Friday 31 May 2013

Going, going, gone.


Going

Going

Gone…..

Right now, if you go to a private hospital as a private patient, you normally go to see a consultant who is hiring a room or basic equipment. They do simple operations on healthy people. They do complicated operations or operations on high risk people, but it takes planning and they have to hire subcontracted staff as well. Medical procedures don’t follow plans. Those private hospitals are rarely capable of dealing with intensive care (ICU), resuscitation, or emergency work. They don’t have 24 hour back up. Doctors and Nurses only come in when they are hired to do so.  That’s why private hospitals are often near NHS ones – it’s easier to get hold of staff at short notice.

When things go wrong, it doesn’t go so well. If there’s an emergency, private patients use the NHS.

At the moment we are paying consultants £120,000 to £250,000 a year. They do work at weekends or at night but don’t like it (understandable) but as we’ve seen, they are quite keen to take on private work at those times.

They don’t want to use private hospitals because they don’t like their patients dying – they would prefer to do those operations in NHS hospitals, then if there is a problem rush the patient into ICU or A and E.

So, the private patients jump the queue to start with (it’s the same consultants as in the NHS and they only have so much time) then when it all goes wrong they jump another queue into Intensive care etc., leaving the rest of us to wait. (No beds, I’m afraid).

Consultants can only be at one place at a time – if they are sloping off to have a look at their private patients in the ‘special wing’, who’s to know? Who will be their priority?

One of the perks of being the manager of a ‘Foundation trust’ is the ability to set your own salary, to write yourself a cheque. Now we can see where it comes from – it’s a business.

The private patients jump the queue but only have to pay for those services they need, when they need them. Meanwhile the stupid taxpayer picks up all the rest of the bills for the really expensive permanent costs that never go away (buildings, equipment, staff costs 365 days a year 24/7).

And the NHS gets to sort out all those really expensive emergencies.

 

Neil Harris

(a don’t stop till you drop production)

Thursday 30 May 2013

Going,going...


 

Going

Going

Gone…..

So much for the world famous hospitals, what about the boring local ones, those are the ones we really care about because they are the ones we need?

Ealing Hospital in West London is under real threat – it faces losing its Accident and Emergency and Maternity. Things flow from that – if maternity goes what future does Gynaecology have? The Stroke unit has closed. If A and E goes, what about cardiac?

Well, they have plans of their own – plans to increase Private Patient income in 2013 by + 231% compared to 2010.

 

Surrey and Sussex plans an increase of +186% and that includes 11 new private rooms.

Their spokesman summed it up;

“As with other trusts, many of our consultants run private practises outside of their NHS work. Many of these consultants prefer to operate in NHS Hospitals where there is 24/7 backup of intensive care facilities, etc, so that they can operate on high-risk patients. These operations are carried out outside NHS sessions, at weekends or out of hours.”

No one voted for any of this, although we will be paying for it. In return we get a first and second class service, which divides us up between those who can pay and those who have to wait.

Tomorrow, I’ll have a look at how insidious it all really is.

 

Neil Harris

(a don’t stop till you drop production)
helpmesortoutthenhs.blogspot.com

Wednesday 29 May 2013

Going.


Going

Going

Gone…..

This is a short series of Blogs on privatisation in the NHS and it’s based on some really useful research by The Observer, and written by Daniel Boffey their Policy Editor. It was published on 7th April 2013, I don’t have the link, I’m afraid.

I’ve written a lot about the obvious threat to the NHS – closing hospitals down and selling off the land. This is worse, more subtle, more insidious. It’s not just the financial consequences, it nibbles away at the ideals of the NHS and divides patients against patients and staff against staff.

There are now 146 Foundation Trusts, soon all trusts will have that status. They have been given freedom from Government control or, another way of looking at it is they have been taken out of our democratically elected control.

The Boards are now business people, running an independent business. Except we are still paying for it all.

The regulations have been changed – ‘Trusts’ can now earn up to 49% of their income from treating private patients. And boy, are they going to take advantage of that. Here are a few choice examples from the article;

Great Ormond Street Hospital for Children.

 

A much loved charity as well as ‘GOSH’, featured in the Olympic Opening Ceremony.

+34% or  +£11 million from private patients for year ending 2013 compared to 2010.

 

Imperial College Healthcare

+ 42% or + £9Million

 

Royal Marsden

+ 28% or + £12.7 million

 

 

NHS Overall +8%

 

40 trusts plan new Private patient units.

 

Then it gets really frightening – Moorfields Eye Hospital is opening a unit in Dubai, to gain work from the Middle and Far East. Want to see your Doctor? – he’s in Dubai.

Why does this matter?

I’ll have a closer look, tomorrow.

 

Neil Harris

(a don’t stop till you drop production)
Home:   helpmesortoutthenhs.blogspot.com

Tuesday 28 May 2013

Moonlighting


So, where has all the money gone?

Here’s some of it;

Gone to profitable private companies siphoning off money from the NHS using NHS Consultants and Doctors moonlighting to do private work. Nurses working for agencies after or before their shift and then too tired to do the work they are paid to do by the NHS.

Here’s a Guardian report of an analysis by the respected Nuffield Trust – mind you Nuffield is a ‘charitable’ Trust which operates private hospitals, largely staffed by NHS staff. ‘Charitable’ doesn’t mean that it’s a ‘charity’ as most people would understand it – benefiting the poor. Private health care providers actually benefit the wealthy and the medical staff who use their facilities.

I’m the only one you can really trust.

 

Randeep Ramesh, social affairs editor

The Guardian, Wednesday 22 May 2013        

 

The report says there has been a rapid rise in the share of NHS-funded patients treated by private providers.

Spending on private services by the NHS reached a record £8.7bn last year, a jump of more than £3bn since 2006, according to research.

A study by the Nuffield Trust and the Institute of Fiscal Studies reveals that the role of non-NHS providers in delivering NHS-funded care in England has increased dramatically from 2006, with the result that in certain areas of healthcare the independent sector is now a fixture in the NHS.

The report gives as an example the proportion of hip and knee replacements delivered by private companies and funded by the NHS, which rose from "negligible" in 2003 to a fifth of all such operations today.

 

The report says choice and competition were embedded into the NHS in 2008 with a significant effect on local hospitals. It says a study last year into three key elective procedures – including hernia operations and hip replacements – found that "there has been a rapid rise in the share of NHS-funded patients treated by private providers, matched by a corresponding fall in the proportion of patients treated by their nearest NHS acute trust".

Spending varied across the regions. In Yorkshire and Humberside, almost 10% of all NHS funds were being used to pay private companies for patient treatment. In the north-east the figure was 4%.The extra cash has helped to protect private healthcare providers from the economic downturn. The report says the revenues of private hospitals over the past five years would have been lower without demand from the NHS – especially given that between 2008 and 2011 private spending on health fell by almost 6% in real terms.

While Labour continued to lavish cash on the NHS – public spending on healthcare in the UK increased in both 2008 and 2009 – the authors say the economic crisis has introduced cuts into the health service. Despite coalition promises to ringfence the NHS budget, the report says spending on health "fell in real terms by 0.7% in 2010 and a further 1.2% in 2011".

 

Anita Charlesworth, Nuffield Trust chief economist and an author of the report, said it was an open question as to whether public funding of the private sector could continue growing. The government's policy is to extend "market reforms" into new parts of the health service.

 

"Whether spending on private providers will continue to increase as NHS spending is essentially frozen is less clear," Charlesworth said. "There is a need to monitor whether the planned extension of choice into community services leads to an increased involvement of the voluntary sector or whether in response the private sector providers also expand into this area."

To recap;

It’s a recession, so people are spending less on private healthcare, so the private sector has capacity to spare.

Public money going to the NHS has fallen in real terms despite what the government says.

Public money is being diverted to private hospitals.

NHS hospitals are losing ‘business’ and going bust.

We have to pick up the tab.

 

Neil Harris

(a don’t stop till you drop production)
Home:   helpmesortoutthenhs.blogspot.com

Wednesday 22 May 2013

More figurin'


 

            WE REVEAL

 L

   WHAT THEY CONCEAL!

This is the second part of an analysis and extract from the Health Service Journal, 3/3/13. It’s a survey comparing the 14 Hospital trusts that are under investigation for having patient mortality rates that are too high with the rest.

The failing trusts have;

Higher;

Mortality rates

Fewer;

Cleaners, Doctors, Nurses and Consultants.

Lower;

Staff happiness, satisfaction at work, confidence in management.

And……

Lower Funding. There’s a surprise.

Here’s the info:

 

“They found a significant relationship between - hospital funding in a health economy and its “organisational stress”, measured by mortality rates and staff survey results. That suggests a relationship between national decisions about how much funding an area will be given, and the quality of care provide.

The news comes as a report by the Royal College of Physicians today said pressure on medical registrars was putting patient safety at risk.

The college’s research said 37 per cent of medical registrars viewed their workload as “unmanageable” and concluded the “balance between specialist and generalist skills” in the medical workforce needed to be addressed “urgently”.

Hospital Indicators for hospital trusts under investigation compared to all others;

Being Investigated Not being investigated

Hospital IndicatorsMean (n=14) Mean (n=133)Sig.

Summary Hospital-level Mortality Indicator (SHMI)113.3 98.7**

 

Hospital Standardised Mortality Ratio (HSMR)111.4 98.4**

 

Percent catchment population aged 65+  17.6%  16.5%

 

Funding Context (£ per capita)  £1,358  £1,392

 

Number of cleaning staff per 100 beds 18.0    23.1**

 

Number of nurses per 100 beds  136.8   143.4

 

Number of doctors (all grades) per 100 beds

56.1  67.5**

 

Number of consultants per 100 beds 19.7  24.0**

Percent staff feeling satisfied with the quality of work and patient care they are able to deliver 72.4%  74.2%

 

 Percent staff who ‘agree’ or ‘strongly agree’ that:    ‘There are enough staff at this trust for me to do my job properly’  29.0%  30.1%

 

‘Care of patients / service users is my trust’s top priority’  51.6%   58.5%**

 

‘I am able to deliver the patient care I aspire to’

66.9%   69.8%

‘I am able to do my job to a standard I am  personally pleased with’  60.9%  62.3%

Senior managers where I work are committed to patient care’ 45.0%  50.5%**

 

 

Difference of means t-test significant at 0.01=** and at 0.05 =*   

** Difference of average is t-test significant at 0.01

Neil Harris

(a don’t stop till you drop production)

Tuesday 21 May 2013

It figures


C CITY DESK

 

When you’re a bit under the weather, there’s nothing like a few real live figures to get your teeth into. Those are the figures governments don’t want you to see.

The next couple of articles are based on a Health Service Journal survey and analysis. I won’t put a link in, it’s subscription only. If you google for it, you can sometimes jiggle it to get access for free (TEE HEE).

Now when they tell you it’s not about money, you can show that it is.

This looks at the 14 Trusts that are being investigated for having higher death rates than they should have.

The HSJ has found that they also had fewer Doctors, Consultants and Cleaners than hospitals that didn’t make the relegation zone.

 

Health Service Journal

Exclusive: Fewer doctors per bed at death-rate investigation trusts

4 March, 2013 | By Ben Clover

An analysis of the 14 hospital trusts being investigated by the Department of Health over higher than expected death rates has highlighted medical staffing as a possible cause.

The 14 trusts were identified because they had higher than expected death rates

- based either on the hospital standardised mortality rate or the summary hospital-level mortality indicator - for two successive years. They are currently subject to a review led by NHS medical director Sir Bruce Keogh.

Analysis for HSJ of those in the group showed they had an average of 56.1 doctors and 19.7 consultant doctors per hundred beds, compared with 67.5 doctors and 24 consultants per hundred beds at trusts which are not being investigated.

Trusts being investigated had 18 cleaning staff per 100 beds, while trusts not being investigated had 23, researchers from the University of Plymouth found.

But the academics found little difference in the number of nurses between the trusts being investigated and those that are not. The rates were 136.8 and 143.3 per 100 beds respectively.

HSJ asked the researchers to make the comparisons. It was carried out by Sheena Asthana, professor of health policy and the University of Plymouth, and Alex Gibson, who is also based at that university.

Now that wouldn’t surprise any of us, would it?

Neil Harris

(a don’t stop till you drop production)
Home:   helpmesortoutthenhs,blogspot.com

Sunday 19 May 2013

Blaming the wrong government.


VHOLD THE

    FRONT PAGE !

This is from ‘The Observer’, today, Sunday 19/5/13. Pretty much my analysis, but this story is down to 38 Degrees.com, an interesting internet protest site:

The NHS Direct health advice service referred an extra 120,000 patients to accident and emergency departments in the past year, compared with the final 12 months of the Labour government.

The increase in the number of calls to the 0845 service that were considered to require "urgent or emergency" assistance came as staffing levels dropped significantly. More than 1,200 fewer people worked on NHS Direct in 2012-13 compared with 2009-10, according to figures from the service. The numbers appear to offer an explanation for at least some of the huge increase in people attending A&E departments and a crash in performance there in the last year.

Of the 143 trusts that have large A&E units, only 18 have hit the target of treating 95% of patients within four hours, with the goal being missed by a widening margin in recent months.

Jeremy Hunt, the health secretary, has claimed that this is due to an extra 4 million people a year attending A&E compared with the numbers under the last government. He has blamed doctors' contracts in 2004 allowing GPs to opt out of offering out-of-hours services for pushing people into hospitals. However, the figures suggest that other factors are at work. The coalition has been running down the NHS Direct service, about 40% of whose staff were nurses, since announcing in summer 2010 that it was to be replaced by a 111 helpline run by private call centres.

However the 111 service, introduced nationally on 1 April, has been beset by major serious problems, with many patients unable to get through for hours or being given poor advice and arriving at A&Es in frustration. The figures revealed today show that, as the NHS Direct service has been winding down, it has been pushing more people to hospitals. The proportion of calls referred to A&E in 2009 was 24% of the 4,864,035 calls, up to 36.5% of 3,585,954 calls in 2012. Suresh Chauhan, of the campaign group 38 Degrees, who obtained the figures, said he feared the 111 helpline, run by staff who lack medical training, was sending more people to A&E than NHS Direct, compounding the problem. "The real cause of this crisis is a policy decision made by this government when it came to power in 2010," he said. "They decided to dismantle the NHS Direct service which triaged out-of-hours calls for medical aid.

"This service, called the 0845 line, had been working for a few years then and had an impressive record of processing the calls by listening to actual problems and giving appropriate guidance." Alan Milburn, who negotiated the GPs' contract changes in 2004, said it was "complete nonsense" to claim that reforms introduced nearly a decade ago to improve GP recruitment were hitting performance levels in emergency wards today. Milburn, an adviser to the coalition on social mobility, said ministers needed to explain why performances in A&E departments had improved in the latter part of the Labour administration, only to worsen since 2010.

"It's complete nonsense and totally spurious to claim a deterioration in accident and emergency performance which only took effect in the last 18 months can somehow be tracked back to a GP contract change from 2005," he said. "Jeremy Hunt is blaming the wrong government. He has to explain how the NHS managed to improve accident and emergency performances despite an increase in the numbers of people attending up until 2010, but has since failed to do so."

 

 Neil Harris

(a don’t stop till you drop production)
Home:  helpmesortoutthenhs.blogspot.com

Saturday 18 May 2013

Timewasters?


Using the information from The College of Emergency Medicine survey into UK Accident and Emergency departments, let’s look at the commonly held view that people are wasting Doctors time at A and E’s with trivial problems.

Here are the Triage categories;

 

1  Immediate       1 %

2  Very Urgent     9%

3  Urgent              38 %

4  Standard          47%

5  Non urgent      5%

 

So, 48% are urgent or worse – that’s nearly half.

I’m not sure what standard means but I suspect that while it may not be urgent it could be pretty unpleasant – say a sprained ankle where the reason you attend is not urgent but you need an X-Ray to check it isn’t broken. Someone faints, then they wake up and are well by the time they get to A and E. - it stops being urgent but could be very serious….or not. It needs to be checked out.

Only 5 % are ‘non urgent’ and probably didn’t need to be there, which is not what you hear from the press, the Health Minister or the professionals.

Here are some other figures for another group; do you think this is the elderly?

1 Immediate      2%

2 Very Urgent    8%

3 Urgent             19%

4 Standard         65%

5 Non urgent     6% 

Here, there are a few more non urgents, a lot more standards and only 29% urgent or worse compared with 48% as a whole. Who are they?

It’s Paediatrics, worried parents bringing little kids in. Even on these figures you couldn’t say they were timewasters – you would say better safe than sorry.

The 5% or 6% ‘non-urgents’ could be diverted by an efficient system of Triage: which is where an experienced Nurse sees all attenders immediately and gauges the urgency of their needs – which includes sending away those who don’t need Hospital treatment.

I think everybody from the Health Minister down to staff is looking to blame patients instead of the real problems of bad organisation, lack of resources, lack of staff and bad management. Now we have some figures to prove it.

95 % of people attending A and E have every right to be there.

Neil Harris

(a don’t stop till you drop production)
helpmesortoutthenhs.blogspot.com

Friday 17 May 2013

If only all the old people would go away....


All the problems are caused by old people – if only they would go away.

I’m being a bit sour – that’s not really what the team at the College of Emergency Medicine are saying. But they do conclude that an aging population is a problem.

I wish I could use their graphics but I can’t extract them from the PDF.

Here are the ages of those attending A and E’s;

Less than 1          3%

1 to 5                    8%

6 to 16                  11%

16 to 64                58%

65 to 80                12%

More than 80      8%

 

1) This probably reflects the age breakdown of the population. As the population gets older attendance at A and E’s will change. We should plan for it instead of trying to drive elderly people away from hospitals when they need them.

2) The under 5’s (11%) take up more places than the older than 80’s (8%).

3) The under 16’s (22%) take up more places than the over 64’s (20%).

4) So why are all hospitals are trying to divert elderly patients from A and E?

Why not try to prevent the young from going to hospital – it would save more resources. For example, sports injuries and injuries caused as a result of Drink and/or drugs make up a substantial proportion of A and E time, yet no one is suggesting that everyone under 30 should be dissuaded from coming to A and E.

As the figures show, young children with all those irritating illnesses caused by lack of immunity as well as injuries resulting from youthful exuberance mean there are too many youngsters in A and E.

Obviously, I don’t mean all that any more than people shouldn’t be treated if they go mountaineering or kite-boarding. Then again, because people are old doesn’t mean they shouldn’t be in hospital either.

We all pay for the service, we all have a right to access it. There needs to be more acceptance of and consideration for the elderly.

Tomorrow I’m going to take a look the attitude that we are wasting their time with pointless attendances at A and E.

 

Neil Harris

(a don’t stop till you drop production)
Home:   helpmesortoutthenhs.blogspot.com

Thursday 16 May 2013

If only I could show you the graphs!


There are some really great graphs in The College of Emergency Medicine report on the crisis in Accident and Emergency departments, unfortunately they are in PDF and not JPEG, so I can’t use them. Take a look at the report and you’ll see what I mean.

The CEM lifted the graphs in turn from the NHS.

It’s an illustration how clever people sometimes can’t spot the obvious because it’s not what they are looking for.

 

Admissions to A and E’s in Scotland:

2001/2    about 1.5 million

2011/12  about 1.6 million.

 

Admissions to A and E’s in England:

2001/2    about 13 million.

2011/12  about 21.75 million.

 

Now what is unimportant in comparing these figures; that they are different countries, different populations, probably slightly differently calculated.

What is important;

If anything, Scotland should be in more difficulties; ageing population, social deprivation, a drinking culture, drug issues, all of which are as serious as in England.

The relative increase in attendances.

Scotland saw an increase of 6.67%

England saw an increase of 67.31%.

Wales and Northern Ireland are similar to Scotland.

The answer?

England has seen an unprecedented number of closures of A and E’s over the last ten years. So there are more attendances at each surviving A and E.

Scotland, with devolved powers, has spent more on their NHS as has Wales. Northern Ireland still receives a massive state subsidy due to the ‘troubles’.

You get what you pay for.

Tomorrow I will take a look at how the time and space given to blaming the elderly for the increase in numbers attending A and E is a diversion from what is really happening.

Neil Harris

(a don’t stop till you drop production)
Home:  helpmesortouthenhs.blogspot.com

Wednesday 15 May 2013

The College of Emergency Medecine speaks out.


HOLD THE FRONT PAGE!

t

          STOP PRESS!

These are the good guys, my comments to follow tomorrow;

 

The College of Emergency Medicine


PRESS STATEMENT Thursday 09 May 2013

Re: The challenges facing Emergency Departments

The College of Emergency Medicine welcomes the statement by the Care Quality Commission chairman David Prior about the challenges facing Emergency Departments. We have been saying for some time that action needs to be taken to address our concerns about the rising demands on Emergency Departments.

The challenges faced are caused by a variety of factors and reflect a system wide challenge for emergency and primary care. These include:

·      Rising numbers of patients presenting to Emergency Departments. Reasons for this include particular pressures due to inadequate social care beds, a frail elderly population with multiple co-morbidities and challenges with out of hours services.

·      An ‘access block’ caused by hospital wards which do not have sufficient capacity to allow patients in a timely way to be moved from the Emergency Department into wards. This causes particular difficulties for ambulances who sometimes are queuing at Emergency Departments at a result. Any further closure of hospital beds needs to be considered only when there is sufficient community based care to cover the needs of patients.

·      Our workforce recruitment is at crisis. We have had three successive years of only 50% fill rates for Senior Emergency Medicine trainees. As a consequence Emergency Departments have a significant shortfall in senior trainees and consultants which adversely affects service delivery and patient safety. Retention of doctors in the specialty is also proving difficult due to the pressures on the service.

·      Our experience of NHS111 is that this is increasing demand in some areas but not universally. We expected some teething problems as the new system beds in but a key issue is having sufficient capacity in primary care for NHS111 to access as an alternative to the Emergency Department.

We need Care Commissioning Groups to urgently commission innovative and consistent tested patient centred services. Approximately 22 million patients were seen in Emergency Departments last year and we believe 15-30% of them did not require Emergency Department services. Redirecting patients away from Emergency Departments only work if reliable alternatives are available.

 

Neil Harris

(a don’t stop till you drop production)
Home:  helpmesortoutthenhs.blogspot.com
 

The frightening fourteen failing trusts.


Before I start the important stuff, this is a brand new Blog and I haven’t worked out where it’s going or how it’s going to get there yet. For the next few days I’m going to pose some questions about how it’s going to go, on my old site;


and I’m encouraging people to have their say about style, content, that sort of thing. Why not take a look at the problem and have your say, anyway you like.

OK, I got my act together to do some work on this – I took the trouble to track down the list of the 14 hospitals under investigation for having higher than expected death rates.

Then I took the recently disclosed ‘never events’, as exposed by BBC News and put the two together. No one else has done that, which seems odd to me.

Two, I couldn’t track down – I didn’t try that hard, sorry about that.

The 14 trusts, identified by the NHS Commissioning Board following the publication of the Francis report, are:

North Cumbria University Hospitals,

United Lincolnshire Hospitals, 12

George Eliot Hospital, 4

Buckinghamshire Healthcare, 5

Northern Lincolnshire and Goole Hospitals, 3

The Dudley Group of Hospitals,

Sherwood Forest Hospitals, 2

Medway, 4

Burton Hospitals 4

Colchester Hospital, 2

Tameside Hospital, 1

Blackpool Teaching Hospitals 2

Basildon and Thurrock University Hospitals 7

East Lancashire Hospitals. 1

 

(The numbers are those of the ‘never happen incidents’)

What’s interesting is that there are only two trusts where there is an obvious link; United Lincolnshire and Basildon and Thurrock. Each had dramatically bad figures.

The rest didn’t and some of the figures were not so bad. Then again 2 out of the 12 I had figures for is a 16.67% correlation. That is significant to me even if the more boring scientists out there would point out that it is also an 83.33% ‘non-correlation’.

If you add Buckingham with 5 it’s 25%.

It’s also possible that many of the ‘never events’ aren’t fatal so I think it’s a useful figure, to be used in combination with other outcome statistics.

The thing is, unless they alter the figures (that’s fraud folks), you can’t ‘game’ these statistics and if it highlights just a few failing hospitals it is going to save more than a few lives.

So, as an example, St. Bartholomew’s seems OK if you’re just looking at mortality rates until you look at the ‘never happen events’, then it all looks a bit worrying.

I’ve got a fascinating article/study into the frightening 14 which compares a number of factors as between the 14 and the rest. I’m having a bit of a struggle at the moment, when I feel better I’ll write it up.

Neil Harris

(a don’t stop till you drop production)