LATEST ARTICLES
Addenbrooke’s shows flaws among elite
25 September 2015
The Care Quality Commission’s decision to classify the renowned Cambridge
University hospitals foundation trust, which runs Addenbrooke’s hospital, as
inadequate is only the latest example of specialist hospitals running into
serious problems with their district general hospital (DGH) services.
Imperial College healthcare NHS trust was designated “requires
improvement” last December, with concerns over cleanliness, weaknesses in
the safety culture and “markedly varied” leadership in its hospitals. The
famous John Radcliffe hospital, part of Oxford University hospitals NHS trust,
was similarly judged “requires improvement” in May 2014 in light of a failure
to learn from “never” events and problems in surgery, while senior doctors
were said to be alienated from the board. In January 2014 the CQC issued
University College London hospitals foundation trust with four compliance
notices over the risk of unsafe surgery, serious problems in A&E and poor
record-keeping on its wards.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
Hunt sounds death knell for foundations
11 September 2015
There is a growing sense of urgency – if not yet panic – at the Department of
Health about the pace of reform in the NHS.
With overwhelming evidence (pdf) that virtually nobody in the health service
believes the target of £22bn of efficiency savings has any chance of being
achieved, and an underlying accumulated deficit among providers close to
£2bn, the health secretary, Jeremy Hunt, is trying to hit the accelerator.
He told the Health Service Journal bluntly that there are “too many trusts as
independent organisations”, and is driving providers towards the model
proposed by Salford Royal foundation trust chief executive Sir David Dalton
of the biggest and best providers having chains and franchises of
organisations and services.
There are some brave assumptions here – that senior managers who are
good at leading one organisation will be good at leading several, which
doesn’t follow, and that there will be sufficient capacity and support to deliver
robust improvements in clinical quality without destabilising services in the
host organisation, which is far from certain. But despite the difficulties, it is
vital that fast, scalable ways to spread excellence are developed.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
Corbyn is right: PFI was a costly mistake
28 August 2015
There can’t be many issues that unite Jeremy Corbyn and Andrew – now
Lord – Lansley, but the impact of the private finance initiative on the NHS is
one of them.
Corbyn has called for a fund to be established to bailout NHS trusts saddled
with PFI schemes. In 2012 Lansley gave seven NHS trusts whose PFI deals
were unaffordable access to a £1.5bn fund. All the deals had been negotiated
under the Labour government.
Last year an inquiry by the public accounts committee into the financial
stability of NHS organisations laid bare the huge burden that PFI deals for
building and operating NHS facilities is imposing. Almost a third of providers
have a PFI scheme, costing the NHS a total of £1.8bn year. Trusts with the
highest charges were most likely to have poor financial results – in 2013-14
four of the six trusts with deficits of more than £25m had a PFI scheme.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
Will some patients have to pay for care?
14 August 2015
With NHS providers on track to run up deficits in the region of £2bn this year,
the spectre of patients paying for more services again looms over the NHS.
Last year’s combined deficit of £822m across the provider sector hid an even
more serious truth: add in the extra £250m from the Treasury and another
£650m transferred from capital budgets and the underlying deficit was nearer
£1.7bn.
With little prospect of finding the required £22bn of efficiencies, and the
Health Foundation and King’s Fund pressing for even more money on top of
the additional £8bn already promised by the chancellor, George Osborne,
one way or another we are going to have to find other ways to pay.
We can thank the Germans for all but killing off one idea that used to be
touted – paying to see your GP. In 2004 Germany introduced a €10 quarterly
payment but the Bundestag unanimously scrapped it eight years later.
Predictably, the cost of administration almost outweighed the money
collected, and there is some evidence that it deterred people on low incomes
from seeing their doctor. The strongest argument against charging to see a
GP here is that it would destroy the best thing about the NHS – that it is free
at the point of need. But there are other ways the edges of that principle
could be blurred.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
Lords defeat reveals devolution’s limit
31 July 2015
A little reported Lords defeat for the government over its plans to devolve
powers to major cities has major implications for local control of the NHS.
Last week an amendment was moved successfully by Labour peer Norman
Warner to the cities and local government devolution bill which stops the
transfer of NHS regulatory functions held by national bodies. Crucially, if the
amendment is not reversed in the Commons, it will ensure any devolved
services adhere to national service standards and are still nationally
accountable.
The bill, part of the “northern powerhouse” drive to devolve responsibilities to
major cities, has become the vehicle for devolving £6bn of health and care
spending to Greater Manchester.
The amendment underscores Labour suspicions that the Conservatives want
to whittle away the health secretary’s ultimate responsibility for providing a
national health service. This caused a row during the passage of Andrew
Lansley’s NHS reforms during the last parliament, when the government had
to accept an amendment spelling out the requirement for the health secretary
to remain accountable no matter how much control was passed to NHS
England.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
Hunt’s NHS vision is already in difficulty
17 July 2015
Jeremy Hunt’s “25-year vision” for the NHS, unveiled this week, is an
amalgam of rapid change, inspiring transatlantic collaboration, another round
of institutional demolition, a gimmick and a plan for the release of dodgy
patient safety data.
The ultimatum to the BMA over seven-day working – forcing through new
seven-day contracts – reflects frustration at the excruciatingly slow progress
towards achieving this key patient safety goal. Getting it in place has been
dogged by questioning of the mortality data, demands for more money and
arguments over the out of hours availability of support services. While all
these have their merits, they do not amount to a justification for endless
prevarication. It is a tough deal for doctors, but it will drive through a crucial
and long overdue cultural change.
But forcing through the gradual adoption of new contracts does not mean it
can be done for free. The contracts will not be enough to deliver the change
in hospitals sliding into deficit. It is possible that some trusts will find
efficiencies from seven-day working but most will need sizeable up-front
investment.
Read the full article on the Guardian Healthcare Network
____________________________________________________________________
What Hunt can learn from predecessors
2 July 2015
What do you learn from taking on the toughest job in government, secretary
of state for health? At the Institute for Government three former secretaries –
Conservative Stephen Dorrell and Labour’s Alan Milburn and Patricia Hewitt –
shared their wisdom alongside incumbent Jeremy Hunt, who was apparently
keen to learn from the wise words of his predecessors.
Co-hosted by the Health Foundation, it followed the publication of Glaziers
and Window Breakers, interviews with 10 former secretaries of state, which
was the first document Hunt found on his desk on returning to the
Department of Health’s Richmond House headquarters after the election.
The fact that even the passing of decades has not diminished their
fascination with the role says a great deal about the hold the post has over
those who occupy it.
As Dorrell pointed out, there is nothing new that health secretaries have to
deal with – a unique mix of policy and management. While the plan to
devolve healthcare powers to Greater Manchester is portrayed as an
innovation, 70 years ago Nye Bevan and Herbert Morrison were debating
within the cabinet of Clement Attlee the tensions between local and national
control of healthcare.
Read the full article on the Guardian Healthcare Network
July to September 2015
Public Policy Media
Richard Vize