I would love to be a fly on the wall in the Government's health department at the moment as the department's policies have recently been attacked from all directions. Health charities, coalition MPs and nationwide GPs have very publicly criticised different aspects of the Government's health policies and I would think that Andrew Lansley, the Secretary of State for Health, will probably spend the upcoming weekend contemplating how much longer he can cling to his post.
To give you some background, Lansley was Shadow secretary for health for ten years before the Tories formed a Government last year. It seems that spending such a long time in a single role in opposition has left Lansley with incredibly ambitious ideas that seem one step removed from the practical reality of a country with a shaky economy. Indeed so protective has Lansley been of his department, rumours have been circulating that it has isolated itself from all other Government offices. A BBC World at One report earlier this year revealed that Cameron has increased the number of policy advisors at Number 10 so he could get a better understanding of the health policy that Lansley has been guarding behind closed doors.
Back in 2001, Britain was starting a decade of cheap credit, low cost of living and continuous growth. As the decade progressed, Lansley could be forgiven for thinking our country was stable enough to allow for the biggest reorganisation of the NHS since its inception in 1948. However, so keen is Lansley to unleash plans that were so long in the making, he seems unwilling to recognise that the country is very different to what he had envisioned. Lansley's NHS reorganisation is meant to cost anywhere between £1.4 and £3 billion pounds - and with the UK supporting a massive deficit it is no wonder the nation is wondering if we can afford these changes right now. Moreover the meltdown of the UK banks has left our country more political. Whereas in the good years we might have been too busy buying expensive clothes on credit and binge drinking away our weekends to criticise our politicians, in our current sober times more and more British people are vocally questioning Government policies.
Yet despite this climate, Lansley announced a "revolution" of our NHS when he released his department's NHS white paper last July. As doctors, health charities, journalists, patients and opposition MPs have begun to understand the implications of this white paper, the dissent has slowly risen. Even Cameron's direct media intervention earlier this year to help 'sell' the Government's NHS white paper has done little to assuage mounting criticism. Cameron may now be calling the NHS changes an "evolution" instead of a "revolution" but many still believe his NHS proposals are leading us down the road of privatisation.
And so to this week. The British Medical Association called an emergency meeting, the first for 17 years, in which GPs voted in favour of the motion that Lansley entirely withdraw the Health bill currently going through parliament and halt reorganisation plans. In separate news, on Monday six health groups refused to sign up to the Government's 'responsibility deal' on alcohol saying that the voluntary measures do not ask enough of the drinks industry. Don Shenker, Chief executive of Alcohol Concern, said that the Government's public health policy's "first priority is to side with big business and protect profits". Finally, Lib Dem activists have voted overwhelmingly to reject the Coalition's NHS reforms as they believe they are unjustified and will be highly damaging.
So where to now? My feeling is that David Cameron will fall back on his old PR background and consider that the way to win round voters is to alter the presentation of NHS reforms. And perhaps he will conclude that Andrew 'Revolution' Lansley is now too toxic a figure to be spearheading such divisive changes. Such a move would suit Clegg as well who, after the fallout of tuition fees, has to show his party that he has listened to their doubts. So I think Lansley's days are numbered and if rumours on Twitter are to be believed a possible replacement might be Grant Shapps, currently the minister for housing and local Government.
But Clegg and Cameron should be warned. A change of Minister might win them some breathing space but they will still have a case to answer as to where the electoral mandate is for such reforms. Neither the Tory or Lib Dem manifestos mentioned such sweeping changes to the NHS, and the Coalition document was also silent on the issue. Lansley may well be forced to fall on his sword but that sword is razor sharp and capable of taking many more victims.
Thursday, 17 March 2011
Tuesday, 8 March 2011
How CF and heart surgery reveal a gap in GP commissioning
As GPs across the country grapple with how best to commission care for their users, the King's Fund raised serious concern last week about how groups of GP consortia can be expected to understand the complexities of our nationwide hospital provision.
In a report out earlier this month called Reconfiguring Hospital Services, the King's Fund says that sorting out how to improve the quality of hospital care may well result in closing some hospitals or consolidating what services each hospital offers. They are concerned that the impending abolishment of strategic health authorities, along with Primary Care Trusts, means that there will be no umbrella view of hospital services and stress that, in their opinion, "Market forces alone are unlikely to result in improvements in quality of care for patients in many hospitals, and could result in deterioration in some cases".
A classic case of such complexities is the current Government review of Specialist services which is currently looking into which hospitals in the UK will provide congenital heart surgery for children. It is recommending that such procedures are carried out in just six or seven hospitals in the future which means that of the four current London providers only two will remain.
The reasons for consolidating care aren't just concerned with funding. There is evidence to suggest that the more surgery a surgeon performs the better he becomes at it and, in addition, the larger the hospital the better the survival rates. This isn't rocket science: one of my first ever posts discussed a surgeon's success in terms of Malcolm Gladwell's theory that it takes 10,000 hours of practice to become great at something.
But while there may be a case for reducing such nationwide congenital surgery centres from 11 to 6 or 7, there are unexpected consequences for those patients who don't have congenital heart conditions but also receive treatment at the hospitals under scrutiny.
The Government's review currently favours maintaining congenital heart surgery at Great Ormond Street Hospital and Evelina Children's hospital, which means Brompton Hospital in London would lose its ability to offer this treatment. I was surprised to hear that the Cystic Fibrosis Trust is campaigning against the Brompton hospital losing its congenital heart care. I'm a CF patient at Brompton and I didn't see the connection.
But the CF Trust is worried that if Brompton loses its ability to provide congenital heart care then it will not have the patient base to justify it having a children's intensive care unit and anaesthesia service. Which means that the care available for paedeatric CF patients will be inadequate. This in turn places additional stress on the other three London hospitals that look after CF patients as they would need to find clinic space and bed space for over 300 additional patients that are currently looked after by Brompton.
And for me, an adult CF patient, it makes me worry that there will be a knock-on effect on the care I receive at Brompton as there would no longer be a future patient base of CF children that would grow up to need an adult CF service. Brompton provides world-class care for Cystic Fibrosis patients so surely it can't be intentional that this service is now under threat?
This does all sound complicated, but it is this detailed understanding of the demands on individual hospitals and the ability to foresee the effects of curtailing certain patient services that the Government must retain. The concern is whether GP consortia will be able to get to grips with the reforms that hospitals will require without the quality of care being affected for all the many patient types that use each hospital.
The King's Fund believes that GP consortia will not have the experience or size to implement major service improvements in hospitals and is urging that the Government's new NHS Commissioning Board be given greater powers to strategically plan hospital services. It argues that without these powers the system will gravitate to a 'market forces' model and this will not provide any improvement in the quality of care patients receive. And remember, the Government promises that a key aim behind its proposed overhaul of the NHS is to improve care - it is clear to me that to do this the Government must start looking at the limitations of GP commissioning as well at the advantages.
In a report out earlier this month called Reconfiguring Hospital Services, the King's Fund says that sorting out how to improve the quality of hospital care may well result in closing some hospitals or consolidating what services each hospital offers. They are concerned that the impending abolishment of strategic health authorities, along with Primary Care Trusts, means that there will be no umbrella view of hospital services and stress that, in their opinion, "Market forces alone are unlikely to result in improvements in quality of care for patients in many hospitals, and could result in deterioration in some cases".
A classic case of such complexities is the current Government review of Specialist services which is currently looking into which hospitals in the UK will provide congenital heart surgery for children. It is recommending that such procedures are carried out in just six or seven hospitals in the future which means that of the four current London providers only two will remain.
The reasons for consolidating care aren't just concerned with funding. There is evidence to suggest that the more surgery a surgeon performs the better he becomes at it and, in addition, the larger the hospital the better the survival rates. This isn't rocket science: one of my first ever posts discussed a surgeon's success in terms of Malcolm Gladwell's theory that it takes 10,000 hours of practice to become great at something.
But while there may be a case for reducing such nationwide congenital surgery centres from 11 to 6 or 7, there are unexpected consequences for those patients who don't have congenital heart conditions but also receive treatment at the hospitals under scrutiny.
The Government's review currently favours maintaining congenital heart surgery at Great Ormond Street Hospital and Evelina Children's hospital, which means Brompton Hospital in London would lose its ability to offer this treatment. I was surprised to hear that the Cystic Fibrosis Trust is campaigning against the Brompton hospital losing its congenital heart care. I'm a CF patient at Brompton and I didn't see the connection.
But the CF Trust is worried that if Brompton loses its ability to provide congenital heart care then it will not have the patient base to justify it having a children's intensive care unit and anaesthesia service. Which means that the care available for paedeatric CF patients will be inadequate. This in turn places additional stress on the other three London hospitals that look after CF patients as they would need to find clinic space and bed space for over 300 additional patients that are currently looked after by Brompton.
And for me, an adult CF patient, it makes me worry that there will be a knock-on effect on the care I receive at Brompton as there would no longer be a future patient base of CF children that would grow up to need an adult CF service. Brompton provides world-class care for Cystic Fibrosis patients so surely it can't be intentional that this service is now under threat?
This does all sound complicated, but it is this detailed understanding of the demands on individual hospitals and the ability to foresee the effects of curtailing certain patient services that the Government must retain. The concern is whether GP consortia will be able to get to grips with the reforms that hospitals will require without the quality of care being affected for all the many patient types that use each hospital.
The King's Fund believes that GP consortia will not have the experience or size to implement major service improvements in hospitals and is urging that the Government's new NHS Commissioning Board be given greater powers to strategically plan hospital services. It argues that without these powers the system will gravitate to a 'market forces' model and this will not provide any improvement in the quality of care patients receive. And remember, the Government promises that a key aim behind its proposed overhaul of the NHS is to improve care - it is clear to me that to do this the Government must start looking at the limitations of GP commissioning as well at the advantages.
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