says:

    Precisely Iain. And who will be signing the contracts in the New NHS?

    Both you and Tom are reinforcing my points. Tom got the best of both worlds – the scanner was bought for them by the PFI people, and they are running it themselves. The trust in question in my blog had to put up with the machine being bought by the private sector and then had to cope with the less-than-efficient operation of their booking and administration service.

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