Deck Chairs on the Titanic?

Will the re-organisation of PCTS make a difference?
Our old one was frequently inept and messed things up by amateur negotiation skills, inability to make decisions and poor record keeping.
The new one consists of the old one plus another even more debt ridden PCT.
The staff of the new one are virtually the same as the previous two organisations. It is difficult to see how things are going to get better (where have I heard that before?)
The newly appointed intrim PCT CEO executive said on the telephone to me that a particular consultant "was not one of those money grabbing doctors " she went on to say that she didnt like hostility or threats- I think she might be in the wrong job

Dr Disgusted - March 2006 Yorkshire Post

Dear Sir

Patricia Hewitt says it is doctors’ fault that the NHS is in financial trouble.
She says that there is “clinical resistance” to change.

Doctors pay has apparently cost more than the Government expected!
The main reason for the NHS crisis is an inept meddling Government.
Less than two years ago GPs negotiated a new contract. Two key elements were a change in our working hours and performance related pay.

The performance related pay consisted of clinical and administrative targets awarded on a points basis. The maximum achievable was 1050 points. The Government estimated GPs would achieve about 750 points on average. The average achieved was more than 900 and some achieved the maximum. This was due to hard work by doctors and their staff. This benefited patients and consequently cost the Government more, hardly GPs fault!

In regard to working hours, our commitment was reduced from 24 hours, 365 day cover to 8-6.30 Monday to Friday. We could then opt out of the remaining hours for a payment of about £7000 per annum. Most of us did this. The Government had been paying GPs very little previously for excellent out of hours cover. Now faced with market forces the cost to obtain GP cover out of hours has become realistic costing the Government more, hardly GPs fault!

In order to reach Government targets, many hospital trusts paid consultants large sums to clear waiting lists in their own time. Now with a crisis looming those same consultants have been instructed to stop seeing patients in order to balance the books on March 31. This has cost the Government more, hardly Consultants fault!.

As for clinical resistance to change, having spent many years sitting in NHS management meetings I can tell you that the resistance is largely due to the inability of NHS managers to make decisions. This is not due to the lack of able managers but to the culture of fear, poor guidance and continuous changing of direction created by central Government.

Low taxes do not necessarily mean cuts in public services

There is a great problem that politicians currently face and in particular the Conservative Party. If they say they are going to reduce taxation the public reaction is "How are you going to pay for it without cutting policemen, nurses and teachers? "The answer about cutting bureaucracy and waste does not seem to be believable. Consequently all politicians are now shy of suggesting any cuts at all.

There is much evidence that a low tax economy is a faster growing one and similarly legislation light countries have many more start up businesses. The overall tax take frequently rises with lower rates. Low income workers pay marginal rates of tax in the region of 70% so there is little incentive to work extra hours. Similarly the Government spends vast amounts collecting tax only to pay it back in tax credits. This does not seem sensible. Why not encourage people to work harder by increasing the incentive to work with rises in tax thresholds?

Another area ripe for cutting is inheritance tax. Many people of now fairly modest means are going to caught by this tax because of property values. It would be a vote winner to raise the limits. Of course any budding Chancellor will realise that although relatively small beer now inheritance tax revenue will soar in years to come.

I feel public opinion has been swayed by continual spin from this Government about tax cutting making it a no -go area at a time when the economy might benefit.

Is the NHS safe in politicians hands - GP magazine

IS THE NHS SAFE IN POLITICIAN’S HANDS?
BY DR PAUL CHARLSON

A taxation funded NHS is always going to be a political issue.
Taxpayers expect the Government to spend their money wisely. It is not surprising that politicians feel the need to prove that this is happening. Has the culture of British politics changed? Has the rise of political spin created a problem that did not previously exist? I would argue that it has.

The Government learned through focus groups that waiting times were a big public concern. Rightly it chose to tackle this issue.
Parliamentary announcements were made that by a certain date waiting lists would fall to a certain length. The Department of Health was directed to make this happen. The Chief Executives of the Strategic Health Authorities were given an ultimatum to make sure waiting time targets were met. If they did not there would be “consequences” . With such pressure to succeed each Strategic Health Authority CEO spoke to each PCT CEO. They were given an ultimatum make sure waiting time targets were met or there would be “consequences” . PCTs had to succeed in reaching the waiting time targets. Managers were recruited and many meetings took place. It soon became clear that the task would not be easy. Doctors were recruited to work at disproportionately higher costs to clear waiting lists. Patients were shipped to distant hospitals to have operations at higher cost. Centres were set up quickly despite disquiet from local clinicians about standards to clear the backlog. Money was diverted from other medical fields to those, which had targets. Toenails were removed rather than major operations because they were quicker to do and reduced waiting lists more effectively. In some places managers drove round to patients houses to hand deliver letters of appointment in order to get the patients in before the March 31st deadline. Despite all efforts some targets were too ambitious. Managers rather than face the wrath of more senior managers resorted to a variety of tactics, which were later revealed in the national press as effectively “fiddling” the figures.

The result of this was that too many PCTs could tick the box “Target achieved”. This pleased the SHAs who could then tick their boxes , which in turn pleased the Department of Health because they could tell Ministers that the targets had been achieved. They could announce in Parliament to a grateful public that waiting lists had fallen and the money had been well spent. Of course Doctors and their patients saw evidence that things were not as they appeared.. George Orwell could not have come up with anything better.

Of course some patients have benefited but has this been the most effective way of managing scarce NHS resources?. Some years later despite record resources being poured into the NHS Primary Care and Hospital Trusts are heading for large deficits. We are already seeing the effects of this in the cuts to training budgets, front line staff and clinical activity. It is going to get worse. After 2008 there will be a drastic percentage term reduction in new money being given to public services including the NHS. Reform an independent think tank has calculated by 2010 there will be an £18 billion deficit in the budget.

The taxpayer, has been encouraged by political spin to believe that our Health Care system is the best in the world. Yet mortality figures for many major diseases rank us with countries such as Turkey rather than the USA and France. Despite this we seem wedded to our system and therein lays a problem. Any politician mentioning private enterprise and limitation of the NHS treatment has been shot down as some form of heathen. NICE has been overturned by public pressure applied to politicians. Yet we badly need to debate issues around the extent of a public funded NHS.

Despite the protestations of the health unions including the BMA, politicians have woken up to the idea that competition amongst providers will bring savings. The public don’t care where they get treated as long as it’s good and fairly local. Yet all main political parties cling to the idea of a public NHS as to argue against this would be political suicide.

David Cameron, the Conservative leader proposed only this week that whilst the NHS would remain public under his leadership an independent body would be set up to run the NHS. He also said that clinicians should be at the heart of decision-making. Andrew Lansley his Health Secretary even went as far as saying that he was happy that GPs earned on average £109K a year because they would earn it as the best placed senior NHS figures to run the service.

Gordon Brown has also spoken of an independent NHS body and The Prime Minister has long been a champion of private enterprise working within the public sector.

It is clear that politicians realise that they cannot go on trying to manage the NHS from Whitehall.
The hope is that with better clinical engagement, less central management and reduction in waste that the figures will add up. There is a strong possibility that sooner or later there will not be enough in the pot. The question then is whether to raise taxes even further, reduce the scope of the NHS by narrowing its provsion or seek additional funding from individuals as they use the service. This might require the introduction of medical insurance on a large scale. All of these options will be politically unpopular and only a radical shift in public opinion is likely to save a Government who introduces such measures.It will take a clever Prime Minister to shift public opinion faster than it will go naturally. It is the public who have tied the hands of politicians.


Perhaps the question should be “Is the NHS safe in the public’s hands?"

Prescription system is a mess and wasteful

Less then 20% of people pay for prescriptions. A proportion of those that have to pay cannot afford £6.65 per item consequently they do not get essential medication?

Patients with hypothyroid disease get not just their Thyroxine free but all prescriptions yet asthmatics and hypertensives who often require far more medication have to pay for all their prescriptions?

There is massive over ordering and waste of medications because most be people dont pay. Consequently they often order "just in case" and never use the medication.

Surely a £1 charge for every medication for everyone would be a better system - simple and waste reducing. Some compensation through taxation could be used to protect the chronically ill and the poorest members of society.

Read my article on www.2020health.org and post please

Tory Party Conference

I have just arrived back from sunny Bournmouth where I was introduced to blogging . Thanks I think to Iain Dale http://iaindale.blogspot.com and James Cleaverly http://jamescleverly.blogspot.com


The conference was a good one. I went to some excellent fringe meetings. Its always a great excuse to talk politics and catch up with old friends and make new ones.

Good things about this conference

Conservatives have always been interested in the environment but at last they seem committed to taking some real action- more later!

They are starting to look like an electable Party at last.

The successful launch of a new health database/think tank www.2020health.org - please sign up and post your views.

William Hague being interviewed by Andrew Rawnsley -excellent

Bad things about this conference

The BBC focusing on more mature Party members when showing general pictures of conference- this does not represent the age demographics of attendees

Waiting an hour to pick up my conference pass

Chris Woodhead attending a fringe meeting with a police escort because he had not been security cleared - ridiculous!!

The thought of Blackpool next year- why not somewhere with better conference facilities?