Dr Blogs

Did the earth move for you as CCGs went LIVE?

I live in East Anglia.

Because of the nature of my work, I know a lot of hospital doctors around the region. All the acute hospitals out here are fit to bursting.

Most of the hospitals have been oscillating between ‘red’ and ‘black’ for a while now, and consultants have given up opening the increasingly desperate emails from their medical directors entitled ‘Discharge patients NOW!’

While patients don’t tend to get stuck in corridors anymore, we’ve created our 21st century equivalents.

The ‘discharge lounges’ are now full of people who’ve only just turned up and aren’t going anywhere. People don’t lie around on trolleys for hours and hours any more, but there are plenty sat in chairs in ‘waiting areas’ with mobile drips next to them.

Then there are the associated problems of heaving hospitals. Noro is rife, ambulances are queuing outside (and even pitching tents) and hard-pressed social workers are struggling to facilitate discharges.

And yet many of these hospitals are big, with lots of beds.

Just as everything should be winding down after winter, and staff are taking a week or two on holiday, and wards would normally be being lined up for deep cleans, there are more patients than ever.

Maybe it’s because of the long winter. Maybe it’s a statistical blip. Maybe it’s because out-of-hours services in primary care have become ineffectual (and should be run by secondary care as has been mooted out here in the past). Maybe it’s a long term trend in demand that we’re ill-equipped to deal with.

Just as I was mulling all this over, I read the following article. (When, oh when, are doctors going to stop wearing bow ties…).

So, in the brave new world, when acute hospitals are running just to stand still, we’re going to reduce their capacity.

How’s that going to happen then? One of the pleasures of my job is that I get to sit in a lot of conference rooms with very intelligent people talking about the future of the NHS. Keogh et al tell me that it’s all going to change: the public will learn to take more responsibility for their health, and develop a different relationship with the NHS; we will adopt a more preventative approach to health and wellbeing harnessing the whole of the public sector; health and social care services will become better integrated; more services will be delivered in the community and people’s homes; the demands on hospitals will fall…

Do we really believe that CCGs, which this month ‘go live’, are going to be able to drive this? I keep hearing that hospital directors sit down with CCG representatives and agree all sorts of things for more progressive services; the CCG representative goes away, then makes contact a couple of days later saying they don’t have the authority to agree any of those issues they discussed. The hospital director shrugs their shoulders and gets back to the daily ‘fire fighting’.

The CCGs don’t have the authority, and the hospitals don’t have the resources.

So, that leaves the NHS Commissioning Board? Well, as far as I’m aware, they’re keen to offer support for reconfiguration as long as that support doesn’t actually cost them anything.

If you needed an example of how difficult reconfiguration is to broker in the NHS, just look at what a mess the national paediatric heart surgery review has become.

It leaves me to conclude that the government and the NHS can have all the policy in the world about how it is going to change, but unless it is significantly incentivised (and I’m not including ‘hospital failure’ as an incentive) then not much is going to change.


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