Wasteful class commissioning.

One of the terms we have not heard banded about for a while is world class commissioning (WCC). What is that you may ask and how does it affect my healthcare? A good question and the answer is it was a buzzword used by those who might have been close to the top of your school’s remedial classes in order to make them sound clever.

You would have thought that such intellectuals who were destined to run PCTs would have used their WCC skills to ensure that public money was well spent and maximize tax payers’ investment. Unfortunately they were not at the top of your average Northernshire comprehensive school’s remedial classes for those brighter than them will either be guests of her Majesty or rubbing their hands with greed for they could spell two 6 letter words a week, instead of the one 5 letter word a week needed to be a world class commissioner of healthcare, and they went into the private sector.

A small piece shows how well the WCC remedials have done in out foxing the private sector. If you cannot sleep well at night we suggest you download the full accounts from here but we do warn you if you are on a NHS N3 connection the massive size of the download (10Mb) could cripple your practice computer system for days.

Just look at the costs on these world class commissioned projects and in particular the weaselly words that describe world class crap. They are under the heading of 31 Losses and Special Payments and other Accounting notes p133 using Adobe reader (128 using account page numbers) and subdivided into the following headings:

Claims abandoned.

The National Decontamination Programme (was that ethnic cleansing or some other form of NHS cleansing for example ward cleaning does anyone know what it actually is?) has written off £ 1,125,841 on two schemes as neither was able to complete its procurement due to insolvency on the part of the preferred bidder.

Excellent even those just retarded enough to be involved in WCC don’t have enough fingers to work out the difference between positive and negative. No doubt their betters in their remedial class will know where the £ 1.25 million has gone or the money needed to run a 10000+ patient GP practice for a year has just gone puff the magic dragon into thin air.

Store losses.

Emergency Preparedness Stockpiles which we are sure that all GPs and hospital doctors will have ready access to in the event of “accidental or malicious release of chemical, biological, radiological or nuclear agents.” This is an understandable mere £ 30,948,109. Anyone know where the current stock is kept just in case we need it?

Pandemic Flu Countermeasures Stockpile The department wrote-off £59 million in relation to counter measures held for the pan(ic)demic flu preparedness (another one for the bingo card) that have now passed their shelf life. An interesting phrase which could be translated as completely useless products.

Fruitless losses.

£ 8 million pay off to a private firm to terminate an ISTC contract. Seems a lot when the cost of ammunition to terminate international terrorist leaders is pence. Still someone will be laughing at the taxpayers’ expense and be assured that as this was at the request of NHS London which was responsible for the management of the contract there will have been plenty of WCC to account for this loss but not to make it good.

Constructive losses

E-learning for healthcare. Bet you knew nothing about this one but following a review of capital projects a decision was made not to allocate further capital to E-learning projects and 20 were cancelled at a loss of £ 6.1 million which cannot be recovered. We can think of plenty of other E-something projects that could do with going the same way.

Look at the recovery of loss recorded in 2009-10. A loss of £ 79.2 million in 2009-10 was reduced by £ 13.7 million because someone found the paperwork. Given that WCC is nothing more than paperwork how could someone not have the relevant paperwork for storage of anti flu drugs to the tune of £ 65.5 million?

There are plenty of other little bits to delight you in this 154 page document try p22(18) and see how much per head your region costs the tax payer, how much cars cost for certain senior doctors and managers p51(47), how much certain senior doctors and nurses got as salaries p53(49) and in pensions and lump sums p54(50) together with DoH expenditure to organizations which certain individuals have connections with p135(131).

Look at the end of the article to see how little politicians understand the health service that they, and they predecessors, have created and seek to improve using the Tripartite market model. The person quoted here is none other than health minister Simon Burns the italics are our additions:

“All these payments relate to contracts signed under Labour (we will do it so much better), who gave the private sector preferential treatment in the NHS (so we won’t of course do that just any willing provider). The contracts were overpriced and the delivery often inadequate.

Our Health and Social Care Bill introduces safeguards that will stop (encourage) this, whilst ensuring that patients are given the best (most expensive) choice of a wide (more limited) range of (privately provided) services (completely similar to the ISTC contracts but with different names).”

Praise be to the Party for ensuring that in the United Kingdom no-one is too thick to fail as there is always NHS management. You cannot fail there either for gross incompetence is always rewarded with success albeit it at the penalty of a sideward promotion and a healthy pension.

And there is more of the same coming our way very soon.

Some ghastly reading about the past and perhaps a ghastly glimpse into the future?

While thrashing our Ferraris into work one morning this week one of us was listening to the news and heard the newscaster say that the PFI (Private Finance Initiative) used by the previous Party to build new hospitals is going to land up costing 6 times more than if the same hospitals had been built directly by the State. Even the Daily Mail have noticed this one.

No surprise there as if you have the money to build a house you do not usually take out a very expensive loan for the same amount to build something and then pay interest on it for years to come.

Unfortunately political dogma is usually not very intelligent, has badly impaired tunnel vision and if you are the Party in charge always wins over reason and rational argument until you lose power.

Nothing new here for this triumph of dogma over reason and logic has been going on for centuries just think of Galileo and the Catholic Church as an example.

Another piece of news that is hardly surprising is the frontpage article on the front of the GP magazine Pulse which we can link to but you now have to register to read it in full.

Local commissioning has cost practices thousands being paid to local consortiums which have produced no savings, no redesigned services and are effectively lapdogs to the local Soviets (PCTs) who block everything as they strive to cling onto power as the axe hangs over their heads.

We suspect that this loss of funds from frontline general practice, with few exceptions, will be the case in most places that practices are paying out money but getting nothing back for themselves and more importantly diverting money from patient care for the purpose of political dogma.

And what of the future? Well, unless someone pulls an all mighty great surprise of a white rabbit of healthcare Utopia out of a hat, we suspect that in 5 to 10 years time similar articles will be being read on the news and being read by a new generation of GPs.

People forget that in order for “markets” to work people have to make profits and customers have to pay for services.

A state run scheme one would hope will break even but, to do the same job and make a profit, will always cost more unless, of course, the state run scheme is such an incredibly inefficient dinosaur of an organization, in which case efficiency savings, sorry comrade reader, efficiency gains, would yield massive profits to the private sector.

Unfortunately the involvement of the private sector inevitably increases cost. If it costs £ 100 to break even then it will cost £ 125 to run privately as Joe Privates needs something for his or her dangling their bits into NHS business.

So are PFI and commissioning, sorry, “world-class” commissioning, two examples of the old Party’s dogmatic successes and financial Prudence? Is the New Party any different?

Praise be to the Party for the reason and logic of dogma which will cost all of us so dear for years to come. And please remember the old Party did all of this dogma in times of plenty . . .

Plus ca change plus c'est la meme chose?

What does “world-class” anything mean in the NHS?

If you live and work in the NHS you will be aware that language changes as it does in the real world. There is nothing new with new terms coming in like CT or CAT scan (computerised tomography/computerised axial tomomgraphy) or MRI (magnetic resonance imaging) scans.

More recently the term MI (Myocardial Infarction or heart attack in old money) has been replaced by NSTEMI (Non ST elevation MI) and STEMI (ST elevation MI) which refer to changes in the appearance of the ECG which determine what is the best treatment for anyone suffering a heart attack.

Certain terms create confusion for example what is the meaning of STI? For some it stands for Sexual Transmitted Infection. It appeared a few years ago in A&E computer generated letters and took a while to work out what it was which is a Soft Tissue Injury.

Another is the abbreviation PID which could mean to a gynaecologist Pelvic Inflammatory Disease (the clap) but to an orthopaedic surgeon could mean a Prolapsed Intervertebral Disc (slipped disc).

So what does the NHS managers buzz world “world-class” mean when put in front of anything?

It certainly does not refer to anything from the first world. When we speak to colleagues Stateside and tell them of local “world-class” commissioning initiatives they fall about laughing and ask how we avoid being sued and how come we are so many years behind them?

It certainly does not refer to the second world which we think may now mean North Korea and possibly China.

The migration of people from Eastern Europe to the UK mean some of our biggest critics are patients from the former Eastern Bloc who can go home on a weeks holiday, get a scan and an operation done to cure them quicker than they can see a totally useless complimentary therapist in this country at a fraction of the cost. They also are better as a result of a trip to the former Soviet Union but still are waiting for NHS “world-class” care when they return.

It can not refer to the third world as patients of ours who have been unfortunate enough to fall ill overseas have all commented on how much better things there are in terms of resources and treatment and remember they have paid their National Insurance and Taxes and are getting their first world treatment from their travel insurance not their own country.

One in particular had in 2.5 hours a MRI scan, a consult with an orthopaedic surgeon and was seen by a physio quicker than their child was seen with a broken wrist in their local “world-class” A&E department.

So which world is the “world-class” world of the NHS and its managers?

Praise be to the Party for giving us the term “world-class”.

Is it the same as kids in the seventies cutting out Rolls Royce insignia and sticking it on their Choppers to make them look better than they actually are?

In fact the Chopper riding kids are now the managers . . . but they haven’t grown up yet or realized how p*ss poor and backward they still are. (With apologies for the more than usual grunt words).

World Class Commissioning League Tables

The team at ND are struggling to cope with world class commissioning (WCC) to use the jargon initials as we thought it meant something useful in medicine called the white cell count. We still do not know what commissioning is other than a means of increasing unnecessary employment of managers to do something but we do not know what.

We have been told by the local Politburo’s commissars that they are overjoyed by the fact that they are in the top ten of “World Class Commissioning” Politburos.

No doubt they will be having a street party, a Soviet style parade, a Politburo wide extra holiday for being so efficient washed down by lashings of vodka and caviar to mark their collective achievement. But hang on, what have they achieved? Well we have reported that they can commission 60+ day waits for cancer care so they must be good or “world class” commissioners but we have also seen how countries do better without WCC.

Let us go to the heart of the league table which here in Northernshire will be followed more avidly by the population than the football league tables, the two codes of rugby, ferret and greyhound racing such is the pride locally at now being in the top 10 WCCers. As our patients never ceased to be amazed at the fact that “world class” treatment is only available if they go private rather than via the local NHS you can see that WCC is a “hot topic” in the bars and coffee shops of Northernshire at this moment in time.

Here is a link to the league table. (Takes a while to load all those pretty graphics that comrade graph and table commissars like so much). We are sure that you will all want to race and see how well your local Politburo is doing.

If you have time and want a laugh have a read of the HSJ from which it was taken here.

HSJ gives you lots of ideas where NHS money goes.

You can read the scientific scoring system used to compile the table here on the PCT competency score link.

Surely we are misreading this “Incompetency Score Tables”?

Those of us that work in Northernshire think that the legend on the left should read:

Locally destroy the NHS

Work not with community partners

Disengage with public and patients

Ignore clinicians

Mismanage knowledge and access needs

Ignore investment

Market?

Discourage any improvement or innovation

Destroy procurement skills

Mismanage the local health system.

You can marvel at the fact that the three areas added up to decide the “world class” rankings (did we miss a w?) are none other than:

Strategy
Finance

Board.

SFB Virgil?

All the things that our patients consider while they are on a trolley with a burst appendix. You hear them say to each other as they wait hours for treatment because there are no beds:

“Never mind the pain comrade, our Politburo’s got a top Board.”

“But mine tops trumps yours as it is better with Strategy and Finance.”

There is no mention of medical or nursing care or provision in these league tables. We wonder why?

Now a little more critical analysis shows a few interesting things.

If you look at the first twenty Politburos in the rankings you will see that 17 of them are North of Watford Gap an area we know is bathed in undreamt of affluence.

That of these top 20 Politburos no less than 14 are “Spearhead” PCTs.

Not heard of “Spearhead” PCTs? We like the word “Spearhead”. It sounds so well tough.

Surely these will be good ones given that name “Spearhead” and at the cutting edge as would any elite military unit given the “spearhead” prefix? They would be elite troops leading any offensive from the front, right?

Well no.

"Spearhead" PCTs are those PCTs with the “worst health and deprivation indicators” including least numbers of doctors per head of population. In terms of health and deprivation they are in the bottom fifth of PCTs.

A link to a list of these is here with a nice letter explaining how good these “world class” “Spearhead” institutions are. We particularly liked the comment re life expectancies: “so the gap continues to widen, and it is widening more for women than men, in Spearheads”. Starting to see some patterns?

PCTs whose managers cannot “commission” enough GPs or adequate health care to meet their patients’ needs are now being called “world class”.

Look carefully at the list and see where your PCT is.

This is probably the best guide to save your life and give you good health care as the closer to the bottom of the list your PCT is the more likely your are to live longer. We would like to have spent more time analysing life expectancy and cancer survival rates to compare with this league table but local knowledge tells us most of the answers.

World class commissioning = world class bull =destroy/dumb down the NHS to the level of the new under class in quality healthcare provision the NHS manager who at best is 30 years of date with 2 less CSEs than one of us at ND Central has.

WCC= New Labour dumb down to the lowest and worst common denominator when it comes to health care. The World Class Commissioner.

Praise be to the Party for giving us WCC. You have been warned.

A few more funnies from the HSJ can be found here, here and here.