More privatisation news.

This article is from today’s ‘Independent’, it exposes government scheming to privatise the George Elliot Hospital – one of our problem trusts. I checked out its record of ‘never happen events’ which, at four is not so good but not so bad either:

George Eliot Hospital NHS Trust 4

                  Wrong implant/prosthesis 2

                  Wrong site surgery 1

                  Retained foreign object post-operation 1

There are other causes of concern – my remedy would be a management shakeout and reorganisation but what does the health secretary propose? To sell it off or give it away.

One of the front runners is SERCO, a private contractor which has been exposed fiddling the figures in Cornwall where it runs a 24 hour emergency doctor service. It got caught again when it lied about tagging bills and again making up invoices for delivering prisoners to court;

 

“The NHS has been “put up for sale” by the Coalition government, Labour have claimed, as it emerged that the Department of Health has approved the possible sell-off a district general hospital.

 

Board papers published by the NHS Development Authority (NDTA) show that the George Eliot Hospital in Warwickshire could be acquired by another NHS trust or “a franchise that may be a non-NHS organisation”.

If the hospital were acquired by a private company it would become the second in two years, after the Hinchingbrooke Health Care Trust was taken over by Circle Health in February last year.

The Health Service Journal reported that the Department of Health had been willing to see the trust begin a process that could lead to franchising, but was awaiting approval from the Treasury, which has now been granted. Andy Burnham, Labour's shadow health secretary said that the decision represented “privatisation driven from the top”.

 

“Everywhere you look, chunks of the NHS are being broken up and handed to the private sector. With this announcement, it is now proceeding at a pace and scale never seen before,” he said.

 

“Ministers have spent all year running down the NHS and their real intent is becoming increasing clear - preparing the ground for more privatisation.

 

”Far from doctors deciding, this is privatisation driven from the top down. David Cameron needs to be reminded he's never been given the permission of the British public to put the NHS up for sale.“

 

The NDTA report, authored by the organisation's director of delivery and development, Dale Bywater, said it would be ”prudent“ for services to commence with a new ”strategic partner“ at the George Eliot on 1 April 2015.

 

Hinchingbrooke Hospital in Huntingdon, Cambridgeshire, last year became the first in the history of the NHS to be run by a private company. The Circle Partnership pledged to turn around the failing 223-bed trust, which was £40m in debt. The trust received high scores in recent patient feedback tests.

 

The George Eliot Hospital NHS Trust provides hospital and community services for around 300,000 patients. The trust has been seeking a partner ”via a competitive procurement process“ for several months.

 

According to the HSJ, several organisations have indicated an interest in running the George Eliot, including Circle Health, Serco and Care UK as well as other local NHS trusts.

 

Mr Burnham has also written to the health secretary Jeremy Hunt, after it was reported that a multi-million pound contract to treat NHS patients with brain tumours was awarded to healthcare giant Hospital Corporation of America International (HCA), which has donated money to the Conservative party. Mr Burnham has asked to know what contact ministers had with HCA, which has donated at least £17,000 to the Conservative party since they came to power.”

 

Neil Harris

(a don’t stop till you drop production)

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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)

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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)

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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)

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The long wait is over.

We finally got there; lumbering ‘Sir’ David Nicholson dragged himself out of bed today, Thursday, with his long anticipated pronouncement on the future of the NHS.

There you are, you are about to retire with a big fat pension and you have a chance to be provocative before you leave – you could do some good, challenge the cowardly politicians, act as a spokesman for the poor, stick up for the staff, put forward a courageous plan, demand more expenditure for a better NHS.

Eh, no. The big plan, the brave new future – close loads of hospitals.

Is that it?

Just what the government wants?

Lazy bones wasn’t as early as I was – he is being interviewed after 8-00 am, I’m going shopping.

At 0710 am I was listening to Anita Charlesworth, chief economist with ‘The Nuffield Trust’ – normally I’m not a fan, it’s a private charitable trust with a research wing, while at the same time it is also a major provider  ‘non-profit’ private medical services. It may be non-profit but lots of people make a lot of money out of it.

Anyway, Ms Charlesworth did the right thing – she quoted Carol Propper of Imperial College, London and her study which showed that merging hospitals did not lead to greater efficiency, lower costs or better patient outcomes. It was the basis of my series ‘Merger mania’ on my other Blog and is on ‘pages’ here.

So much for Nicholson.

Of course, Carol Propper won’t be getting honoured, while I bet Nicholson will soon be a ‘Lord’ and will wander into a series of well-paid part time posts, to ease the pain of his retirement.

He is going to say that without the cuts there will be ‘many more mid-staffs hospitals’ – at which point I may need to ring 111 about my blood pressure – he was ‘in charge’ of the NHS area which brought us the mid staffs hospitals scandal.

More to follow…after Tesco’s.

Neil Harris

(a don’t stop till you drop production)  

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Happy 65th birthday, the present comes later.

OK, here’s a clue to what’s coming– I unearthed this today although it was published on Friday 5/7/13.

I had to do some checking first – it’s written by a ‘David Nicholson’ and is in The Guardian newpapers ‘Comment is Free’ section of their website, so he might have been any David Nicholson. He could have been a ‘Dave Nicholson’. Or ‘Davey’.

Actually it is the ‘Sir’ David Nicholson - he must have been adopting his ‘man of the people’ disguise for the Guardian readers. The quotes are in italics, my sour comments are in bigtype;

 

The NHS must adapt if it is to survive another 65 years

Responding to massive cultural changes is key to the NHS's future – but putting patients first must remain at its core

David Nicholson      

 

Blah, Blah, Blah…

healthcare system that is free to everyone at the point of delivery, based on clinical need, not ability to pay.

Meaningless platitudes…

The world moves on and all institutions must adapt to survive.

Excuses…

We are caring for a growing number of patients, and their needs are changing as more people live longer, many with long-term conditions. Our budget will not keep pace with rising demand

It’s all your fault really…

the expectations of our patients are changing 

No, what I meant to say was that it was the health workers fault as well…

We must ensure that in every part of the NHS we have a culture that puts patients first – no ifs and no buts

Luckily, none of it was my fault…

thousands of words have been written about the public inquiry into the tragedy at Mid-Staffordshire NHS Foundation Trust. But at the heart of the report was a simple idea: listen to patients and do something about what they tell you.

This is where the B/S/  begins…

Patient power must drive the NHS of the future.

Perhaps this wasn’t the best example …

Look at how the banking and retail industries have modernised by investing in involving their customers.

They went bankrupt and we had to spend billions to bail them out…

 We can do something similar.

It’s a D.I.Y. internet only, can’t find a human, call centre in Nepal, computer says no, no one gives a d@#n world..

We can build an NHS in which patients not only help manage their treatment, they take more responsibility for their records, booking appointments, and organising what happens.

If you think its bad now…

That could truly transform the relationship between the NHS, patients and communities.

Then again, as all the Banks are bankrupt perhaps its not such a bad analogy….

Around the world, countries are responding differently to the age of financial austerity and the rising costs of healthcare. In this country we have said: we are not going to reduce what we offer, we are not going to compromise on care being free at point-of-use, and we are not going to invest more money. So the way to square the circle is to redesign services.

No, of course that’s impossible so…

But as a nation we have a poor record at making this change happen. Too often, legitimate but competing interests collide to create inertia, which means patients do not get the care they should.

The government is wonderful… I agree with everything my bosses say….

We should recognise the commitment of the government to the NHS and its continued protection of the NHS budget. And there are two measures in the coalition government's NHS reforms which offer a way through.

I think they might be stupid enough to believe this….

Locally, the creation of clinical commissioning groups means clinicians will lead service redesign for our NHS.

The future belongs to me…..

Nationally, the creation of NHS England, independent from the government, frees the NHS to produce a long-term NHS strategy.

No more political control, no more democratic control… we can use those clever PR people to have pretend consultations so that we can do want…what we always wanted to do….

A strategy produced with the public and based not on reduction of what we offer, but on change to the way we deliver.

Because we know best what you really want, even if you think you want something completely different…

Political campaigns often cite the slogan "Save the NHS". But salvation lies in renewal, not the status quo.

What everybody wants is for you to go before your ‘vision’ does any more harm.

We want local control – by patients, by clinicians and by health workers, by democratically elected councillors, accountable to us, the electorate.

We want democratically elected governments to be responsible for the money we pay, preparing national strategies with the finest medical minds, concerned only with outcomes.

We may even want some more money spent – taken from areas where we don’t want it spent.

We don’t want grey, anonymous managers telling us what we should have.

We want Doctors running hospitals, helped by managers and not the other way round.

 We don’t want hospital trusts removed from our democracy, making money for individuals and corporations out of the taxes we pay.

And I think you should resign now and shut up for the future, ‘Sir’ David.

Neil Harris

(a don’t stop till you drop production)   

 

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Nicholson's great big plan is coming.

I’ve got that terrible sinking feeling, the one that the captain of a great oil tanker has when he can see the reef two miles ahead, he’s turned the wheel (it’s only a little knob these days) but nothing is going to turn the ship in time. It’s the lack of control that’s so depressing.

During the last few days there have been a series of articles in the press quoting unnamed ‘senior NHS managers’, and that is a code for a briefing from the head of the NHS; ‘Sir’ David Nicholson who is always described by The Daily Mail as the ‘Man with no shame’ because he won’t resign.

In my recent Blog ‘The Future belongs to us’, I pointed out how often his recent speech at the NHS Confederation referred to making major, fundamental reforms in the time he has left – outside the control of the press or politicians.

All the press briefings (senior managers) are saying that the NHS will run out of money and that fundamental reforms are needed before it’s too late. Coupled with Nicholson’s stated wish to avoid the short-termism and localism of politicians as well as his irritation with the press disagreeing with him;

We are in for a plan to shut all local hospitals, sell off the land, build huge monster regional hospitals, paid for by the Private Finance Initiative.

Everything will be a Foundation Trust – so we have no democratic control, no democratic input, and with the PFI – no financial control.

Of course we will be paying for it all.

Oh, and Sir David Nicholson ends up as Lord Nicholson of Mid Staffordshire as a reward for all the dirty work he has done on behalf of the politicians.

If we let him….

Neil Harris

(a don’t stop till you drop production)

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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)

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