As a recent double-lung transplant patient I was shocked to read that Papworth hospital is under threat of closure from the Treasury. As the UK’s largest cardiothoracic hospital, it is one of only seven hospitals in the UK that performs heart and/or lung transplants, and, with the exception of Harefield (where I had my surgery), has almost double the number of patients in after-care then its nearest rival.
Yet this hospital’s vital and successful role in the UK’s delivery of transplants, amongst other essential services, is now at risk. The Government is demanding yet another review about moving Papworth services in part or in entirety to Peterborough City hospital, to help bail out the latter from its crippling debts. This comes despite the fact Peterborough’s debts are entirely unconnected to Papworth, which is one of the NHS’s strongest financial performers.
Transplants are incredibly complex procedures that need highly experienced clinical teams and specialized equipment for the surgery, and before and after care. It isn’t an exaggeration to say that the excellence behind these established teams is keeping people alive for longer.
Katherine Graham, who received a heart and lung transplant at Papworth last September, said: “I have seen at first hand the amazing work and dedication of staff and have received first class care at all times.” This personal experience is reflected in the hospital’s Friends and Family test score of 85%, the highest in East Anglia.
Yet Graham believes that a move to Peterborough “would result in diluting our care and the expertise that has already been achieved at Papworth and would jeopardize our futures.” She’s right to be concerned. In addition to being debt-laden, in its most recent Care Quality Commission (CQC) inspection Peterborough hospital failed to meet two essential standards, including providing appropriate care for its patients.
Back in July 2010, when the Government published its white paper on its intended radical NHS reforms, the foreword, signed by Cameron, Clegg and then-health minister, Lansley, said:
“Patients will be at the heart of everything we do. So they will have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care.”
Controversially patient choice was intended to create a market in healthcare in which hospitals with excellent standards of care would thrive as more patients chose to attend them, while those who gave poorer care would be left to close if they couldn’t attract more patients by improving their services, and therefore gaining increased funding.
There are huge problems with designing healthcare provisions on this model, not least the fact that the poorest or most ill patients have less capability to travel far for treatment, but the Treasury’s intervention over Papworth undermines the reforms’ positive focus on patient experience as it is perversely penalizing one hospital for being successful and rewarding the other for failure.
Yet it is evocative of the future direction the Government is taking with hospital restructuring. Still brooding after appeal court judges ruled it acted illegally in cutting A&E and maternity services at London’s Lewisham hospital, the Government is pushing a critical amendment to the Health care bill through parliament. It would allow administrators to force changes upon financially viable hospitals which neighbour failing hospitals, without the need to consult patients or doctors.
It is a fallacy to say that patients will have any real influence over NHS spending when services at their local or chosen hospitals can be closed without clinical justification, or, in many cases, when closure would actual harm outstanding care. The drive for improved health standards that patient choice was meant to champion cannot succeed if hospitals which provide excellent care are seconded to those that have the highest debts.
I am incredibly grateful to the NHS and the team at Harefield who helped give me back my life through a transplant. I would be devastated if my friends’ chances of getting the same life-changing opportunity at Papworth are jeopardised by this Government’s chaotic and unfair attitude to hospital reorganization which prioritizes reducing debt over saving lives.
Showing posts with label Lansley. Show all posts
Showing posts with label Lansley. Show all posts
Thursday, 20 February 2014
Wednesday, 9 May 2012
NHS could be the real problem for the coalition come election time
After last week’s wake-up call at the local elections, the Coalition is under pressure to re-examine how its policies reflect voters’ expectations. While there is much debate about the merits of Lord reform, gay marriage, austerity targets and growth policies, the two parties would do well to turn their attention to recent passing of the Health and Social Care bill.
Yesterday’s decision by the Government to veto the information commissioner’s legal demand to publish the risk register reminds us all what a controversial bill this truly was. The Government is still not keen to reveal to the public the extremities of the risk assessment, although an early version of the register, leaked in March, suggests that the worst case scenario of these reforms would be that “the Bill proceeds, without assurance that the whole system is affordable." The document continues: "There is a risk that costs of the future system cannot be controlled."
No wonder the bill received such widespread criticism in the run-up to it becoming law. In February this year, eight significant health organisations fully opposed the bill, two opposed it in its current form and three were neutral. On top of that a YouGov survey showed the 65% of NHS staff wanted the bill withdrawn in its entirety.
I repeat these statistics as it shows the uphill battle the Government has to secure good outcomes from such a fiercely unpopular policy.
Since the bill became law there has been on-the-ground confusion on how best to implement its policy’s, a situation not helped by aggressive private companies there were waiting in the wings ready to take advantage of this initial knowledge vacumn. Virgin now controls 18 NHS contracts across 15 counties, and Labour back-bencher Dr Éoin Clarke estimates that £2 billion worth of NHS contracts have now been given to private companies.
Despite this plethora of contracts there is no evidence that such outsourcing of NHS contracts will deliver better services, increased choice or long-term control of costs. Indeed, the first NHS hospital to be completely privately run, Hinchingbrooke in Cambridgeshire, has recently caused a furore by announcing it intends to make a profit of £60 million in the next decade despite concerns that to do so would mean making 'eyewatering cuts'. On top of this there are ludicrous stories of physiotherapists who aren’t allowed to touch their patients following a new contract agreed by Principia clinical commissioning group (replacing the local Primacy Care Trust) in Rushcliffe, Nottinghamshire.
If a patient is unhappy with the care they are offered they can complain to Healthwatch, but they’d have to wait five months as, despite the fact that the bill is already on the statute books, it doesn’t launch until October this year. Once this organisation does finally get round to opening, it can then pass on complaints to the Care Quality Commission (CQC) which is now responsible for ensuring that private health providers are honouring the quality expected of them. This is the same CQC that has been overseeing private social care providers since 2009 and has twice been humiliated by BBC Panorama revelation's of abuse at care homes that the CQC had already inspected multiple times and declared acceptable. Despite clearly struggling in its current role, the Government expects the CQC to more than double its workload with 30% less staff. The public may accept private providers profiting from NHS work, but in exchange it will expect the service it receives to be better than what is currently on offer and it is clear that the systems in place to manage this are already found wanting before they get off the starting block.
It isn’t even clear that in the current rush to implement these reforms the basic principles of free market capitalism are honoured, a principle that is the bedrock behind the spending decentralisation of this Tory-led Government. Despite health secretary Lansley’s much vaunted initiative of giving GPs the budget and power to buy services for its patients, it is alleged one local commissioning group in West Sussex weren’t told about a new contract award to Virgin healthcare until after it was signed off. The commissioning board were therefore not able to consider the merit of the bid in comparison to other interested parties – a clear failure of the health bill’s objective of tendering-out NHS work to help achieve better value for money for the taxpayer.
After such a turbulent month the Government most probably couldn’t bear the horrendous headlines that would result if it revealed what risks it is truly taking with our beloved NHS. But whether made public or not, those risks outlined by the risk register still remain. No doubt the Government is hedging its bets that the new Health Bill would have bedded in by the time an election is called in 2015, and any initial concerns by the public would have been proved false. Three years is also enough time for the NHS as we know it to have unravelled, for charges for non-urgent surgery or treatment to be mooted, for waiting lists to grow, for private companies to make large profits while limiting the contact patients have with doctors. And the first few months of policy implementation don't embue one with confidence that the NHS is in safe hands.
So Cameron and Clegg be warned: the battle to push the health bill through parliament could prove miniscule compared to the battle on voters’ doorsteps in 2015 to convince them that you can be trusted with the NHS.
Yesterday’s decision by the Government to veto the information commissioner’s legal demand to publish the risk register reminds us all what a controversial bill this truly was. The Government is still not keen to reveal to the public the extremities of the risk assessment, although an early version of the register, leaked in March, suggests that the worst case scenario of these reforms would be that “the Bill proceeds, without assurance that the whole system is affordable." The document continues: "There is a risk that costs of the future system cannot be controlled."
No wonder the bill received such widespread criticism in the run-up to it becoming law. In February this year, eight significant health organisations fully opposed the bill, two opposed it in its current form and three were neutral. On top of that a YouGov survey showed the 65% of NHS staff wanted the bill withdrawn in its entirety.
I repeat these statistics as it shows the uphill battle the Government has to secure good outcomes from such a fiercely unpopular policy.
Since the bill became law there has been on-the-ground confusion on how best to implement its policy’s, a situation not helped by aggressive private companies there were waiting in the wings ready to take advantage of this initial knowledge vacumn. Virgin now controls 18 NHS contracts across 15 counties, and Labour back-bencher Dr Éoin Clarke estimates that £2 billion worth of NHS contracts have now been given to private companies.
Despite this plethora of contracts there is no evidence that such outsourcing of NHS contracts will deliver better services, increased choice or long-term control of costs. Indeed, the first NHS hospital to be completely privately run, Hinchingbrooke in Cambridgeshire, has recently caused a furore by announcing it intends to make a profit of £60 million in the next decade despite concerns that to do so would mean making 'eyewatering cuts'. On top of this there are ludicrous stories of physiotherapists who aren’t allowed to touch their patients following a new contract agreed by Principia clinical commissioning group (replacing the local Primacy Care Trust) in Rushcliffe, Nottinghamshire.
If a patient is unhappy with the care they are offered they can complain to Healthwatch, but they’d have to wait five months as, despite the fact that the bill is already on the statute books, it doesn’t launch until October this year. Once this organisation does finally get round to opening, it can then pass on complaints to the Care Quality Commission (CQC) which is now responsible for ensuring that private health providers are honouring the quality expected of them. This is the same CQC that has been overseeing private social care providers since 2009 and has twice been humiliated by BBC Panorama revelation's of abuse at care homes that the CQC had already inspected multiple times and declared acceptable. Despite clearly struggling in its current role, the Government expects the CQC to more than double its workload with 30% less staff. The public may accept private providers profiting from NHS work, but in exchange it will expect the service it receives to be better than what is currently on offer and it is clear that the systems in place to manage this are already found wanting before they get off the starting block.
It isn’t even clear that in the current rush to implement these reforms the basic principles of free market capitalism are honoured, a principle that is the bedrock behind the spending decentralisation of this Tory-led Government. Despite health secretary Lansley’s much vaunted initiative of giving GPs the budget and power to buy services for its patients, it is alleged one local commissioning group in West Sussex weren’t told about a new contract award to Virgin healthcare until after it was signed off. The commissioning board were therefore not able to consider the merit of the bid in comparison to other interested parties – a clear failure of the health bill’s objective of tendering-out NHS work to help achieve better value for money for the taxpayer.
After such a turbulent month the Government most probably couldn’t bear the horrendous headlines that would result if it revealed what risks it is truly taking with our beloved NHS. But whether made public or not, those risks outlined by the risk register still remain. No doubt the Government is hedging its bets that the new Health Bill would have bedded in by the time an election is called in 2015, and any initial concerns by the public would have been proved false. Three years is also enough time for the NHS as we know it to have unravelled, for charges for non-urgent surgery or treatment to be mooted, for waiting lists to grow, for private companies to make large profits while limiting the contact patients have with doctors. And the first few months of policy implementation don't embue one with confidence that the NHS is in safe hands.
So Cameron and Clegg be warned: the battle to push the health bill through parliament could prove miniscule compared to the battle on voters’ doorsteps in 2015 to convince them that you can be trusted with the NHS.
Friday, 10 February 2012
Reason #3 why the NHS bill should be dropped
We live in a democracy and the way this Bill has been handled is thoroughly undemocratic.
The Government is sitting on a risk register of its NHS reforms and refuses to publish it until after the Lords have debated the bill. The Government has logged an appeal against a decision by the Information Commissioner that this document must be in the public domain. The lengthy appeal process means the information will only be released after the Bill becomes law. How can anyone debate the merits of a huge change in the NHS without all the information to hand? Unsurprisingly there is an early day motion signed by 75 MPs and counting demanding that this information be released. According to a Labour Party member, the risk analysis warns that the reformed NHS will become unaffordable due to a huge 'surge' in costs. No wonder Lansley is adament no one should read it.
Just as concerning, the reforms are already being enacted across the country before the Bill has even passed. I've posted on this before, but in short the Bill looks to give GP commissioning powers and open up the NHS to'any willing provider' (although this has recently been amended to 'any qualified provider'). Health Secretary Lansley believes that 97% of the country is now already covered by GP commissioning and current Primary Care Trusts are tendering out health contracts to 'alternative providers' (i.e. private companies). This has all happened while the Bill was officially 'paused' by David Cameron. It is unacceptable that any elected Government enacts controversial reforms without the approval of an elected parliament. There is also the glaring fact that these reforms do not have an electoral mandate as they did not figure in either Liberal Democrats or Tory party election manifestos.
The Coalition is twisting the processes of democracy to suit its own ends - I would hate the Health Bill to set a dangerous precedent.
The Government is sitting on a risk register of its NHS reforms and refuses to publish it until after the Lords have debated the bill. The Government has logged an appeal against a decision by the Information Commissioner that this document must be in the public domain. The lengthy appeal process means the information will only be released after the Bill becomes law. How can anyone debate the merits of a huge change in the NHS without all the information to hand? Unsurprisingly there is an early day motion signed by 75 MPs and counting demanding that this information be released. According to a Labour Party member, the risk analysis warns that the reformed NHS will become unaffordable due to a huge 'surge' in costs. No wonder Lansley is adament no one should read it.
Just as concerning, the reforms are already being enacted across the country before the Bill has even passed. I've posted on this before, but in short the Bill looks to give GP commissioning powers and open up the NHS to'any willing provider' (although this has recently been amended to 'any qualified provider'). Health Secretary Lansley believes that 97% of the country is now already covered by GP commissioning and current Primary Care Trusts are tendering out health contracts to 'alternative providers' (i.e. private companies). This has all happened while the Bill was officially 'paused' by David Cameron. It is unacceptable that any elected Government enacts controversial reforms without the approval of an elected parliament. There is also the glaring fact that these reforms do not have an electoral mandate as they did not figure in either Liberal Democrats or Tory party election manifestos.
The Coalition is twisting the processes of democracy to suit its own ends - I would hate the Health Bill to set a dangerous precedent.
Tuesday, 2 November 2010
NICE loses power to save Government from hostile headlines?
There has been mixed reaction to the news that NICE is losing its power to reject new drugs that it thinks do not show value for money. The change, announced last week, means that NICE (the National Institute for health and Clinical Excellence) will still exist but its power will be much curtailed - it can provide advice but it will no longer control the NHS drugs purse.
Initial reaction is that this might be a good idea. NICE has long been the ogre of the tabloids as there is a real human cost behind every drug that it says the NHS will not fund. Especially as these drugs have been proven by pharmaceutical companies to have some benefit, it's just that NICE thinks the benefit is minimal compared to the price demanded by its manufacturers.
But although NICE might have been sidelined, there is still no more money for the NHS. In fact despite the coalition honouring its promise to give a real-term increase to the NHS purse, the NHS is actually facing a tightening of its budget as it faces future increases of only 0.8% a year compared to a previous average increase of 4% a year.
So NICE's powers might be gone, but the rationing of drugs is still a reality that the NHS must face. Andrew Lansley, the health secretary, has outlined plans for the responsibility for deciding if a drug is of value to be transferred to local PCTs. This responsibility will then ultimately be handed over to GP consortium']s if Lansley NHS reforms are passed.
The abolition of NICE will clearly exacerbate the problem of the postcode lottery - whereby someone living in one borough will access drugs, and often enjoy a longer life expectancy, than someone in another borough. This may well cause nasty tabloid headlines but local restrictions won't cause quite the hostility towards the Government that a nationwide ban has done in the past. Mike Hobday, the head of policy for MacMillan Cancer Support hints that the negative public portrayal of NICE had a hand in its downfall when he said: "NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers".
And the Government has already hedged its bets when it comes to cancer, the most emotive and political of all health problems, by promising a stand-alone cancer drug fund that patients can apply to if their local NHS won't fund a particular treatment.
Drug rationing is an inevitability of the NHS, as are the hostile headlines it creates, and drug restrictions will continue to be enforced whether NICE controls the purse or 152 local bureaucrats do instead. So the reduction of NICE's powers may well turn out to be a smokes and mirrors exercise to avoid the public recognising the true funding problems the NHS will face over the coming decade.
Initial reaction is that this might be a good idea. NICE has long been the ogre of the tabloids as there is a real human cost behind every drug that it says the NHS will not fund. Especially as these drugs have been proven by pharmaceutical companies to have some benefit, it's just that NICE thinks the benefit is minimal compared to the price demanded by its manufacturers.
But although NICE might have been sidelined, there is still no more money for the NHS. In fact despite the coalition honouring its promise to give a real-term increase to the NHS purse, the NHS is actually facing a tightening of its budget as it faces future increases of only 0.8% a year compared to a previous average increase of 4% a year.
So NICE's powers might be gone, but the rationing of drugs is still a reality that the NHS must face. Andrew Lansley, the health secretary, has outlined plans for the responsibility for deciding if a drug is of value to be transferred to local PCTs. This responsibility will then ultimately be handed over to GP consortium']s if Lansley NHS reforms are passed.
The abolition of NICE will clearly exacerbate the problem of the postcode lottery - whereby someone living in one borough will access drugs, and often enjoy a longer life expectancy, than someone in another borough. This may well cause nasty tabloid headlines but local restrictions won't cause quite the hostility towards the Government that a nationwide ban has done in the past. Mike Hobday, the head of policy for MacMillan Cancer Support hints that the negative public portrayal of NICE had a hand in its downfall when he said: "NICE has too often misread the public mood in rejecting clinically effective drugs for rare cancers".
And the Government has already hedged its bets when it comes to cancer, the most emotive and political of all health problems, by promising a stand-alone cancer drug fund that patients can apply to if their local NHS won't fund a particular treatment.
Drug rationing is an inevitability of the NHS, as are the hostile headlines it creates, and drug restrictions will continue to be enforced whether NICE controls the purse or 152 local bureaucrats do instead. So the reduction of NICE's powers may well turn out to be a smokes and mirrors exercise to avoid the public recognising the true funding problems the NHS will face over the coming decade.
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