Tuesday 30 December 2014

Overpaid NHS Mangers - can anyone be worth £600,000 a year?



I’ve been monitoring the huge amounts of money paid to NHS Managers in past articles; here is another Daily Telegraph investigation.

Of course what would be interesting would be to compare the biggest salaries with the quality of treatment in the NHS Trust – I doubt there is any benefit from overpaying managers.

Quite separately the NHS itself has released a study which indicates that NHS mangers are using outdated and inefficient methods which indicates that these payments are unjustified.

Far worse; failure is never punished – they just leave and grab another NHS job somewhere else.

Of course….we are paying for all this.

Oh and care workers who do the real work are earning between one twentieth and one fortieth of these fat cat salaries.

 

Telegraph.co.uk

Tuesday 30 December 2014

The rise of the £300,000 NHS fatcats
 

Investigation discloses doubling in number of NHS managers being paid equivalent of at least £300,000 a year, with some on as much as £620,000 annually

NHS trusts said the payments were justified to secure “high calibre” expertise at short notice.

 

By  Laura Donnelly, Health Editor

 

10:00PM GMT 27 Dec 2015

The number of NHS managers being paid the equivalent of more than £300,000 a year has doubled in just 12 months, it can be disclosed.

In some cases, cash-strapped health trusts are hiring temporary executives for hundreds of thousands of pounds, an investigation by The Telegraph has found.

Patients’ groups said the “exorbitant” rates could not be justified, and nursing leaders said the sums were a “kick in the teeth” for junior staff who were refused a one per cent pay rise.

NHS board reports indicate that during 2013-14, 44 “interim” executives were employed on rates of £1,000 a day — the equivalent of £228,000 a year — compared with 24 the year before.

There was an even sharper increase at the top end of the scale. In the last financial year, 22 executives were paid the equivalent of at least £300,000 a year — compared with 11 the year before and just four in 2010-11. In most cases, the payments were not made directly to the managers, but via agencies, which were able to take a share.

 

Meanwhile, NHS finances spiralled out of control, with trusts running up a combined deficit of £500 million, before the Government announced plans to spend an extra £2 billion next year on the NHS.

 

Rotherham Foundation Trust paid the equivalent of £621,000 a year for the services of Michael Morgan as chief executive. Mr Morgan worked for Rotherham trust for 10 months, until last November.

Accounts for eight of the months show payments of £380,000 plus expenses — the equivalent of £621,000 over 12 months, a sum that would cover the salaries of 28 nurses.

NHS trusts said the payments were justified to secure “high calibre” expertise at short notice.

But the investigation found some managers stayed in post for more than a year, on rates worth far more than the Prime Minister’s £142,500 salary.

Peter Reading was paid £405,000 to be chief executive of Peterborough and Stamford Hospitals Foundation trust. He left in June, after almost two and a half years. Several of the organisations which hired executives at high rates faced major problems.

Colchester Hospitals foundation trust, which last month told patients to keep away from A & E unless their condition was life-threatening, hired two temporary executives, Kim Hodgson and Evelyn Barker, on rates of £387,000 a year during 2013-14.

Medway foundation trust, recently named as having one of the worst A &  Es in the country according to patient surveys, paid Nigel Beverley rates of £1,740 a day until he left just before an inspection found A &  E in a “state of crisis”.

Some individuals saw their pay rates soar. In 2010, Ian Miller was the highest paid NHS manager in the England, earning £310,000 for nine months’ work for the South East Coast Strategic Health Authority in 2009-10 — which equates to £400,000 a year.

Last year he was paid £251,000 for five months’ work as director of finance at Maidstone and Tunbridge Wells — the equivalent of £602,000 a year.
 
In 2012, the NHS said senior managers should not be employed “off payroll” — often through an agency — except in exceptional circumstances that should never last more than six months. But the 10 highest earners were all employed off payroll, in some cases through companies they owned or controlled, and three stayed more than six months.


The payments included VAT, and there is no suggestion that any individuals were using their off-payroll status to avoid paying tax or national insurance contributions.

Others moved from trust to trust, often commanding the same high rates while keeping within the “six-month” rule.

Although trusts do not have to pay national insurance and pension contributions for managers who are off payroll, in some cases they have paid significant expenses.

Rotherham paid £7,000 a month to cover the expenses of Mr Morgan and two colleagues paid via a consultancy firm, amounting to an extra £84,000 a year between the three.

Katherine Murphy, chief executive of the Patients Association, said the spending was “unacceptable.” She added: “Investment is urgently needed on the front line.”

Dr Peter Carter, chief executive of the Royal College of Nursing said: “For sums this large to be spent instead on paying temporary managers is a kick in the teeth to nurses and a blow to patient care.

 

Rotherham trust said the majority of those it hired on an interim basis, including Mr Morgan, were no longer working for the organisation.

A spokesman added: “The majority of board members who were on the Board 18 months ago when the contract was awarded, are no longer working for the trust; this includes the chief executive and chairman.”

Maidstone and Tunbridge Wells said the sums paid to Maxentius specialist financial support, which provided Mr Miller’s services, “provided independent financial expertise that was essential in helping the Trust achieve £23.5 million in efficiency savings last year without impacting on patient care”.

Peterborough and Stamford Hospitals said payments for Dr Reading’s services did not include any provision for pension, holiday pay or sick pay adding that the trust was not able to recruit a permanent candidate at the time.

Colchester Hospital foundation trust, which has been in special measures since October 2013, said its exceptional circumstances required “outstanding leaders with the right skills and experience.”

Monitor, the regulator for foundation trusts, which was responsible for the appointments to Medway, said trusts with failing leadership sometimes needed to appoint senior staff on an interim basis.

 

The paychecks:

 

Michael Morgan chief executive, Rotherham Foundation Trust

Payment during 2013/14: £380,000 plus expenses to work 7 months, 3 weeks

Annual equivalent: £621,000 including expenses

 

Ian Miller, director of finance, Maidstone and Tunbridge Wells Trust

Payment during 2013/14: £251,000 to work 5 months

Annual equivalent: £602,000

 

Peter Reading, chief executive, Peterborough and Stamford Hospitals Foundation Trust

Payment during 2013/14: £405,000 to work all year

 

Antony Sumara, chief executive, Royal Bolton Foundation Trust

Payment during 2013/14: £105,000 to work 12 weeks

Annual equivalent: £399,000

 

Nigel Beverley, chief executive, Medway Foundation Trust

Payment during 2013/14: £40,000 to work 7 weeks - trust said he was on daily

rates of £1,740

Annual equivalent: £397,000

 

Kim Hodgson, chief executive, Colchester Hospitals Foundation Trust

Payment during 2013/14: £95,000 to work 11 weeks

Annual equivalent: £387,000

Evelyn Barker, chief operating officer, Colchester Hospitals Foundation Trust

 

Payment during 2013/14: £95,000 to work 11 weeks

Annual equivalent: £387,000

Jon Scott, chief operating officer, Kettering General Hospital Foundation Trust 

 

Payment during 2013/14: £135,000 to work 4 months, 1 week

Annual equivalent: £383,000

 

Colin Gentile, director of finance, Dartford and Gravesham Trust

Payment during 2013/14: £185,000 to work 6 months

Annual equivalent: £370,000

 

Bill Boa, interim director of finance, Burton Hospitals Foundation Trust 

Payment during 2013/14: £134,000 to work 6 months

Annual equivalent: £368,000

 

All figures taken from trusts’ annual reports and other documents.

Rotherham Foundation Trust paid an additional £7K a month for expenses for Mr Morgan and two colleagues: a third share of this has been included in calculations of his yearly cost to the trust. 
Neil Harris
(a don't stop till you drop production)

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Saturday 27 December 2014

Is it better to be ill when the senior Doctors are all away?


I thought I’d reprint this excellent and amusing research study reported in Ars technica which is a very good technical website and well worth looking at.

It’s Christmas nonsense but given the problems I’ve had with some Doctors it made me laugh.

I’ve put the simple explanation for this at the end of the reprinted article;

Ars technica

When the doctor’s away, the patient is more likely to survive

Deaths due to heart problems drop during major cardiology gatherings.

by John Timmer - Dec 26 2014

 

"Don't get sick on a weekend." That advice is also part of a title of a research paper that evaluates the fates of patients who go through the emergency room on a weekend. These patients are more likely to die. It's just one of a number of studies that suggests patients who enter the hospital while the staffing is lower or the staff more relaxed end up with worse results.

 

But the precise cause of this enhanced weekend mortality has been hard to determine; is it the reduced staff, a more leisurely approach to care, or some other factor? To try to get at the cause, some researchers obtained records of heart patients who had a critical event during a time when hospitals were at full staff, but heart specialists were likely to be out of town. Unexpectedly, they found that the patients did significantly better when the relevant specialists were unavailable.

 

The study relied on medicare records to track patients that were admitted to a hospital with a serious heart condition: acute myocardial infarction, heart failure, or cardiac arrest. The key measure was simply whether the patient was still alive 30 days later.

 

That may sound simple, but the rest of the analysis was remarkably sophisticated. To figure out when heart specialists were most likely to be present at hospitals, they selected two large cardiology meetings: the American Heart Association and the American College of Cardiology, both of which attract over 10,000 participants. Patients admitted during the meetings were compared with groups admitted three weeks before and after. Reasoning that researchers are more likely to attend these meetings, they analyzed teaching hospitals separately from regular ones.

 

As additional controls, they checked a number of additional meetings for oncology, gastroenterology, and orthopedics specialists. They also looked at the impacts of additional critical injuries, like gastrointestinal bleeding and hip fractures, as well as non-critical cardiac problems.

 

In total, there were tens of thousands of patients involved. And the trends were clear. At teaching hospitals, the rate of death after heart failure was 24.8 percent on non-meeting days. While the cardiologists were out of town, it dropped to 17 percent. A similar trend was apparent with cardiac arrests, where death rates fell from 68.6 percent to 59 percent while cardiology meetings were happening. There was no significant difference with acute myocardial infarction patients.

 

So, having specialists in town appeared to make matters worse for patients—the exact opposite of the hypothesis the researchers set out to examine. The various controls suggested the effect was robust, and it persisted after adjusting for other potential influences, like age and sex.

 

In a press release accompanying the report, one of its authors, Anupam Jena, said "That's a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions." What could possibly be causing it? The authors consider three possibilities. First, there's something involved with the changes in cardiology staffing that occur when specialists go out of town that actually increases care. The second is that there are fewer people having outpatient or same-day procedures, given that doctors wouldn't schedule these when they knew they'd be absent. This would allow the remaining physicians to better focus care on the serious cases.

 

The final possibility that they consider is that the doctors that remain behind are more cautious about the care they give, avoiding aggressive procedures such as the use of angioplasty or stents to re-open clogged heart vessels. This would be consistent with the lack of effect in acute myocardial infarction patients, where this procedure is used less often.

 

Although their analysis can't distinguish among these possibilities, it's clear that this effect warrants further attention. Both because it's possible that the long-term survival evens out thanks to more aggressive treatment, and because we might find out that we've been acting a bit too aggressively.

Obviously, the reason why death rate falls when senior Doctors are away at conventions is very simple; these are the most experienced and senior doctors. They do the most complex and dangerous procedures and they make sure they are available to follow up operations.

When there is a convention, they reschedule difficult procedures for when they are back.

The most complex and dangerous procedures (being the most risky) are most likely to result in deaths.

Still, a bit of Christmas fun!

Neil Harris

(a don’t stop till you drop production)
 

Friday 5 December 2014

Yet more evidence of rationing in the NHS.


Yesterday, when I highlighted unofficial rationing of NHS services I could have done with the results of this major survey, reported in The Daily Telegraph today.

As you can see, age discrimination (in addition to how many other forms of discrimination?) is already here;

Age bias means elderly less than half as likely as young to have cancer surgery

 

A damning report warns of 'worrying' discrimination against the elderly, with

Young cancer sufferers more than twice as likely to end up having surgery

 

By  Laura Donnelly, Health Editor

 05 Dec 2014

Age discrimination means tens of thousands of cancer sufferers are being denied life-saving surgery, a major report has warned.

Research on more than 350,000 operations found that younger patients were more than twice as likely as pensioners to receive surgery for 19 different types of cancer.

Experts said the findings suggested a “worrying” bias against older sufferers, and expressed fear that pensioners were being denied surgery which might save their life.

They said the findings were especially important, because around half of cancers which are cured involve surgery.

The study by Cancer Research UK and the National Cancer Intelligence Network (NCIN) looked at all operations on adults in England for 21 types of cancer between 2006 and 2010.

It found that for 19 types of disease, younger patients were far more likely than older ones to receive major surgery.

Overall, those under the age of 55 were two and a half times more likely than those over the age of 75 to receive surgery across all 21 cancer types examined. In total, 59 per cent of younger people had surgery, compared with 23 per cent for older age groups. The differences were most acute for those suffering from kidney and ovarian cancers.

But the same patterns were seen in breast, lung and bowel cancer, the three biggest cancer killers, analysts said. The only two cancers where no differences were found were two types of surgery on the windpipe.

Nick Ormiston-Smith, Cancer Research UK’s head of statistics, said research suggested that patients who could benefit from surgery were being overlooked because of their age.

“These figures provide further detail about the age bias that older cancer patients face,” he said.

“We need to understand what is driving this difference. Earlier diagnosis is incredibly important and something we’re pushing for as it will mean more patients will be suitable for surgery and other treatments. But if older patients are not being offered a surgical option, that is wrong.”

In some cases, older patients may not have been well enough for surgery, or cancer might have been diagnosed late, he said, while others might have chosen not to have an operation. But the charity said the trends painted “a worrying picture” which required investigation.

Earlier this year the Royal College of Surgeons warned that in some parts of the country, no-one over the age of 75 is being offered surgery for breast cancer, while in others, few had bowel cancer surgery or knee and hip replacements.

The college's president said modern surgery offered much quicker recovery than the past, and urged older patients who felt they had been denied it on age grounds to speak "frankly" to their doctors.

The trends come despite legislation which came into force in October 2012 making it illegal for NHS staff to deny surgery to patients on the basis of age alone.

The new study found that 80 per cent of women with ovarian cancer who were under the age of 55 underwent operations to remove tumours. Among those aged 75 to 84, just 37 per cent had surgery.

Three quarters of men and women under the age of 55 with kidney cancer had operations, compared with just one in three of those aged 75 to 84.

Three quarters of women with breast cancer under the age of 55 had surgery, compared with less than one quarter of those over the age of 85.

Among bowel cancer patients, two thirds of under 55s had surgery, dropping to 39 per cent among those over the age of 85.

Clare Marx, President of the Royal College of Surgeons, said: “Age alone must not be a reason for denying patients access to surgical opinion or treatment. In the case of cancer, surgery is an effective treatment for many forms of the disease and leads to thousands of patients being cured.

"The major consideration should always be their biological state rather than their age." She said the current trends were "worrying" and must be tackled.

 

Dr Mick Peake, clinical lead for the National Cancer Intelligence Network (NCIN), said: “Surgeons take into account a number of factors when deciding whether to offer surgery to older cancer patients, such as whether the individual has other illnesses and the patient’s own personal choice.

 

“However, surgery is an effective treatment for many types of cancer and we need to ensure that patients are assessed on their individual fitness to undergo treatments irrespective of their age.”

If resources are short that means it’s time for a political debate about the resources available – in public and in the open. It’s never right to have secret rationing.

Neil Harris

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

Contact me:  neilwithpromisestokeep@gmail.com

Thursday 4 December 2014

More rationing of NHS services.


This is very disturbing, even if on the face of it, it seems perfectly reasonable; if you smoke or are obese you won’t get an essential operation done in Devon.

The health commissioning consortium is in the red and has to ‘ration’ operations. If you are in certain groups you will miss out.

It’s dangerous because health provision should be determined by need, not by virtue.

You see, if every smoker gave up they would then have to ration operations by some other means. How about age or by alcohol intake or by criminal record or by I.Q.

What about by colour?

Not such a great idea. It just shows how dangerous clever people can be when human decency goes out of the window.

OnMedica - News

CCG tightens up pre-surgery requirements on BMI and smoking

Louise Prime

Thursday, 4 December 2014

 A clinical commissioning group with predicted deficits for this year of over £14m has extended requirements on weight management and smoking before planned surgery, in order to prioritise essential services. North, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) said the temporary restrictions would help it to comply with its legal duty to live within its financial resources.

 

Last month NEW Devon CCG said it would have to take “urgent and necessary” steps to prioritise the requirements set out in the NHS Constitution. It said morbidly obese patients (body mass index ≥35) awaiting hip and knee operations would be required to attain a BMI below 35, or to lose 5% of their weight (whichever is the lesser weight loss), before planned surgery. In addition, patients would have to have quit smoking at least six weeks before planned surgery.

 

Yesterday the CCG announced further measures to allow it to prioritise essential services. It said it was temporarily extending the BMI requirement to routine surgical procedures – but clarified that this would not apply to people needing urgently or immediately necessary surgery, such as cancer surgery, nor to patients with a date for surgery. It also said it was extending the quit-smoking requirement to eight weeks before planned surgery. However, it confirmed that “at this time” it would not be restricting in-vitro fertilisation or caesarean sections on medical grounds.

 

The CCG also agreed temporary changes to: its choice of drugs to treat wet age-related macular degeneration; shockwave therapy for tendon problems and bursitis; restrictions on certain types of shoulder surgery; restrictions on removal of earwax in hospitals; treating cataracts in each eye separately; and restrictions on additional hearing aids. It said it expects to announce further measures “in due course”.

 

NEW Devon CCG chair Dr Tim Burke said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

 

“Clinicians have carefully reviewed a number of measures, taking into account the impacts of their temporary withdrawal to decide which we will implement.

 

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”

 

The CCG said last year it returned a £14.5m deficit, and had originally predicted the same this year – but it had “gradually lost confidence” in meeting this, as demand for services is beyond what it can afford.

 

Dr Burke said: “The services we are temporarily restricting were chosen for a number of reasons … We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them. If they are able to do this it will also have long-term health benefits for them.

“We are committed to being open about what we are considering and how the decisions are being made. We are publishing our decisions and producing information for the patients affected about the available treatment options for them.”

But he said: “The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”

If you don’t have enough resources you need to fight to get the funds the people of Devon need.

Neil Harris

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

Contact me:  neilwithpromisestokeep@gmail.com

Wednesday 3 December 2014

The lastest research on Stroke treatment.


This is a lesson that should have been learnt two years ago; if you have a stroke you are more likely to survive if you get specialist treatment as soon as possible. If you have a stroke, the sooner you have specialist treatment the less severe the damage will be.

As a result, the NHS in London shut most of its stroke units (nearly every London Accident and Emergency treated strokes before). In their place came a few specialist units staffed 24/7 by qualified Doctors and Nurses specialising in the treatment of strokes.

Result? Improved outcomes for patients and a better work/life balance for staff.

This study shows what happens if you don’t do that and what the result of having too few staff is;

By Sophie Borland Health Correspondent for the Daily Mail

 

Published: 01:02, 2 December 2014  | Updated: 08:15, 2 December 2014 

 

Stroke patients are a third more likely to die if admitted to units which are

badly staffed on Saturday mornings

 

Sir Bruce Keogh, the NHS medical director, is leading a major review of how

hospitals can encourage senior staff to work at weekends.

 

It follows a series of studies suggesting that patients admitted on a Saturday

or Sunday are up to 16 per cent more likely to die.

 

But the doctors’ union, the British Medical Association, has described the plans

as ‘unworkable’ as the NHS cannot afford to employ more senior staff at

weekends.

 

Because so few specialist stroke doctors work at weekends the researchers looked at the number of nurses on wards at 10am on a Saturday.

They found the chances of stroke victims dying within 30 days of being admitted on a Saturday were a third higher on wards where there were an average of three nurses for every 20 beds compared to those with three nurses to 10 beds.

 

The few doctors who work weekends are ‘firefighting’ in A&E, and stroke patients at risk of being neglected.

NHS guidelines state there should be at least three nurses for every ten

patients on a stroke unit at all times.

 

But figures show that only 27 per cent of the 183 NHS hospitals with stroke

units have at least three nurses for ten patients at weekends.

 

Professor Rudd said: ‘Even really big hospitals have very few staff at nights and weekends and most of those are going to be firefighting admissions down in the emergency department.

‘Patients sitting on a ward – there’s less observation 20 or 30 years ago when

every ward would have had their own doctors on 24 hours a day.

 

‘When I was training, whether you were doing urology (kidneys and bladder) or

neurology (the brain), every team would have had their rota. That’s all gone

now.

 

‘In that situation, we are very dependent on skilled nurses to recognise when

someone might be on the brink of developing a chest infection or a blood clot on the lungs or any other complication that can happen with stroke.

‘If those conditions do get picked up early, they are much more effectively treated.

‘Nursing levels can make a big difference to whether or not you survive after a

stroke.’

Around 125,000 patients suffer a stroke in England every year and they cause

40,000 deaths.

The study – published in the journal PLOS One - did not calculate exactly how

many of these can be directly blamed on a lack of weekend staff.

 

Sir Bruce Keogh, the NHS medical director, is leading a major review of how

hospitals can encourage senior staff to work at weekends

The study found that the risk of patients dying within 30 days on units which

did have three nurses for every ten patients was 11.2 per cent.

 

But this rose to 15.2 per cent on units which had half the safe level of nurses

– three for every 20 beds.

Jon Barrick, Chief Executive of the Stroke Association said: ‘Stroke is an

emergency and it can happen at any time. Patients should receive specialist care around the clock and a lack of staff will mean they will suffer unnecessarily.

‘There is a considerable body of evidence showing the level of care you receive

in the first few hours after your stroke, as well as in the longer-term, can

make a big difference to your recovery.’

Dr Peter Carter, Chief Executive and General Secretary of the Royal College of

Nursing, said: ‘It’s unacceptable that so many hospitals are still failing to

make sure they have enough nurses on duty to care for stroke patients.

‘If a hospital has enough nurses in place, stroke patients are more likely to

survive and to recover.’

 

So now you know.

London’s experience is to shut stroke units and have regional units which have sufficient staff on rotas to deal with stroke patients at any time. The collegiate atmosphere produces better trained and motivated staff.

How about it?

Neil Harris

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

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