Wednesday, 25 August 2010

Liberating the NHS: some thoughts on the Great Patriotic White Paper 006 of 007.


Well comrades, still awake? We are now onto the penultimate battle of the Great Patriotic White Paper of liberation of the NHS entitled : “Cutting bureaucracy and improving efficiency”.

Images of the team at ND Central walking around our local Soviet with chainsaws sprung to mind at our regular resistance meeting but then we must on and read.

A short spiel on economics follows but then: “Cutting bureaucracy and administrative costs.”

We are told that the new Party’s “ . . . first task is to increase the proportion of resource available for front-line services, by cutting the costs of health bureaucracy”.

Read on dear reader for “Over the past decade, layers of national and regional organizations have accumulated, resulting in excessive bureaucracy, inefficiency and duplication”. We won’t say we told you so but just read UK General Practice and medical bloggers to see how it is.

Onto the second paragraph 5.4 which says that “PCTs – with administrative costs of over a billion pounds a year – and practice based commissioners, will be replaced by GP consortia”.

An interesting statement that which shows those who wrote it have not got a clue. PCTs = crap and expensive yes but “practice based commissioners” have cost local practices a fortune to do nothing so how does that save the NHS? And who are the practice based commissioners?

None other than the self same GPs who will be in GP consortia. And who do we think they are going to employ to do the commissioning while they do their day job? So clearly lots and lots of central Government “savings” farmed out elsewhere. Or did we miss something?

“The Department will shortly publish a review of its arm’s length bodies. . . . we abolish organizations that do not need to exist.”

Anyone need any help? Just read a few medical blogs for starters. Have chainsaw will travel.

Lots more flannel follows but in para 5.6 a small glimmer of realization “But it has rapidly become clear to us that the NHS simply cannot afford to afford to support the costs of the existing bureaucracy; and the Government has a moral obligation to release as much money as possible into supporting front-line care.”

We cannot argue that last one with the good comrade Marshals but we have a sneaking suspicion as we probe further behind the White Paper that bureaucracy is going to increase via the NHS Commissioning Board and all 150 of its yet to be announced 150 “outcomes” which we suspect will enable GP consortia to swim the 100 meters in a “record” time while weighed down with a huge millstone of bureaucracy tied around their neck from central Government regardless of any moral obligation they may feel.

At present, there are over 260,000 data returns to the Department of Health . . . we will consult on the findings . . .”

Another done deal?

“The Government will cut the bureaucracy involved in medical research”.

What does that mean it will take less than a year to get approval for a medical research project? Can you imagine Alexander Fleming advancing medical science in today’s climate? A potential yes from the team at ND Central although it does involve a “review” = another committee.

Para 5.10 scuppers out limited joy re medical research with the following words:

“We are moving to a system of control based on quality and economic regulation, commissioning and payments by results, rather than national and regional management”.

The words "payment by results" have dashed all hope as another attempt to resuscitate the long decayed corpse of the NHS internal market appears to be on the cards here.

“ . . . we are committed to reducing the overall burdens of regulation across the health and social care sectors. . . . undertake a wide-ranging review . . . with a view to making significant reductions.”

Starting to recognize the pattern? Cut costs so have a review establish a committee but then:

“The reforms in this White Paper will themselves have one-off costs. We shall ensure these are affordable . . . while ensuring funding is focused on front-line patient care.”

Which bit of the chicken and the egg did we miss here. We will spend more on the frontline but in order to do so we have to spend more money on a review. Guess which, comrade patient, will come first to you and your family? The chicken, or, the egg?

Still do not be dispirited for read the next bit “Increasing NHS productivity and quality.” It starts with the following battle winning sentence:

The reforms in this White Paper will provide the NHS with greater incentives to increase efficiency and quality:

for such words have motivated NHS staff for generations to shout the following encouraging words urging their fellow comrade workers onto victory:

On no not another set of reforms”.

Another cuddly grey box from NHS La La land follows full of patient words and pseudo market language.

Para 5.13 states the “Taken together, these ten changes will bring about a revolution in NHS efficiency.”

And so after ascending onto Mount Sinai the latter day prophets Dave and Nick (Davnic?) did descend and bring down carved on 2 pieces of silicon chip the new 10 commandments of revolutionary NHS efficiency.

Para 5.14 starts with “Enhanced financial controls” which starts with “As well as providing incentives for greater efficiency, the new arrangements will provide for greater financial control:

And is followed but a second cuddly grey box. And look who pops up yet again? The NHS Commissioning Board with yet more responsibility. This is surely going to be a very small Board at this rate of knots?

Making savings during the transition” follows on with “We will implement the reforms in this White Paper as rapidly as possible”. Always a worry as how rapidly is rapid to the political classes? “But the NHS cannot wait for them all to be in place to begin to deliver improvements in quality and productivity”.

Patients are rightly demanding the former and the national economic position requires the later”. Patient usually want to see good medical care and care bugger all about the costs as they don’t pay up front and Governments have used this fact for years to bugger up the Health Service with numerous failed reforms.

And finally on to the last 2 mammoth paragraphs of section 5. The first of these starts with a QIPP = “The existing Quality, Innovation, Productivity and Prevention initiative will continue with even greater urgency, but with a stronger focus on general practice leadership.”

Lots of buzz word bingo words follow including reference to such QIPP successes as the “productive ward programme” = how to clean out broom cupboards, “increased self care” = stop eating/smoking/drinking you fat b*stards and the use of new technologies for people with long-term conditions = more nurses in call centres. All "proven" successes from a bygone Party.

A little nod to the Greens with some “improving energy” and “working with the Carbon Trust” should see all our patients healed remotely by an energy efficiency remote access call centre which is cost neutral.

The final paragraph is good for a few laughs as it would appear that “SHAs and PCTs have a current role in supporting QIPP”. This is sounding somewhat Soviet but read on:

In discharging this, and to pave the way for the new arrangements, they should seek to develop leadership of QIPP to emerging GP consortia and local authorities as rapidly as possible, wherever they are willing and able to take this on.”

So things that are to disappear are to take on leadership and then more worryingly:

“The Department of will require SHAs and PCTs to have an increased focus on maintaining financial control during the transition period, and they will be supported in this task by Monitor, The Department will not hesitate to increase financial control arrangements during the transition, wherever it is necessary to maintain financial balance; in such instances, central control will be a necessary precursor to subsequent devolution to GP consortia.”

Someone once said “No one would remember the Good Samaritan if he’d only had good intentions. He had money as well”. So if we tell the public that GPs are in charge but in reality we maintain the ancien regime and when Johnny GP starts to try spending money we stop him via central control who will be at fault?

Does this sound familiar?

Praise be to the Party for is that last paragraph another way of saying the Party is dead long live the Party? And blame the GPs when it goes wrong for they have the “control” but we have the money?

1 comment:

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