Tuesday 30 July 2013

Good planning


I should stop reading the Nursing Times, it depresses me. The following article comes from their site, I’m responsible for the edits.

Question;

What;

1] Fell by 4% last year.

2] Will rise by 2% this year.

3] Will fall by 30,000 between 2014/2016?

 

 

Nursing numbers decline again with more cuts planned

Nursing Times

29 July, 2013 | By Shaun Lintern

Real cuts in the number of NHS nurses – almost 1,000 in a month – have continued to emerge as more than 140 hospital foundation trusts plan to slash their workforce by 30,000 by 2016.

Latest figures, from the Health and Social Care Information Centre, show the number of nursing posts in the health service dropped by 956 between March and April – leaving a total of 307,939 whole time equivalent nursing midwifery and health visiting staff.

This is almost 3,000 fewer than when the coalition government took office in May 2010, while the total headcount has reduced by more than 5,000.

The cuts in nurse numbers have been criticised as “dangerous” by shadow health secretary Andy Burnham. Royal College of Nursing chief executive and general secretary Peter Carter highlighted recent scandals, saying: “Where nurse numbers are slashed, standards of care plummet.”

The figures were published last week, one day after latest three-year plans from 145 foundation trusts exposed plans to brutally cut the NHS workforce by 30,000 whole time equivalent staff in the next two financial years.

The annual review of FT plans by the regulator Monitor revealed there was a 4% fall in the number of nurses at their organisations during the last financial year, 2012-13.

During the current 2013-14 year, FTs plan to increase staff in response to the Francis report on Mid Staffordshire Foundation Trust and this month’s mortality review of trusts with high death rates the report, published by NHS England medical director Sir Bruce Keogh.

The Monitor reports said FTs are planning to recruit staff as a “short-term fix”, with 4,133, or 2%, more nurses along with 5,867 doctors, healthcare assistants and other frontline staff. They will off-set the cost of this year’s £500m recruitment by imposing a 39% cut in the use of bank and agency staff, the plans suggest.

But during the 2014-16, trusts are planning a return to staff reductions and want to cut 30,000 WTE staff, with a majority coming from nursing.

This is despite predictions by the Centre for Workforce Intelligence of a potential nursing shortage. It believes the NHS is likely to have 47,500 fewer nurses than it needs by 2016, as revealed by Nursing Times in June.

RCN policy director Howard Catton described the FT’s plans as a “classic example of boom and bust, yo-yo approach to workforce planning”.

“We have to move away from this, it’s not sustainable for the future,” he warned. The Francis and Keogh reports crossed the Rubicon in terms of making nursing cuts a patient safety issue.”

 

Good planning, good patient care?

Errh no.

Neil Harris

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

Monday 29 July 2013

The end of NHS Direct.


Hangin’ on…

The Largest provider of the NHS England ‘111’ non-emergency telephone service is walking away from its contracts.

NHS Direct used to cover the whole of England with its fine telephone advice service – provided by nurses. It got the axe to save money (thanks to Sir David Nicholson).

The creating of the ‘111’ service has been one big problem, as this Blog has reported before and as these  two stories today confirm;

NHS Direct won 11 of the 46 regional contracts for the new service, covering 34% of the population.

In June it pulled out of two areas, Cornwall and North Essex but now says the remaining nine are "financially unsustainable" as well. It had complained that the volume of calls at North West and West Midlands had fallen short by 30 to 40% of the contracted amounts and the service was now  "financially unsustainable". There haven’t been enough calls to make it pay (people don’t trust the service) and the calls take too long (unqualified staff).

Here’s the real problem;

NHS Direct used to be paid more than £20 per call while the payment to the new 111 call centres is only between £7 and £9 per call. This reflects that NHS Direct was based on advice from nurses, the new service uses call centre staff and a computer check list.

 

 NHS Direct has lost £2.8m since April and was "heading for a deficit of £26m if we continue to run the same volume of 111 services until the end of this financial year".

 

The organisation is now seeking a "managed transfer" of its 111 contracts, which have between two and five years left to run, to another provider.  

NHS Direct's current 111 services are;

Buckinghamshire

East London and the City

South East London

Sutton and Merton

West Midlands

Lancashire and Cumbria

Greater Manchester

Merseyside and Cheshire

Somerset

 

‘111’ was supposed to be running in April, some areas won’t now have coverage until next year – the NHS Direct areas will have a pretty uncertain future until a new operator can be found.

 

                            =======//=======

There’s no harmony at ‘Harmoni’, a private ‘111’ provider. Channel 4’s Dispatches programme has been doing some snooping and found  ‘staff shortages, long waits for callers and some cases of ambulances being called out unnecessarily.’

 

One call centre manager is recorded saying that ‘the service was "unsafe" at weekends because there were too few staff to deal with the calls coming in.’

NHS Direct was a real success story, appreciated by all of us who used it. It gave good, helpful advice and saved unnecessary visits to A and E which was saving the NHS money and saving patients unnecessary problems as well.

NHS Direct walking away from the ‘111’ contracts kills off the remainder of the organisation and ensures that it won’t be economically viable to revive it. So, while we will regret it, I doubt NHS England will.

Meanwhile, I’m sure Nicholson, so keen on leaving behind his ‘legacy’, can chalk this one up as another victory – I don’t.

 

Neil Harris

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

Saturday 27 July 2013

End of NHS care.


Now it begins;
 
 
UHands Off
                 It’s our NHS.

Cambridgeshire and Peterborough Clinical Commissioning Group are putting out to tender £1 Billion of medical services in their area to private providers. This will cover ‘end of life care’ amongst other provision for the elderly.

It’s a 5 year contract worth £160 million a year for 5 years with a 2 year extension option.

Currently there are 6 separate contracts with the NHS, 4 hospital trusts, a mental health trust and a community services trust. The new contract is so large and the current suppliers so diverse that they will not be able to compete with the multi-nationals likely to win the contract.

Virgin Care which already has a £450 million pound contract in Surrey is eyeing up the profits, as is Circle which runs Hinchinbrooke Hospital and Serco which was recently exposed as providing inadequate GP cover and lying about it on it’s out of hours contract in Cornwall.

According to the Institute for Fiscal Studies and the Nuffield Trust, the £100 Billion NHS budget now bleeds over £8.7 Billion in private contracts.

So what happens to the existing providers when the new contract is signed? Do the hospitals shut down, or do the new private bosses come in and take over the public assets that we used to own, using them to milk the profits without paying for the facilities.

In other words we pay, they profit.

I’m approaching ‘end of life’ care. I don’t want to get it from Richard Branson’s Virgin, Serco or G4S.

Neil Harris

(a don’t stop till you drop production)

Friday 26 July 2013

With the toe of my size 11, 12 hole, Doc Marten boot.


The Nursing and Midwifery Council (NMC) has met and struck off two Accident and Emergency nurses from Stafford Hospital, part of Mid-Staffs NHS Trust, where so many died, needlessly.

There have been far too few examples of disciplinary action taken and all of them far too late. In the case of Tracy White, she is not only still employed by the hospital – she’s now a manager!

Despite White being struck off as a nurse, Maggie Oldham the current Chief Executive said of her; “She has been employed as a clinical site manager. We will now take time to give careful consideration to the NMC panel’s decision”.

I’d give her some careful consideration – with the toe of my size 11, 12 hole Doc Marten boot.

It’s her co-defendant I really want to Blog about, Sharon Turner;

She was foul-mouthed and abusive about patients, falsified A and E waiting times to make it appear as though A and E had dealt with patients within the 4 hours target, bullied other nurses into falsifying records and was racially abusive towards junior doctors. Here are a few choice quotes;

“I don’t give a flying F@#k about patients, they can wait”

“I’ll make your life hell and get rid of you in 6 months” (to a fellow nurse)

“I’ll drive you to drink and you’ll be out of here” (to another nurse)

“He should have taken a few more pills and done the job properly” (about a nurse who took an overdose)

“she’s a dirty little monkey” (referring to an elderly patient and refusing to assist a nurse change her)

I could go on. The point is that this nasty, viscious, cruel, lazy, racist bully was as much a menace to her co-workers as she was to the patients who were unlucky enough to receive her ‘care’.

Oh and by the way, Sharon Turner, you are very welcome to take my comments up with me, any time you wish.

One bully is a problem, when it’s tolerated and spreads it becomes the culture at work.

The bully picks on the weak – that’s usually the patients but it’s also workmates who are unprotected.

So Turner picked on junior doctors because they have little respect from their fellow doctors.

In particular, she picked on racial minorities because their colleagues were less likely to protect them.

It was tolerated by her fellow nurses (all guilty of not taking action) because of the bullying attitude that senior medical staff and management have towards nurses and care assistants in general.

Can you tell how angry I am?

Neil Harris

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

The Keogh Review review, part 3.


The Good,the Bad and the Ugly

These are my conclusions about the report.

 

The Ugly

The 14 Trusts were failing 10 years ago, failing now and likely to be failing in 10 years time unless real changes are made.

A number of the trusts, despite prior warning of inspection, were still unsafe or not properly staffed when Keogh came calling.

If management couldn’t get its act together to sort everything out before an inspection, when would it?  Unless the management changes it is going to happen again, as soon as the Keogh spotlight has moved on.

The report doesn’t identify management or managing clinicians as a problem and it should have spelt that out. The problems start at the top even if they don’t finish there.

The managers get the big rewards, they should pay the price when things go wrong.

 

The Bad

Because it was so quick, the report does little except highlight areas of concern and raise good intentions for the future. These include;

The need to listen to patients.

Staff morale – every study indicates that low morale or alienation leads to increased mortality rates for patients.

Inadequate staffing levels – a danger for staff.

Too much reliance on agency staff or a high staff turnover to fill the gaps and ignoring the problems that forced staff to leave in the first place. Long service is a sign that people are happy. Happy people make happy patients.

Not enough consideration given to junior doctors and nurses – to tap their enthusiasm and idealism.

In short – too many question marks and too few answers.

 

 

The Good

As reports go, it was quick and decisive and Keogh identified the safety problems, taking action quickly.

As he says, after taking emergency action it’s time to debate what was going wrong and then check up on how the Trusts have acted following the review.

Plainly, managers need to be losing their jobs if it doesn’t improve – however much you argue about numbers, people have been dying. From the tone of the report, it is implied that there will be follow up action.

He wants Junior Doctors and Nurses to be involved far more than they currently are. The implication is that they are likely to be more up to date, more modern in their outlook, more committed and more concerned than their older, worn down colleagues.

He wants hospitals to listen to patients.

It gives every indication that Keogh wants to change things for the better. Let’s keep an eye out on what happens next.

My say;

For what it’s worth, my view is that there was too much time spent on whether the mortality figures are helpful or not – it’s a red herring. Mortality figures have proved to be a very useful indicator of problems, up till now. Unfortunately managers have realised that and have been massaging the figures, ‘gaming’ the codes. You can go on expensive courses to learn how to do it.

However, there are many other indicators and they are all of value.

Here’s three lists that the report took account of:

In-patient, Cancer survey, PEAT – privacy and dignity, Complaints about clinical aspects, Ombudsmans Rating, PEAT Environment, PEAT Food, Friends and Family test, Patient voice comments.

Then they looked at;

Harm incidents, ‘never events’, patient safety incidents, medical error, MRSA/ C-Diff infection rates, litigation, coroners concerns.

Then they looked at indicators of staff dissatisfaction and alienation;

Ratio of Nurses to beds, periods of working, vacancies unfilled, sickness rates, staff leaving rates.

As I found when I was analysing the never events, when you look at any one indicator it doesn’t obviously have much relation to any other indicator.

As I also found when I was comparing never events with mortality rates, a trust can succeed on some indicators, but failing on others can still be an indication that the trust is failing.

We need to be looking at the widest possible range of indicators, for patient outcomes, for staff alienation, for clinical excellence and pro-actively look for areas of concern.

The more indicators the better, the less likely they can be fixed. Broadly, if hospitals are failing on several indicators, its time to take a close look at everything else.

And that, I think, is what Keogh’s report is saying.

But;

My big problem is that nowhere is there any mention of democracy – of democratic control. Once upon a time, we paid the taxes, the government ran the NHS and was responsible for any failures. When things went wrong a minister had to resign. Now, Foundation Trusts are independent, the government is off the hook and we have no control. Neither do the local authorities, whose elected representatives used to have some influence. It seems that all we have left is to stand protesting at the hospital gates. Or Blogging!

You don’t have to be very political – ‘No taxation without representation’, cuts across left and right. At the very least, we need to take back control and ownership of our NHS, because we could have done a better job.

Then;

There is no mention of democracy in the workplace.

No mention of the Trades Unions and professional bodies representing staff – they should have a role.

There’s no breakdown of the workforce and the role that inequality, prejudice and bullying plays in creating alienation.

As I keep saying;

1) The majority of NHS staff are working class.

2) The majority of NHS staff are women.

3) The majority of NHS staff are from ethnic minorities.

But this report does not discuss equal opportunities and fairness at work or the climate of fear and division that there is, right now.

Then;

There are managers, often with little or no experience of running hospitals - ordering clinicians about. Once upon a time, Doctors ran hospitals, helped by administrators, who ‘administered’. I know which I’d prefer.

It’s not just Doctors – there are nurses, care assistants and all kinds of specialists. A hospital is a whole collection of competing specialisms and interests fighting for scarce resources.

And that’s not even taking account of healthcare outside of hospital, fighting over the same money.

What Keogh has done is lay down a marker – a brand new start. He’s opened a debate and we need to dictate the form that debate takes. Because if we do nothing the agenda will be set by NHS bureaucrats, hospital managers, a biased press, Big Pharma, private finance initiative rip-off merchants, and private healthcare.

Then we really will be left standing at the gates.

Neil Harris

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

Thursday 25 July 2013

The Keogh Review review, part 2.


At the conclusion of Sir Bruce Keogh’s letter to the health minister are these paragraphs;

“Finally, not one of these trusts has been given a clean bill of health by my review teams. These reviews have been highly rigorous and uncovered previously undisclosed problems in care. The rapid responsive review reports and the risk summit summaries make uncomfortable reading.

However, this is not a time for hasty reactions and recriminations. Any immediate safety issues we uncovered have been dealt with. It is a time for considered debate, a concerted improvement effort and a focus on clear accountability. So, I expect the carefully considered and agreed action plans to be enacted with serious consequences for failure to do so.”

I’ll be taking him up on that and here are a few issues for debate;

It’s clear that there were arguments raging amongst the people involved in the review, as these passages on mortality rates show:

“It is important to understand that mortality in all NHS hospitals has been falling over the last decade: overall mortality has fallen by about 30% and the improvement is even greater when the increasing complexity of patients being treated is taken into account. Interestingly, the rate of improvement in the 14 hospitals under review has been similar to other NHS hospitals.”

Which shows that the 14 had had some improvements, but they had started 10 years ago lagging behind and after the decade ended, they were still lagging behind.

The usual excuses didn’t explain what was going wrong, though;

“Factors that might have been expected – and are frequently claimed - to impact on high mortality, such as access to funding and the poor health of the local population, were not found to be statistically-correlated with the results of these trusts. The average for the 14 trusts is broadly the same as the England average in terms of funding and the socio-economic make-up of the populations they serve.”

This following passage says it all really – some of the failing hospitals were more concerned about explaining away the bad figures rather than improving patient outcomes. That makes it a management failure although nowhere in the report is there any mention of managers or boards.

“Clinical coding accuracy, and depth of coding, can in some cases impact on mortality indicator values for hospitals. Coding patients to make them appear sicker or identifying a higher amount of co-morbidities can improve mortality ratios. No statistical measure is ever perfect, but some organisations were not engaging in the message the data was giving as they felt it was wrong. Investigation into the signals that the data gives needs to be both about how data quality can be improved by clinician engagement and also clinical care and service delivery investigation to identify if improvements can be made. We found some trusts focusing too much time on the former and not the latter.”

This passage in the covering letter is an attack on government leaking a few days before publication – that 13000 had died needlessly in these trusts (a Lynton Crosby briefing, allegedly), which echoed leaks earlier in the year that 30,000 had died in the NHS as a whole, due to neglect. As I said back then, this was a political attack on the public ownership basis of the NHS and on its staff, who deserve better;

“the complexity of using and interpreting aggregate measures of mortality, including HSMR and SHMI. The fact that the use of these two different measures of mortality to determine which trusts to review generated two completely different lists of outlier trusts illustrates this point. However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths. Robert Francis himself said, ‘it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care’”

This next passage confirms what I have been arguing about for so long – that the Accident and Emergency is the heart of any hospital. Shut it down and you start the process of closing the hospital. If it isn’t working right, the problem is going to spread further:

“Over 90% of deaths in hospital happen when patients are admitted in an emergency, rather than for a planned procedure. It is not altogether surprising, therefore, that all of the 14 trusts we reviewed had higher than expected mortality in non-elective (urgent and emergency) care and only one (Tameside General Hospital) had high mortality for elective (planned) care. The performance of majority of the trusts was much worse than expected for their emergency patients, with admissions at the weekend and at night particularly problematic. General medicine, critical care and geriatric medicine were treatment areas with higher than expected mortality rates.”

Here he is saying that you have to look at the whole system and especially at staffing and staff morale;

“Understanding the causes of high mortality is not usually about finding a rogue surgeon or problems in a single surgical speciality. It is more likely to be found in the combination of problems that to a differing extent are experienced by all hospitals in the NHS: busy A&E departments and wards, the treatment of the elderly in and out of hospital, and the need to recruit and retain excellent staff. Such issues are complex and require a ‘whole system’ approach to deal with them. This is why it has been so important that this review has involved all the key players.”

My conclusions tomorrow.

Neil Harris

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

Wednesday 24 July 2013

The Keogh Review review part 1.


You will all have been surprised that I waited so long before I Blogged about Sir Bruce Keogh’s (The NHS Medical Director) review of the 14 failing hospital trusts – it’s not like me. That’s because this needed some thought.

The Keogh Review, came about because of the public anger at the unneccesary deaths (600 to 1200) which occurred at Mid Staffordshire NHS Foundation Trust and in particular at the failure of the management, doctors and nurses to provide basic, compassionate care to the elderly, terminally ill and sick patients who were unlucky enough to be treated at this group of hospitals. I commented widely on the Francis report into this scandal in my other (rather silly) Blog at the time of publication:

The exposure of Mid-Staffs came about through the Dr Foster Unit based at Imperial College, London and headed by Professor Brian Jarman, who had been analysing mortality rates. The unit collated and published mortality figures for all hospitals so that they could be compared with what was expected. If the rate was too high, it was a cause for concern. It’s still controversial – you can ‘fix’ the figures by changing the way deaths are coded. I wrote a lot about that too. Some hospitals feel they are unfairly hit for serving high risk communities or undertaking more complex operations or treating high risk individuals. There’s a lot to argue about.

All the same, the result was the identification of 14 Trusts that gave cause for concern – too many deaths over a long period.

As a result, Keogh, his team and Pricewaterhouse went in, consulted and then analysed whether there was a problem and, if so, how to deal with it. The press seem to have looked only at his covering letter to the Health Minister, which is by way of a summary. We need to look a bit further.

My first point is that it’s a remarkably quick report – far too quick to be final but that’s really commendable. The patients in those areas have waited too long, things needed to change and quickly. I think that’s starting to happen.

 

Secondly, the most remarkable thing is how useless the management of the 14 Trusts are. They knew that they were going to be investigated, it wasn’t a secret. Not least, Keogh had a travelling consultation process which went to each trust area to talk to patients. That means they had plenty of notice of an inspection.

So, take a look at this damning passage;

“3.2 Where we took immediate action to protect patients

The most important part of my remit was to take action to protect patients from harm where we found instances of poor care or risky environments or practices. We employed the ‘precautionary principle’ in undertaking this review. Where we found areas of concern, we acted immediately (we didn’t wait for a disaster so that we could be absolutely certain).

Actions taken included: immediate closure of operating theatres; rapid improvements to out of hours stroke services; instigating changes to staffing levels and deployment; and dealing with backlogs of complaints from patients.

1) The review had to shut operating theatres?

The only reason to do that would be that they were unhygienic or there was equipment unsuitable for use.

Was no one checking? Managers, Surgeons, Nurses?

2) Out of hours stroke services.

This simply means that those hospitals were not treating strokes out of hours because they didn’t have specialist staff available. If your stroke was at the weekend you waited in a bed till Monday.

Nowadays everybody knows that if you don’t treat strokes quickly, outcomes are worse, people are more disabled than they need to be and are more at risk of dying. Minutes count. Sometimes just taking Aspirin in time makes a difference.

3) Changes to staffing levels and deployment – not enough nurses and doctors.

All of this would have been obvious to the lowliest member of staff and to most members of the public – yet it took this review to sort it out.

I was very critical back at Easter about the way Leeds General Hospital’s Children’s Heart Unit was closed down. It happened the day after the campaign to save it had won a High Court Judgement declaring that the decision making process which led to proposals to shut it down had been flawed. At the time I felt this was badly handled by Keogh – I thought it was highly ‘political’.

I now realise that he was in the midst of this whole process of 14 hospital inspections and in some cases this was leading to emergency actions. I can imagine that he was appalled by what was being discovered and trying to do something quickly to sort it out. It’s in that context that interested and biased parties were lobbying him about Leeds.

I still don’t think it was handled well but I now understand the pressures that he was under at the time. His ‘mistake’ was one which was on the right side, compared with those made in the past which avoided the problems. He’s trying to make a new start.

It also isn’t right to look at this report without taking in the other changes that have been happening recently: last week, England’s new Chief Inspector of Hospitals, Professor Sir Mike Richards ordered investigations into Barts Health Trust as well as Barking, Havering and Redbridge; Croydon; and South London Healthcare, based on their appalling record in ‘never events’, the errors that should never happen.

There is a clear change in direction at the Care Quality Commission: how it does its job of inspecting trusts and care homes, although changing that will take time. In particular, inspections need to be carried out by people with some qualification and experience to do so.

I get the feeling that the clinicians have finally got the message that something very wrong was going on and that they had better do something to change it. I hope so, anyway.

Am I getting soft in my old age? Well, I am being won over, the question is whether I’ve just been schmoozed by this report or whether it’s for real. I’m going to be a bit more critical in the second part of this review.

Neil Harris

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

Tuesday 23 July 2013

Lynton Crosby - the smoking gun.


I found this interesting article by Jamie Doward of The Observer on the NUJ web site, dated December 2012.

 

“Campaigners raise alarm over tobacco giants' lobbying against plain packaging

 

Anti-smoking campaigners have expressed alarm that "big tobacco" has been employing two of the world's most powerful lobbying companies in a bid to stymie the introduction of plain packaging for cigarettes.

Crosby Textor, which has been hired by the Conservative party to provide "strategic direction" at the next election, has played a powerful behind-the-scenes role in mobilising opposition to the Australian government's plans for plain packaging, which became law on Saturday.

Tobacco giants fear that the landmark law, which they tried to thwart by funnelling millions of pounds into an array of front groups purportedly representing small shopkeepers, will be copied around the world. The UK government has concluded a consultation on the issue and will report next year. Many other countries are studying Australia's decision closely.

 

News that Lynton Crosby, described as the "master of the dark political arts" and "Australia's Karl Rove", is to become the Tories' election mastermind triggered concerns from campaigners. "It's very alarming that Mr Crosby now has the ear of the prime minister while the government is still trying to make its mind up whether to bring in such a law," said Deborah Arnott, head of Action on Smoking and Health (Ash).

 

While Crosby was federal director of the Liberals in Australia, the party accepted substantial donations from the tobacco lobby. Crosby Textor's co-founder, Mark Textor, has been an adviser to the tobacco industry in Australia, fighting plain packaging.

His clients have included Philip Morris, the owner of the Marlboro brand. His company, which has opened an office in London, Crosby Textor Fullbrook (CTF), has been on retainer for tobacco firms since the 1980s.

CTF has also represented British American Tobacco. Mark Fullbrook, CTF's co-founder, was also head of campaigning for the Tories.”

 

Crosby and Textor also masterminded Boris Johnson’s first campaign to win election as London Mayor. I wonder what clients they have with London interests?

Neil Harris

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

Lynton Crosby.


In my last Blog (Keeping count), I was reporting on how the Office of National Statistics proposes to save money by stopping the collection of statistics in areas vital to public health. It isn’t just penny-pinching, its more sinister.

It just so happens that ‘Lynton Crosby’ has been in the news all weekend. He is Prime Minister David Cameron’s election campaign strategy manager, except the campaign won’t be starting just yet – there’s two years to go.

So, Crosby hasn’t given up the day-job – he’s a big fish in the P.R. pond. He set up ‘Crosby-Textor’ (guess who the ‘Crosby’ is) A.K.A. ‘CTF Partners’ and a lucrative business it is too. He’s going to hang on in there as long as he can.

It’s just that we don’t know for sure who his clients are. Every day we get a little leak or two – plainly the other fish in the PR pond are a bit jealous of the access he’s got to the PM.

One of CTF Partners clients is the U.S. based multi-national Phillip Morris, who sell cigarettes. Is it co-incidental that the governments declared policy of outlawing branding of cigarette packets has been quietly dropped? Research indicates that removing branding makes smoking far less attractive.

In the Guardian today, it was revealed that another client is the ‘H5 Private Healthcare Alliance’. The Guardian got hold of a slide presentation advising the sharks of private healthcare how to promote themselves  - to the Public, to the NHS and to the Government. Also how these predators can take advantage of the new NHS regime – for profit.

‘H5’ hasn’t been around too long – it was set up in December 2010, just before the Governments Health and Social Care Bill was published. This ‘reform’ of the NHS abolished the Primary Care Trusts and the safeguards they were required to uphold and replaced it with local Commissioning groups.

‘H5 has been extraordinarily successful on behalf of the fat-cats of private healthcare. As a result of their lobbying behind the scenes, there is now a requirement that the provision of all NHS services must be put out to tender – that not only opens up the whole of the (profitable) parts to private control but it leaves a nice option to the private sector; they can ignore the unprofitable, difficult and downright dangerous jobs they don’t want.

Anytime a plum service they did want is commissioned to the NHS, they can take the commissioning group to court. Nice work if you can get it – the NHS just can’t compete.

I decided to take a look at ‘PR Week’s’ PR and Public Relations news which is always a well-thumbed read in this household.

“Alex Deane, head of public affairs at Weber Shandwick, has worked with Crosby previously…called on Crosby to take ‘a leave of absence’ from his firm to dedicate himself to the Conservative role full-time, to help silence questions over undue influence.

Another critical step, he added, was for Crosby’s agency to declare his clients. ‘As agencies we all declare our clients through the APPC and PRCA as we believe in transparency, and it’s not helped Crosby’s case that they have not declared theirs. Transparency would help salvage the situation and lance the boil.’”

Chance would be a fine thing.

Plainly, all the other PR fish are panicking that CTF will get all the best clients because they will have gained the ‘mistaken’ impression that Crosby will be able to lobby on their behalf with the PM.

So anyway, this Blog would also like to see CTF’s list of clients – would it by any chance include some Alcohol producers or those in the entertainment and hospitality industries? Because the long touted government policy of ‘minimum pricing’ for alcohol, which would have improved public health by reducing binge drinking, has also been quietly dropped.

Remember the ONS? If they aren’t collecting negative statisitics on smoking and drinking then there won’t be any bad health news in the years to come and no more irritating calls to make smoking and drinking less attractive.

Ker-ching.

Neil Harris

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

Monday 22 July 2013

Keeping count.


When America and Britain invaded Iraq in 2003, the armies made two decisions which allowed them to manipulate the news.

First they didn’t allow independent journalists in unless they were approved and ‘embedded’.

Secondly, civilian deaths always look bad so they decided that they wouldn’t keep count.

Controlling the journalists and controlling the statistics allowed them to control the news.

On the 11th July, the Guardian newspaper got hold of an internal letter from the Director General of the Office of National Statistics, with a ‘restricted’ annex setting out proposed cuts to 23 areas of statistics, currently collected by the ONS.

Here is a selection;

Alcohol.

Smoking

Teenage Pregnancies

Infant Mortality

Cancer Survival statistics

‘Healthy’ Life Expectancy figures

Reducing the coding and analysis of cause of death data to the legally required minimum.

 

I’m not the first to point out that these are all areas where this country comes out very badly compared with similar European countries.

These are all figures people need to make sensible decisions about their lives.

They are building block figures for health authorities and professionals looking for clues to causes of death or illnesses.

They are all politically sensitive.

Good statistics save lives and fuel developments in medicine.

Or by removing the source of embarrassing news, you control it.

Neil Harris

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

Thursday 18 July 2013

Exclusive - you read it here first!


VHOLD THE

    FRONT PAGE !

 

There’s no messing about on this site – back in May I applauded the BBC in researching and publishing the list of ‘Never Events’, that’s where hospitals mess up in ways which the NHS has indicated should never happen – they are unnecessary and preventable. I put the figures into an easy to read form and republished them. I also highlighted the ‘bottom 21’ as a real cause for concern and I picked out Barts as a trust that should be investigated. Here’s what I wrote back then;

 

 

 

“My own ‘Lantern Rouge’ (that’s the Tour de France prize for finishing last) is because I’ve picked out the two separate entries for ‘Bart’s’;

Barts & The London NHS Trust 8

              Retained foreign object post-operation 4

              Wrong site surgery 2

              Misplaced naso-or oro-gastric tubes 2

Barts Health NHS Trust 11

               Retained foreign object post-operation 4

               Wrong site surgery 3

               Misplaced naso-or oro-gastric tubes 2

               Wrong implant/prosthesis 1

               Air Embolism 1

and I did so because Barts Health was formed on 1 April 2012 by the merger of Barts and the London NHS Trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust.

For starters that means that St Bartholomew’s may have had its figures split in two and actually had 19 ‘never happen’ incidents over that four year period which is seriously worrying. Even more worrying is that the newly combined Trust – the four hospitals together- seems to have had 11 incidents in just under a year (2012/13).

If you want to get really frightened, add up the number of incidents over the four hospitals for those four years – it’s a total of 27. Or is there duplication in these figures? Have they tried to separate the new from the old, producing double counting? I hope so – mind you where the NHS is concerned the problem is usually undercounting problems.

Either way, it’s not what I would call a centre of excellence.

So if Barts it isn’t being investigated right now, it’s time it was.”

 

That was two months ago. This is from today’s report from the ‘London Standard’;

“An inquiry was ordered today at Britain’s biggest health trust in response to the deaths of 28 patients due to medical blunders last year.

 Barts health trust — which runs six London hospitals — was declared at “high risk” of failing patients, with major concerns about delays in cancer care and hundreds of emergency cases readmitted for further treatment.

The inquiry was ordered by England’s new Chief Inspector of Hospitals, Professor Sir Mike Richards, in his first day in the job. It comes after Barts last night said it was calling in financial trouble-shooters to address a £93 million debt.

Sir Mike was alerted by whistle-blowers, patient complaints and key measures indicating the performance at Barts was markedly worse than the national average. This included 10 “never events” — things that should never happen in surgery — involving seven cases where swabs were left inside patients, two cases where the wrong teeth were removed and one where the wrong eye implant was inserted.

 

Barts also admitted 348 serious incidents in 2012/13, including 129 at The Royal London Hospital in Whitechapel, and 105 at Whipps Cross in Leytonstone. Of these, 28 resulted in death.

 

 

The investigation — one of four announced into London trusts — is a setback to Barts’s hopes of becoming a self-governing foundation trust by 2016. Fifteen months ago Barts took control of Newham and Whipps Cross hospital trusts to become the biggest NHS trust in Britain, and the busiest A&E service in London with more than 6,000 attendances a week. Sir Mike said: “There is too much variation in the quality of care patients receive — poor hospitals will need to up their game and learn from the best. I will not tolerate poor or mediocre care.” Barts is preparing to axe up to 1,000 vacant posts and move overlapping services to single sites in a bid to save cash.

It has been hamstrung by private finance initiative costs of about £115 million a year for the new Royal London site; a fall in patient numbers; and an £8.5 million redundancy and redeployment bill for 112 staff axed following last year’s merger. It has also had fines for leaving orthopaedic patients to wait more than a year for treatment.

The other London trusts being investigated are Barking, Havering and Redbridge; Croydon; and South London Healthcare.”

Remember, you read it here first.

 

Neil Harris

(a don’t stop till you drop production)

 
Home:  helpmesortoutthehs.blogspot.com