Wednesday, 28 July 2010

Liberating the NHS: some thoughts on the Great Patriotic White Paper 003 of 007.


Recovered yet from the last chapter of the NHS “Liberation” War? It is hard work comrade and many will suffer as we fight to achieve the true liberation of the NHS Motherland on the orders of the new comrade Marshals NC/DC.

So mount up as we go onward to the second battle “Putting the patient and public first”.

Stirring words from our comrade Marshals and they should know given their collective humble upbringings about comrade Joe Public and their healthcare needs.

Don’t forget your bingo card so let us begin with the first section of this battle of liberation: “Shared decision-making: nothing about me without me”.

Notice the start of possible subtle recurring themes? “Nothing about me without me”. Seen this before?

“The Government’s ambition is to achieve healthcare outcomes that are among the best in the world. This can only be realised by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone.”

Sounds good a bit more flannel and then:

“But compared to other sectors, healthcare systems are in their infancy in putting the experience of the user first”.

They certainly are for when you are a politician or a manager who might speak to one or two patients a week, if they are lucky, in one of their “surgeries”, see how much time they spend listening to the experiences of the user.

If you guys came and spent a couple of weeks in an A&E department, a general Practice surgery and an acute hospital admissions unit you would realize why. For none of your advisors have ever been there. The troops on the ground know what the problems are there and their managers and politicians ignore them or deny them.

Still we know when grunts and patients on the ground complain that there is no ammunition,beds or nurses there will be more pearl handled sidearms for the managers as a result.

They will look into the problems, do nothing and pat themselves on the back for doing so well.

“The new NHS Commissioning Board will champion patient and carer involvement, and the Secretary of State will hold it to account for progress. In the meantime, the Department will work with patients, carers and professional groups, to bring forward proposals about transforming care through shared decision-making.”

Not the NHS Commissioning Board again? Its responsibilities mushroom every few paragraphs. How will it cope? Is the buzz word “champion” the same as the word “ignore”?

Shared decision-making” is that the same as more "consultation exercises"?

Onto “An NHS Information revolution”. More good Soviet top down words here “revolution”. Jo S would be so proud of his new boys.

Information is not knowledge or experience. You can read a book on how to drive a car, fly an airplane but still that is theory. Information in isolation is not experience or necessarily how to do something.

“The Government intends to bring about an NHS information revolution to correct the imbalance in who knows what. Or aim is to give people access to comprehensive, trustworthy and easy to understand information from a range of sources on conditions, treatments, lifestyle choices and how to look after their own and their family’s health.”

That paragraph is clearly written by someone who has never worked in frontline healthcare as you would be amazed by just how much information, and disinformation, is out there. Just try listening to patients. Information is not the problem, quality care is.

Read on:

“The information revolution is also about new ways of delivering care, such as enabling patients to communicate with their clinicians about their health status on-line. We will provide a range of on-line services which will mean services being provided much more efficiently at a time and a place that is convenient for patients and carers, and will also enable greater efficiency”.

Now we like technology, well some of us do here at ND Central, and have had a Eureka moment after reading that paragraph.

For example: why not let surgeries and patients book hospital appointments on line and call it Choose and Book?

Or why not let patients be able to ring a call center 24/7 to discuss their symptoms and let us call it NHS Direct?

All examples of centrally imposed NHS IT driven efficiency? Excellent bring it on (line) we love progress. All of the above ideas have been tried, failed increased GP workload and patients hate them. They want to see real doctors and nurses.

Spend more to achieve less? Been there done it and all we get is more “efficient” square wheels.

We bet no-one in frontline healthcare wrote that pile of smoking dung which smacks of something repeating itself comrade for the clear “benefit” of the comrade patient.

“Information generated by patients themselves will be critical to this process, and will include much wider use of effective tools like Patient-Reported Outcome Measures (PROMS), patient experience data and real-time feedback.”

Amazingly frontline healthcare professionals like doctors and nurses already do this on a daily basis with no fancy initials and without having to go to a PROM.

It is called talking to, listening to and learning from patients.

If several of them say to you “I have seen surgeon Y and they were crap”, and they have complications you can report this and nothing happens.

You then stop referring patient to that surgeon and thereby improve healthcare without involving useless management “tools” and abbreviations.

Read on and see that the rise of data collection management via already failed methods e.g. patient experience surveys and real-time feedback which results, as it does now, with patients being completely ignored.

Imagine a health service manager listening to Ferdinand Magellan saying “I have sailed round the world?” He would have been told his metrics did not meet the patient experience survey results and therefore the world was still flat.

Read paragraph 2.8 in its full but only if you are having difficulty sleeping and want a laugh. Look at the last sentence and what we said 2 paragraphs above.

The last sentence says “The Department will seek views on how best to ensure this approach is developed in a coherent way”.

Not that difficult but you might have to start by talking to people who probably already have the information you want for the first time.

Paragraph 2.9 starts with “Information will improve accountability”.

We think you can ignore the rest of that long paragraph as historically whistleblowers who point out something is wrong have been persecuted. We respectfully draw your attention to this site (slow to load).

We see only the creation of more useless and expensive management who will be unable to see a Gulf of Mexico sized oil spill on a sheet of A4 paper even when someone tells them “there is something seriously wrong here”.

More information about commissioning of healthcare will also improve public accountability”.

And who’s going to provide this?

The GPs who are being GPs now, who will soon be working on commissioning, and also having to produce reports about their commissioning, or possibly a new type of manager to improve accountability?

In another little cuddly grey box there are a few more bits of common sense that have been frequently ignored. It says that “In future, there should be increasing amounts of robust information comparable between similar providers on:

Safety with no doubt added matron power for example about levels of healthcare-associated infections, adverse events and avoidable deaths, broken down by providers and clinical teams.

Effectiveness: for example, mortality rates? does this mean deaths possibly on a ward by ward basis to not doing . . . and patient-reported outcome measures. Is that another tacky stretch limo trip to a local PROM or are we just thick up North?

If you are concerned regarding the liberation of your own personal medical details, a keystone to the doctor patient relationship for centuries, then hold on to your hat for the Parties of the individual are about to possibly show their commitment to you.

Paragraph 2.11 starts benignly enough:

“We will enable patients to have control of their health records. This will start with access to the records held by their GP and over time this will extend to health records held by all providers. The patient will determine who can access their records and easily be able to see changes when they are made to their records. We will consult on arrangements, including appropriate confidentiality safeguards, later this year”.

Sound familiar? Looks like the online transfer of medical records will continue even though it is totally unnecessary for the treatment of patients and will cost a bomb.

2.12 “Our aim is that people should be able to share their records with third parties. . . .We will make it simple for a patient to download their record and pass it, in a standard format, to any organization of their choice.”

But then the next paragraph shows the underlying reason for NHS computerization of records the “Making aggregated, anonymised data available to the university and research sectors . . .” and how long before the private sector gets its hands on all this information and exploits it? Think it hasn’t already been doing this for a while? Click this link.

Ask your doctor if you have given your consent to take part? And Big Brother wants more.

There will of course be robust safeguards “. . . to protect personally identifiable information. We will consider introducing a voluntary accreditation system . . .”.

Patients and carers (and hackers?) will be able to access the information they want through a range of means . . .”

Now we would not suggest that Big Brother is going to become bigger just read further:

We will ensure the right data is collected by the Health and Social Care Information Centre to enable people to exercise choice.”

Old Party out New Party in, spot the difference? Déjà vu? NHS IT looks like it is going to get bigger like it or not. And it continues in a similar vein until the excitement of “Increased choice and control .”

Are we having another flash back here? The choice word again but here with the control word. New Party same as Old Party for they admit that “The previous Government made a start on patient choice . . .”.

It certainly did it, denied it par excellence. You could have any choice as long as it was that chosen for you by the local Party and its commissars.

Of course the implication is that the failure of choice is the GPs’ fault “just under half of patients recall their GP has offered them choice”. Could this be because there was no choice or is that people don’t remember much?

Can you describe what your other half is wearing today? Try it, it might be important if there were to be a disaster and you would want to try and identify someone over the phone. Were they wearing their pink or grey shirt with their jeans or where they wearing slacks? Try it.

There is another little cuddly grey box full of nice things a bit like a child looking in through a sweet shop window at lots of nice things but knowing also that nice things are expensive. “You can even register with any GP practice with an open list without being restricted by where they live.” Familiar?

Another long boring paragraph but alarm bells ring when the words “. . . maximising use of Choose and Book.” Why? This is centrally controlled denial of Choice by morons who claim you have a choice.

Talk about resuscitating dodos, we have said before no-one writing this White Paper has been in Front Line medicine for decades.

The previous Government recently started a programme of personal health budget pilots. International evidence, and evidence from social care, shows that these have much potential to help improve outcomes . . .”

In other words if you have to pay for something you might not use it so much but read on:

“ the Department will encourage further pilots to come forward and explore the potential for introducing the right to a personal health budget in discrete areas such as continuing care.”

We like the word “discrete” Does that mean a wad of twenty pound notes in a plain brown envelope passed under the desk to a patient with a certain illness? “Don’t tell anyone I am giving you this money or they will all want it.”

“We expect the choice of treatment and provider to become reality for patients in the vast majority of NHS-funded services by no later than 2013/4. The NHS Commissioning Board will have a key role . . .”

Haven’t we already had “choice springing out of our eyeballs? And the NHS Commissioning Board following the end of the SHA/PCTs how are the 5 lowly paid members of this board going to be oversee yet another task?

Onward comrades, and remember this is a hard war of liberation, to the next section. Stay awake for we would hate for our NHS to be overtaken by evil Soviet forces called Government so let us rally and read “Patient and public voice”.

Sounds so lovely but Uri do not listen to your sergeant when he says no-one listens to the patient or the public voice.

But onwards we must not tire for the good comrade Marshals ND/DC say:

“We will strengthen the Collective voice of patients, and we will bring forward provisions in the forth coming Health Bill to create Health Watch England, a new consumer champion within the Care Quality Commission.”

In the same way that criminal gangs introduce their own street speak so does any new Government possie introduce a whole load of ghetto speak like this possibly more quangos:

“Local Involvement Networks (LINks) will become the local Health Watch, creating a local infrastructure, and we will enhance the role of local authorities in promoting choice and complaints advocacy through the Health Watch arrangements they commission”.

Presumably under the Big Society all these new organizations will be staffed by local volunteers?

Brace yourselves comrades for what follows may be a work of fiction para 2.26:

“All sources of feedback, of which complaints are an important part, should be a central mechanism for providers to assess the quality of their services. We want to avoid the experience of Mid-Staffordhsire, where patients and staff concerns were contunally overlooked while systemic failure in quality of care went unchecked.”

The words bull and excrement come to mind and if you want to see how this works in practice check out the Ward 87 blog. There is a lot there regarding events in Staffordshire and it will take a lot of time to read but it is very enlightening.

Still it might all get mentioned on the “Local Health Watch” TV program investigating crimes against local health care.

Skip the cuddly grey box it is merely brown and smelly and another layer of bureaucracy to replace the SH/PCTs that will disappear.

And at long last we reach the end with a nice little “onion” picture of the new cuddly NC/DC version of healthcare for the future.

Praise be to the Party for once again putting the patient first behind the Party and all its new quangos. Are we just dumb oop North or have we just had a mega déjà vu moment from Za Nu labour in terms of health policy?