A few stories in today's press got me thinking today. The first is about a man who is taking the NHS to court for refusing him a gastric bypass as, at 43, his BMI is not high enough to warrant the operation. The Daily Mail has responded to this in its typical manner with a headline screaming: 'Give me a gastric bypass! It's my human right'. Although many of the Mail's headlines are unfair this one is particularly harsh. The man in question has type 2 diabetes which has already caused him blindness in one eye, complications with his kidneys and he is now a wheelchair user. A gastric bypass has been shown to cure type 2 diabetes so this operation could literally save his life. He has already asked his Primary Care Trust (PCT) to deviate from their normal 'rules' over who is entitled to the operation on the grounds his other health issues make him an exceptional case. Yet his application was rejected. Moreover if he had lived in the neighbouring PCT he would have received the bypass without any appeals as they allow the operation for anyone with a BMI over 35.
Another article that caught my attention was a piece in the Guardian showing that NHS waiting times are increasing. The Guardian revealed that "The number of patients waiting more than six weeks for a diagnostic test has risen from 3,378 to 15,667 in the last year". Even more outrageous is "the small but growing number of cancer patients having to wait more than one or two months for treatment". This has left doctors to make the point that such delays could ultimately mean the difference between cancer killing their patients or not.
I'm not going to delve into the emotional stress faced by people waiting for diagnostic tests but instead will use the Coalition's favourite argument for reforms and talk in monetary terms.
It is clear to any rational person that delaying treatment for cancer patients or for those who are critically obese will cost the NHS more money in the long-term. Cancer that takes longer to cure costs the NHS more in bed space, consultancy time and medicine. A man who's obesity is causing diabetes to threaten his kidneys and his ability to walk will also increase costs to society, both medically and in social care.
I've spoken many times about the fact that the NHS is meant to be saving 4% every year for the next four years. Many economists believe this is impossible and as these heath rationing stories increase it seems that they are right. And what is this health rationing to achieve? Ill patients don't get better without treatment so clearly the costs won't go away unless patients are left to die or, as perhaps the Government hopes, seek private treatment.
To meet today's monetary targets, tomorrow's will be astronomical. This is seriously a case of false economics.And as we are only in year two of a five year cost saving plan it can only get worse. If something doesn't change waiting lists will soar.
The Government is so focused on pushing through its radical NHS reform plans, it seems to have lost the will to keep today's NHS functioning. Instead we are left with a postcode lottery of care and a Government insisting that waiting lists are 'broadly stable'. Tell that to the cancer patient who had to wait two months to start treatment.
Monday, 11 July 2011
Wednesday, 1 June 2011
The Winterbourne abuse scandal provides a stark warning against NHS privatisation
This week's Panorama about systematic abuse of patients at Winterbourne View private care home was shocking and uncomfortable television. Yet behind the fear of the patients, routinely and daily abused by their carers, was a story to be told about how private companies operate in social care. And it is a story we must pay urgent attention to as our Government looks to open up mainstream NHS treatment to 'any willing provider' - exactly what has already happened in social care.
What truly shocked me about the Panorama programme, wasn't just the terrible individuals metting out suffering to vulnerable young adults, but the complete failure of the Care Quality Commission to identify the abuse. CQC is the Government regulator of social care providers, it is meant to ensure that private health providers that win Government contracts ensure that quality of service does not come a lowly second to a profit motive. Yet during three inspections of the unit the CQC did not uncover any inappropriate behaviour and, even more worryingly, it failed to act on three emails it received from a highly qualified nurse who used to work at Winterbourne which detailed the abuse at the unit. The question is: how many other units have passed a CQC inspection are also hiding dark secrets?
Whereas social care has already been opened up to private providers, the health service is still largely nationalised. Yet the Government's controversial Health and Social care bill wishes to allows 'any willing provider' such as private companies and charities to compete for health contracts. The Government will be reliant on the CQC and 'people power' to ensure these providers are of good quality.
Lansley in speaking with the Guardian in February believes that people will 'vote with their feet' and go elsewhere if the health service they receive is not good enough. I've doubted this is possible since I heard this claim - a person's ability to maintain family life and jobs relies very often on accessing local health care regardless of its quality. But the scandal of Winterbourne shows that very vulnerable people cannot exercise a choice at all. Which would leave them at the mercy of the CQC to ensure "quality and safety" from their health provider - if the CQC is already struggling to identify problem providers can it really be trusted to do so in the future with a vastly expanded portfolio of providers to oversee?
Moreover, while the Panorama programme caught the nation's attention over extreme abuse, it would be terrible if we saw a patient's basic safety as the only target to aim for. The documentary also showed that the patients, in the words of an expert, 'had nothing to do' day in and day out. Disgracefully the Government pays £3,500 a week for each patient to live there but other than basic carer supervision there appears no programme of activities or experiences that might enable a person to learn how to gain independence and move out of the institution. Where is the quality or value for money there? Winterbourne is meant to be a therapeutic environment yet one can only imagine that once Castlebeck, the company behind Winterbourne, creamed off its profits there was only enough money left for basic care.
The same day the Winterbourne scandal hit the nation's papers the alarm was also sounded on the financial fragility of Southern Cross, a provider of care homes for 31,000 elderly residents. City analysts believe that a series of poor decisions taken when it was owned by a private equity company have brought the care home to its knees, generating real fear amongst residents as to what will happen to them if the business folds.
There is no suggestion that care at Southern Cross is in anyway substandard but its financial concerns yet again leave highly vulnerable people exposed by the machinations of a private company in the pursuit of profit over consistent and reliable care.
I only hope that the public recognises that these simultaneous failures in social care are stark warnings of what could happen to our health care system if private companies are allowed to cherry pick services it wishes to offer, gleaning off profit at the very expense of the people it is meant to be providing a first-rate service to. At the very least, the CQC must not be given any more 'providers' to oversee until it has become apparent how widespread its failure runs, people are held to account, and meaningful reforms are implemented.
What truly shocked me about the Panorama programme, wasn't just the terrible individuals metting out suffering to vulnerable young adults, but the complete failure of the Care Quality Commission to identify the abuse. CQC is the Government regulator of social care providers, it is meant to ensure that private health providers that win Government contracts ensure that quality of service does not come a lowly second to a profit motive. Yet during three inspections of the unit the CQC did not uncover any inappropriate behaviour and, even more worryingly, it failed to act on three emails it received from a highly qualified nurse who used to work at Winterbourne which detailed the abuse at the unit. The question is: how many other units have passed a CQC inspection are also hiding dark secrets?
Whereas social care has already been opened up to private providers, the health service is still largely nationalised. Yet the Government's controversial Health and Social care bill wishes to allows 'any willing provider' such as private companies and charities to compete for health contracts. The Government will be reliant on the CQC and 'people power' to ensure these providers are of good quality.
Lansley in speaking with the Guardian in February believes that people will 'vote with their feet' and go elsewhere if the health service they receive is not good enough. I've doubted this is possible since I heard this claim - a person's ability to maintain family life and jobs relies very often on accessing local health care regardless of its quality. But the scandal of Winterbourne shows that very vulnerable people cannot exercise a choice at all. Which would leave them at the mercy of the CQC to ensure "quality and safety" from their health provider - if the CQC is already struggling to identify problem providers can it really be trusted to do so in the future with a vastly expanded portfolio of providers to oversee?
Moreover, while the Panorama programme caught the nation's attention over extreme abuse, it would be terrible if we saw a patient's basic safety as the only target to aim for. The documentary also showed that the patients, in the words of an expert, 'had nothing to do' day in and day out. Disgracefully the Government pays £3,500 a week for each patient to live there but other than basic carer supervision there appears no programme of activities or experiences that might enable a person to learn how to gain independence and move out of the institution. Where is the quality or value for money there? Winterbourne is meant to be a therapeutic environment yet one can only imagine that once Castlebeck, the company behind Winterbourne, creamed off its profits there was only enough money left for basic care.
The same day the Winterbourne scandal hit the nation's papers the alarm was also sounded on the financial fragility of Southern Cross, a provider of care homes for 31,000 elderly residents. City analysts believe that a series of poor decisions taken when it was owned by a private equity company have brought the care home to its knees, generating real fear amongst residents as to what will happen to them if the business folds.
There is no suggestion that care at Southern Cross is in anyway substandard but its financial concerns yet again leave highly vulnerable people exposed by the machinations of a private company in the pursuit of profit over consistent and reliable care.
I only hope that the public recognises that these simultaneous failures in social care are stark warnings of what could happen to our health care system if private companies are allowed to cherry pick services it wishes to offer, gleaning off profit at the very expense of the people it is meant to be providing a first-rate service to. At the very least, the CQC must not be given any more 'providers' to oversee until it has become apparent how widespread its failure runs, people are held to account, and meaningful reforms are implemented.
Thursday, 12 May 2011
Are disability cuts just aimed at 'scroungers'?
I'm in hospital for the next couple of weeks trying to get healthy for my upcoming wedding (one month to go!). I've just taken part in a Guardian panel piece about yesterday's Hardest Hit March which demonstrated against the Government's plethora of cuts against disabled people.
I know there seems to be a prevailing concept in the wider society that these cuts are justified because it is only effecting those that aren't truly ill and just want an easy life. But that really isn't the case. I wasn't well enough to go on the march yesterday so to do my bit I've compiled some news stories about how disabled people are already being effected by cuts and their fears for the future. Please just spend thirty minutes reading around the issue with an open mind.
The Guardian is obviously a good place to start but there have been stories cropping up in even the more right wing media. Here's a selection of writing to get everyone thinking:
Guardian: Disabled people are marching for their lives
Guardian: It is now officially unsustainable to support disabled people
The Sun: No Cash as leg may grow back
The Mirror: Amputee loses benefit after walking
Scotland's Evening Times: Call for fairer benefits test as men [declared fit to work] die
Guardian: 'The Medical was an absolute joke' Heavily researched piece on flawed ESA medical tests
The Independent: Disability charities raise welfare concerns
I know there seems to be a prevailing concept in the wider society that these cuts are justified because it is only effecting those that aren't truly ill and just want an easy life. But that really isn't the case. I wasn't well enough to go on the march yesterday so to do my bit I've compiled some news stories about how disabled people are already being effected by cuts and their fears for the future. Please just spend thirty minutes reading around the issue with an open mind.
The Guardian is obviously a good place to start but there have been stories cropping up in even the more right wing media. Here's a selection of writing to get everyone thinking:
Guardian: Disabled people are marching for their lives
Guardian: It is now officially unsustainable to support disabled people
The Sun: No Cash as leg may grow back
The Mirror: Amputee loses benefit after walking
Scotland's Evening Times: Call for fairer benefits test as men [declared fit to work] die
Guardian: 'The Medical was an absolute joke' Heavily researched piece on flawed ESA medical tests
The Independent: Disability charities raise welfare concerns
Tuesday, 3 May 2011
Are 85 hospitals under threat of closure?
A good day to hide bad news seems to be becoming a modern day adage in UK politics, and the Royal Wedding last Friday proved no exception. While the nation was giddy with nuptial fever, Monitor, the regulator of NHS Foundation trusts warned that hospitals may have to make 'efficiency savings' of 6 - 7% for each of the next five years. This is even worse than the original target set by the Department of Health of 4% for each year.
Worryingly these 'savings' were highlighted in a letter to Foundation Trust (FT) applicants - i.e. hospitals that wish to become a Foundation Trust but haven't yet. The Government has set a deadline of April 2014 for the remaining 85 hospitals and mental health units to achieve FT status. As such to become an FT they MUST achieve the financial savings demanded by Monitor. Aside from the fact that 'enforced savings' are really just a euphemism for cuts, the real question is what happens if these hospitals cannot achieve such savage savings?
The Government has avoided providing a Plan B for such hospitals, and it is unclear whether a hospital will be allowed FT status even if it is unable demonstrate it can balance its books under such stringent demands. An alternative would be to allow an extension to the April 2014 deadline (a possibility considering the climbdown on the GP commissioning deadline). But a third option is also very possible: hospitals will just be allowed to close down.
The 'Liberating the NHS: Legislative framework and next steps' document recognises that some "organisations" will not manage to "thrive" under the "tough financial times ahead". As a clear warning to those that struggle to balance their books, it states on page 134:
"Taxpayers' funding needs to be used to pay for the services that patients need, not to prop up failing organisations that make ineffective use of the resources they receive. The transitional arrangements will ensure that there is no unnecessary failure: if there are simple steps that can be taken to make an organisation succeed Monitor will retain a role during the transition to ensure that these steps are taken." (My own italics)
Furthermore, Dr David Bennett, head of the economic regulator Monitor, admitted to the BBC in March, that hospitals that get into financial difficulty will "ultimately close". So clearly the Government can envisage a scenario where a hospital will be allowed to fail and the implicit assumption is that the Government will place the blame squarely on that hospital for doing so.
Yet this is incredibly unfair on those hospitals that are yet to achieve FT status. They are now attempting to do so under a harsher remit than any of those who have achieved it to date: indeed these savings are so tough that leading health economists doubt they are achievable.
A 4% saving has already been criticised as unrealistic by health economists. But speaking to the BBC about these latest statistics, John Appleby, chief economist at the health think tank the King's Fund said: "I can see a hospital doing this [6% savings] for one or two years, but not five years".
So either the financial bar has been set so high as to be intentionally unachievable (allowing the Government to prune its expensive stock of hospitals) or the Government has no real understanding of what a 6% saving actually means to a hospital. Either way by 2014 patients will be understandably angry if their local hospital is under threat of closure, when in reality it was the savings targets themselves that were financially unviable, not the hospital struggling to meet them.
Worryingly these 'savings' were highlighted in a letter to Foundation Trust (FT) applicants - i.e. hospitals that wish to become a Foundation Trust but haven't yet. The Government has set a deadline of April 2014 for the remaining 85 hospitals and mental health units to achieve FT status. As such to become an FT they MUST achieve the financial savings demanded by Monitor. Aside from the fact that 'enforced savings' are really just a euphemism for cuts, the real question is what happens if these hospitals cannot achieve such savage savings?
The Government has avoided providing a Plan B for such hospitals, and it is unclear whether a hospital will be allowed FT status even if it is unable demonstrate it can balance its books under such stringent demands. An alternative would be to allow an extension to the April 2014 deadline (a possibility considering the climbdown on the GP commissioning deadline). But a third option is also very possible: hospitals will just be allowed to close down.
The 'Liberating the NHS: Legislative framework and next steps' document recognises that some "organisations" will not manage to "thrive" under the "tough financial times ahead". As a clear warning to those that struggle to balance their books, it states on page 134:
"Taxpayers' funding needs to be used to pay for the services that patients need, not to prop up failing organisations that make ineffective use of the resources they receive. The transitional arrangements will ensure that there is no unnecessary failure: if there are simple steps that can be taken to make an organisation succeed Monitor will retain a role during the transition to ensure that these steps are taken." (My own italics)
Furthermore, Dr David Bennett, head of the economic regulator Monitor, admitted to the BBC in March, that hospitals that get into financial difficulty will "ultimately close". So clearly the Government can envisage a scenario where a hospital will be allowed to fail and the implicit assumption is that the Government will place the blame squarely on that hospital for doing so.
Yet this is incredibly unfair on those hospitals that are yet to achieve FT status. They are now attempting to do so under a harsher remit than any of those who have achieved it to date: indeed these savings are so tough that leading health economists doubt they are achievable.
A 4% saving has already been criticised as unrealistic by health economists. But speaking to the BBC about these latest statistics, John Appleby, chief economist at the health think tank the King's Fund said: "I can see a hospital doing this [6% savings] for one or two years, but not five years".
So either the financial bar has been set so high as to be intentionally unachievable (allowing the Government to prune its expensive stock of hospitals) or the Government has no real understanding of what a 6% saving actually means to a hospital. Either way by 2014 patients will be understandably angry if their local hospital is under threat of closure, when in reality it was the savings targets themselves that were financially unviable, not the hospital struggling to meet them.
Tuesday, 12 April 2011
Widespread genetic screening risks creating 'inferior' citizens
Back in 1995, my 14-year-old self was sitting on the dusty floor of my all-girls’ school hall listening to a morning assembly. With the aim of promoting public speaking, each class had to give one annual school assembly speech on a topic of their choosing. That morning it was the turn of five 11-year-olds who had decided to tackle a topic beyond their years: abortion. At 8.50am on one nondescript Spring morning my whole life was pronounced worthless as they declared that mothers carrying foetuses with Cystic Fibrosis (CF) would understandably want a termination. As a CF sufferer myself, I laughed aloud at the suggestion. Even as the illness has slowly ruined my lungs over the years, my life is still definitely one that is worth living.
Yet a report out this week by the Human Genetics Commission reminded me of those thoughtless 11-year-olds. Its pronouncement that they see “no specific social, ethical or legal principles" against offering nationwide preconception screening of genetic conditions seemed, at best, ill thought through.
In its report, ‘Increasing options, informing choice’, the Commission recommends that any person should be eligible for tests to show whether they are a carrier of genetic abnormalities that could result in their child being born with illnesses such as CF or Sickle Cell Anemia. Currently such tests are limited to people who already know there is a family risk of such illnesses.
The report believes that by widening out pre-screening to every potential parent in the UK people “can make informed choices about the reproductive options available to them.” Yet these choices seem to be very limited: remain childless, have an abortion, or endure lengthy, and possibly futile, IVF treatment.
It is possible to carry out an antenatal test called Chorionic villus sampling to see whether a foetus has CF, so that the family can choose to abort the pregnancy before birth. Cystic Fibrosis is a tough illness and it cuts life expectancy by at least 50%. Yet people with CF can live a relatively normal life for long periods of time. We have active childhoods, careers of our choosing and a life lived independently. I have a great life full of amazing friends. I’ve had a brilliant education, a good career, and even now when my health is really quite bad I live with an amazing man who I’m marrying in two months’ time. Is this a life that would have been better aborted?
Moreover, it is easy to imagine a scenario where a childless couple in their fifties may look back on multiple abortions, undergone due to fear of bringing up a child with CF, and wonder if it wouldn’t have been better to have experienced parenthood with all the hardships and happiness it would have brought with it. Perhaps the knowledge that pre-screening brings may be as painful as the very grief it was aimed at avoiding.
If both parents are a carrier of the defective CF gene, IVF is the only way to be sure of not conceiving a child with CF. In a process called Pre-implantation Genetic Diagnosis (PGD) each embryo is screened to ensure it is genetically ‘normal’ before implantation in the womb: there is at best a 30% success rate. But with NHS funding currently under strain, IVF is being severely limited across the country. In the last three years, nearly one in five Primary Care Trusts (PCTs) have cut IVF funding, with nine areas refusing funding altogether. Even fewer PCTs are prepared to pay for PGD in comparison with traditional IVF procedures and privately the procedure costs £3,000 per attempt.
It would be a nightmare scenario if CF became a ‘poor’ person’s illness, only prevalent in parts of society that cannot afford private PGD sessions. What implications will this have into research for a cure, or for NHS and welfare provisions for people with such illnesses?
It is unsurprising that Dr David King, director of Human Genetics Alert, said that if the report recommendations were put into action "it will inevitably lead to young people [diagnosed as carriers] being stigmatised and becoming unmarriageable, and disabled people will feel even more threatened."
For me the recommendations of the Human Genetics Commission imply that a life with CF, or Sickle Cell, or any other serious genetic illness, is a life not worth living. Ultimately no one chooses to have CF but isn’t that different to taking active steps to avoid having a child with CF? The Commission seems ignorant of the fact that people with severe illnesses have a lot to give, both to the people who love them and the society of which they are a part.
Everyone has hardships in their life, and CF is mine, but living with it has given me strength as well as pain. Rather than encouraging people to consider children with genetic illnesses as inferior, it should be recognised that our society is in fact strengthened when it comprises a diverse range of people with their own unique way of living their life as best they can.
Thursday, 17 March 2011
Are Lansley's days well and truly numbered?
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.
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.
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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