What was the point of getting consultants to report on the NHS?

Before we get on to discussing the consultants' report on the NHS, a preamble. I find it pretty bizarre that any employer, in this case the British government, pays out good money (our money of course) for an external consultancy firm to provide recommendations for the NHS. Particularly a Labour government. How likely was it, do you think, that a Labour government was ever going to accept a report from a firm such as McKinsey? Did the government think McKinsey might recommend staff increases?

The NHS is apparently the largest employer in the world. Many people (and politicians wanting to get elected) are happy to trot out the mantra, as Health minister Mike O'Brien does:

"... In core frontline services like maternity, nursing and primary care we need more staff rather than fewer."

- without then going on to look at the obvious corollary: what's to happen with levels of non-frontline activities. Quite the contrary! In the sentence immediately preceding the one I quote above, Mike O'Brien opines:

"The government does not believe the right answer to improving the NHS now or in the future is to cut the NHS workforce.

So what, according to you Mr O'Brien, is the right answer? Bearing in mind that the government brief to the consultants was to "come up with proposals for how savings could be made". There is silence from Mike O'Brien on this vital matter, except to put the kybosh on the whole report thus:

"Ministers have rejected the suggested proposals in the McKinsey report and there are no plans to adopt these proposals in the future."

OK, so another tens/hundreds(?) of thousands of Pounds of our money down the drain! No surprise there then, that's what this government specialises in - squandering money it does not have.

The context of this ridiculous exercise in self-delusion is electoral politics - no politician has the courage (whether in the governing Labour Party, or the likely future government of the Conservative Party) to state the obvious - that much of the waste that is said to exemplify the NHS is a function of its chronic over-manning, not its under-manning! Of course it needs to become 'more efficient' rather than simply indulge in yet more job-creation for the sake of it and think that this will solve the underlying problem, which is people working less-efficiently than they should be. For Gawd's sake, what planet do these people live on? No, the real reason for this determined myopia is that with a country mired deeply in recession and with an election inevitable within 9 months at the maximum, and with official unemployment figures already already rising rapidly (the 'dsguised' unemployment is already much greater and has been so for many years) the last thing an unpopular government needs is to accept a report which plans for an increase of 137,000 in unemployment numbers - for who else, even if there were not already a recession, would be likely to employ many of these people?

The whole mind-set which has blighted healthcare politics in the UK for decades is summed-up in these ridiculous statements from two of the 'unions' who effectively dictate to the Labour government (and in various ways to other political parties, too, in rather blunt terms) how this country's healthcare has to be run to avoid them 'cutting-up rough'. First from the self- acknowledged union, Unison, whose head of health, Karen Jennings, says:

"The McKinsey report comes up with the same old formulaic answers and their much-repeated mantra of job cuts as the answer to NHS savings. "There is no room for complacency in the NHS. We must constantly look for new ways to be efficient and to deliver better patient care."

- fair enough, in her first sentence she trots out her ideological objections to reducing employment levels, that much I understand, although I disagree fundamentally of course. But what does the obfuscatory second sentence mean? It seems to me to be trying to say a lot when it actually says almost nothing, other than that Ms Jennings is skilled in the art of meaningless verbiage masquerading as intelligent commentary.

Now on to that other 'union', the British Medical Association (BMA) which, despite its name which [deliberately?] suggests it is some kind-of quasi-official body is in fact a professional 'trade' body designed to protect the interests of medical practitioners of one kind or another as well as enforcing professional standards as the price of admittance to the 'club'. On the one had it does a lot of good, but ignore at your peril its naked self-interest on behalf of its members in other ways. At least Dr Mark Porter of the BMA is being intellectually honest when he stated clearly its official position:

"If implemented, these short-sighted proposals would have been disastrous. "We welcome the commitment given by the government that it has rejected them and does not see workforce cuts as the solution to the challenges facing the NHS."

This brings me to a question that I have for many years asked about the NHS. Does the National Health Service exist to provide medical care to the British people, or is its principal function to provide employment to the 1.3 or so million people employed by it? Of course even I would agree that the answer to this question has to be a combination of both to a certain extent, but I give definite priority to its basic function being to provide health services, whereas the 'unions' (and politicians, whether ideologically supportive or coerced by the electoral realities of a benefits-addicted electorate) seem to think it is basically a glorified 'make work' scheme.

John Appleby, chief economist at The King's Fund, basically talks about 'tractor production figures':

"I don't really see the necessity for actually cutting jobs, but I certainly do see the necessity for employees and the NHS overall to find new ways of working, being more productive, being more efficient."

However, Sir Gerry Robinson, a successful and apparently wealthy businessman, sums the whole issue up:

"You wonder at the mindset behind getting a report like that and then saying because it is not politically acceptable, we are not actually going to do anything with it," he told Radio 4's Today. "It's infuriating, the way the government handles the NHS and the way the opposition handles the game that gets played."

As he says, he saw an "enormous amount of waste" and [felt that] jobs should go (when he presented a BBC series about the NHS), saying that he was "infuriated" by yet another report, which cost a lot of money and "tells you the obvious". Quite!

Welcome to Britain and its crazy healthcare politics.

Keep religion out of medicine!

I have to say that if I was in hospital as a patient and some nurse or doctor tried to 'pray for me' or talk to me of religion I would be more than upset, I would be tremendously angry. The worrying and frightening thing is, though, that if I was very ill and in much pain I might be reluctant to voice my dislike for fear of possible 'repercussions' in my medical care.

In my experience some people with a strong religious faith simply do not understand that their ministrations are not wanted and can come across as, and actually be, 'pushy' in their efforts to 'help' a poor ignorant person like me who doesn't want them to peddle their religion in my direction. It is equally true that I have known a few deeply-religious individuals who were exceedingly discreet in their faith, without in any way hiding it, but they would never dream of imposing their religious views on others who did not wish to hear it; I certainly respect such people and would never belittle their faith.

For the avoidance of any doubt or confusion it should be left to patients in hospital to express a wish for some kind of spiritual guidance or support - and to the chaplaincy service to provide it. Personally I have no objection to a nurse or doctor wearing a small and unobtrusive crucifix (for example), but unless a patient seeing it asks them for support of a spiritual kind they must not take it upon themselves to offer this - and if I was not actually in extremis and such a thing happened to me I would like to think I would have no hesitation in telling the person who had done so to 'get knotted'!

Elgin hospital closes two wards after Clostridium difficile deaths

Dr Gray's hospital in Elgin has been obliged to close two wards after two deaths and 12 other positive tests for superbug Clostridium difficile. Six people remain in quarantine there. Two strains of the infection have been detected, indicating that different sources may be responsible.

NHS Grampian have arranged for "acutely-ill patients to be transferred to hospitals in Aberdeen and Inverness".

Strokes and how to recognise the signs

The NHS has been running a couple of advertisements over the past week or so to highlight recognition signals for when someone is having a stroke. I've never seen a stroke happen, but I have seen the results on a number of occasions and, quite frankly, it can be terrifying, specially when the person involved was well-known to me before as someone who was bright, intelligent and quick-witted. I don't mind saying that having a major stroke, which didn't kill me outright, would be my own special idea of hell. I hope these two advertisements may help someone who witnesses one happening to recognise quickly what is going on and to give the sufferer the best possible chance at prompt medical treatment.

I am intrigued to know how they got the two actors to display such realistic facial traits - I imagine there is some element of image manipulation involved, but it is very clever. And frightening.

SNP abolishes most NHS car parking charges in Scotland

I'm ambivalent about this change announced by Scottish Health Secretary Nicola Sturgeon MSP. Having occasionally had to visit patients regularly at Raigmore Hospital in Inverness during their sometimes quite lengthy stays there (my mother on several occasions and a few friends) I have been irritated by having to pay to park at the hospital. Against this must be set the fact that the parking fee was quite minimal (either a pound or two pounds, I confess I don't recall as it was such a relatively small amount), although I recognise for some others the small charge levied would still prove very burdensome.

However, the main problem at Raigmore is not the fee to park, in my opinion. No, the problem is that whilst the car park is quite large, it is almost always completely full when one arrives and one must circulate around the car park several times in the hope that someone will leave just as you are approaching and that you can grab the space before some other forlorn seeker of a space to leave their jalopy gets there first! (I use that word in the loosest possible sense, as irony really, as my car is certainly not old or decrepit, not are most others left in the car park.)

The last time I had a need to visit Raigmore regularly was a few weeks before last Christmas when my mother spent several weeks there - one feature of even the minimal parking fee is that it is usually possible to find a place to park after circling the car park only for five or ten minutes. However, I recall that on one of her previous hospitalisations, several years ago and before the car parking fees were introduced, that it was almost completely impossible to find a place to park between the hours of about 8.30am and 5.15pm because a lot of people working in Inverness used the free parking at Raigmore to park their cars the whole day whilst at work, making use of the frequent buses which call at Raigmore to get into the city and back again in the evening. Parking at one of the municipal car parks in the city cost quite few pounds a day, even with a monthly parking concession so the attraction of free parking was obvious. The small fee which exists now is at least a small deterrent to this kind of illicit use of the hospital parking.

I heard Ms Sturgeon today in a news bulletin saying she wanted to improve public transport to reduce the number of people who would need to use a car to get to/from their local hospital and this is obviously a laudable aim, if she can achieve it. However the city bus service to Raigmore is from what I have observed already pretty good, but Raigmore's catchment area extends well beyond Inverness to some pretty rural areas as well as to many smaller towns all throughout the Highlands, where the local 'cottage'-type hospitals are not equipped to deal with more serious cases and quite a lot of people visiting Raigmore have no ready access, or no access at all in some cases, to ANY kind of public transport and it is difficult to see how, given the spread-out and low-density nature of the population throughout most of the Highlands, this problem can be tackled realistically and not at absolutely huge cost. It may be different for hospitals in large urban areas where most of the patients and visitors live within the same large urban area.

So whilst I can see that this is a 'good' move on the part of our SNP Scottish Executive (aka 'Government') to try and ensure that treatment under the NHS is, in the mantra, 'free at the point of need' (if you believe wholly in the principles underlying the NHS, which I do not entirely, in all honesty) I'm wondering about the possible unintended consequences and how I'm going to find a place to park at Raigmore when I need to after the parking fee is abolished.

Labour's statist NHS policies inadvertantly exposed at PMQs

Not the greatest PMQs ever - neither Harman nor Hague scored any major points, although Harman was nowhere near as good as last time; her responses were mostly confused non sequiturs, of an even more formulaic 'party line' nature than is usually the case, and she didn't seem to believe half of it herself.

However, one of the questions from a Labour MP hit me in the face; I only half-listened to the response from Harman and indeed think it was relatively unimportant (and certainly menaingless). What I found interesting was the mind-set which allowed a question with that content to be asked in the first place.

Anne Snelgrove MP, Labour, Swindon South, asked this question:

Will my Right Honourable Friend join me in thanking the hard-working staff of the Great Western Hospital in Swindon who have used extra funding from the Government to cut C-difficile cases to well below target and will she ensure that the Matrons throughout the country have the resources to keep the NHS sparkling in its 60th anniversary year?

Harriet Harman MP, Labour, Leader of the House responded with a perfectly-standard formula, albeit grotesquely padded-out to disguise the platitudes she was mouthing, whilst not forgetting a gratuitous swipe at the last government, which left office more than 11 years ago:

I congratulate the staff at Great Western Hospital and throughout the National Health Service in tackling hospital acquired infection; it's important work and I think it's an opportunity on the 60th anniversary of the National Health Service to pay tribute to the entire staff team of the National Health Service who have kept it going even when it was under-resourced and struggling and to pay tribute too to their work under the leadership of Arad Darzi [sp?]. Two thousand clinicians have been involved in shaping a consultation paper for the way forward and I hope that all staff in the NHS - not only can we thank them for their work, but invite them to help us shape the way forward for the future for the NHS.

- bizarre sentence structure there toward the end (and I've done my best to type exactly what she said from my recording) and much of it meaningless verbiage, but that's not unusual with responses at PMQs.

No, what interests me about this exchange was one small part of it, the bit I've high-lighted in red and focussing in on the few words that I've underlined. Is it really the case that the target for C-difficile infection is so far above 'zero', that success can be said to have occurred when infection levels have been held to well below that target, whatever it is? Personally I believe that the only acceptable target should be 'zero' infections, even if I am perfectly prepared to concede that this is never likely to be achieved, or certainly not consistently oner a lengthy period.

It's the whole language of debate on the subject of the NHS in general that I take great exception to. The self-congratulatory tone of much of the discussion on the NHS, particularly [but not eclusively] from the Labour side, is so depressing. Regarding as a success a level of C-difficile infections 'well below' a target which is set some way above zero is just one small example of the poverty of ambition which surrounds conventional thinking on how to manage health-care in this country.

"The Spine" (*) suffers a setback

(Please see UPDATE at end)

Contractor Fujitsu-Siemens has, probably justifiably, walked away from the NHS e-record contract; to coin a phrase, the 'spine' has not landed. Rather, it has crashed. [Geddit?!]

Is anybody surprised? Quite apart from my lack of surprise, I can't say I'm disappointed either. Centralised databases don't have a particularly high acceptability rating in Bill's estimation.

(*) UPDATE: (Thursday 29MAY08 09.47 BST) A commenter has pointed out this is not 'the spine', so the title of this post is inaccurate, if 'catchy'. I noticed the term wasn't used in the linked report and wondered why that was, but I assumed it had to be part of the same thing; obviously I was wrong.

The sick mentality that guides the NHS

I just came across a letter from Ben Bradshaw MP, Minister of State for Health Services, to the Economist magazine and published in its 26th January edition - it has been lurking in one of my bags since leaving home and I only got around to perusing it last evening.

I can't find the letter in the online edition - perhaps I've not looked in quite the right place - so I'm going to quote parts of the lengthy second (and final) paragraph as what he writes there seems to me to encapsulate a lot of what is hateful about the mentality guiding the NHS:

"A fundamental principle of the NHS, supported by all political parties, is that treatment should be available to patients based on need and not on the ability to pay."

If you believe in the principle of socialised medicine provision, which I am not in any way sure that I do, then this seems inevitable. But for the sake of argument, let us suppose it is a sound way of doing things. What does it lead on to?

"Patients are, of course, entitled to seek private medical treatment if they so wish."

Now this is really decent of our political masters, isn't it!? They graciously accept that we have the right to deal with our own health care outside the NHS if we choose.

Of course, if you do take out private health insurance (as I and many others have) then it will cost you more than just the insurance premium. You will also pay a health insurance tax. So despite the seeming innocence of the 'State' permitting one to do something outside its control, they still want to punish you for doing so.

"Co-payments undermine the the principle of fair and equal treatment for all and risk creating a two-tier health service - one for those with the ability to pay and another for those that do not. Such a system would directly contravene the principles and values of the NHS."

When I read ridicuous communistic propaganda like this masquerading as a genuine concern with what is best for people concerned about their health I really feel like screaming and smashing some windows. Co-payments of various kinds have been a fundamental part, perhaps a regrettable part, of the NHS almost since its inception! Dental charges, charging for prescriptions and for various things connected with eye-care have a long history under the NHS. You can read a couple of websites which cover the topic in depth here (Citizens' Advice Bureau) and here (Socialist Health Association - not my usual reading, as you might rightly imagine!).

The pretence that the NHS is, or has mostly always been, 'free at the point of need' is fine as a slogan, but it has never been more than an aspiration because of these pesky little charges tagged on. Then of course come the exemptions from payment - adding a huge layer of bureaucracy to the whole edifice in order to administer them.

But of course these are not the co-payments which Mr Bradshaw is referring to, because all the others have become completely orthodox over many years. No, what M Bradshaw objects to is people paying for addtional drugs privately, not available under the NHS, to enhance the NHS treatment they are getting for illnesses such as cancer. Basically what he wishes to establish as a principle is that if someone gets additional treatment privately for something that they are already being treated for under the NHS, then that NHS treatment also becomes chargeable! Have you ever heard of anything so ridiculous in all your life? Or unfair?! Or mean-spirited?! Or simply wrong-headed?! What principle exactly is Mr Bradshaw trying to protect? If NICE (National Institute for Clinical Excellence) say a drug may not be prescribed under the NHS, ostensibly for reasons of lack of efficacy, but in reality as a cost-containment measure, what possible harm can it do for someone to use their own money to buy the drug? And in any case the patient would still have paid his/her contributions to the NHS over the years so why shouldn't they continue to receive the treatment they other wise would have if they hadn't opted for additional private treatment. It's not as if the government is going to offer them some kind of refund for treatment it will thus be with-holding.

What it really boils down to is the 'State' saying to citizens (i.e. we helots) that if everyone cannot have something, then none may have it. Or at least not without suffering enormous additional cost.

The sooner the State gets out of the business of directly influencing medical treatments, or teaching or any other state-provided service for that matter, which are more properly the province of relevant professionals, the better it will be. Prescription charges are a very long-standing form of co-payment; why is some poor lady who wants to spend her own money on a drug like Avastin being punished for doing so? Logically, if you follow this line of reasoning, I should be charged for all my doctor visits (very rare as a matter of fact) whenever I pay for a prescription for my anti-eczema ointment. That's how illogical and mean-spirited and condescending is Mr Bradshaw's whole sad premise.

The price of being ill in Highland is being forced to go cold turkey on nicotine!

Just another story about our crazy, socialist health-care system, the NHS.

NHS Highland has decided to extend the general ban on smoking in enclosed public areas throughout Scotland to cover all the grounds around its premises because, as Chairman Garry Coutts puts it:

"Smoking is the single biggest cause of illness in Highland and we cannot be seen to condone it anywhere on our premises. However we accept that there are still issues we have to iron out with staff and we will do this before formally agreeing to introduce a site-wide ban. We will also ensure that staff and patients have access to help to give up smoking."

Now as anyone who knows me, or indeed who has read this blog off and on, must be aware I have never smoked and abhor the practice - nevertheless I do not have the 'militant' anti-smoking attitude of some people who are often, in my experience, usually former smokers themselves.

However the reasoning behind this change in policy by NHS Highland is wrong-headed, it seems to me, on a number of counts:
- First, what is this about "cannot be seen to condone it"? The Scottish Parliament, God love 'em(!), has decided in its wisdom to ban smoking in all enclosed public premises, but they have not yet chosen to ban it in open-air locations throughout the country. Since when did NHS Highland become a quasi legislative body?
- Second, smoking remains (apart from in enclosed public spaces) a legal activity and whilst I personally find it unattractive to see huddled groups of people outside offices, pubs, restaurants [and yes, Raigmore Hospital, too] smoking cigarettes in a furtive manner, I am aware that nicotine is an addictive substance which it is difficult to stop using once one has become addicted to it;
- Third, Mr Coutts seems to be confused about the purpose of the NHS. It is to serve the needs of ill people. Mr Coutts's qualms about introducing this latest extension of the 'holier than thou' and 'nanny state' aspect of living in Scotland is because "there are still issues we have to iron out with staff". The reality is that in [the 'socialist republic' of] Scotland one must tread extremely warily when contemplating any change in the publically-funded sector of the economy because although people working in such sectors are supposed to be serving the public, the way in which such services operate is in practice entirely centred around the whims of the employees. And of course the public sector of the economy is huge in Scotland generally and even larger in areas such as the Highlands. It really is just like being in the former communist Eastern Europe, except that we haven't had our revolution against the tyranny of Socialism. Yet.
- Fourth the 'nanny state', which Mr Coutts wishes to strengthen, deigns to include some lip service "exemption for patients who staff feel are considerably distressed, anxious or vulnerable" - but I bet that those patients who may be extremely unwell (perhaps even as a result of smoking-related illnesses) will be made to feel as guilty and as uncomfortable as possible if they try and avail themselves of this exemption. Frankly it must be an awful prospect for some elderly lifelong smoker faced with the necessity of going into hospital in Scotland - that really is 'cruel and unusual treatment' under the false mask of patient concern - when what people need is good care in a relaxed and stress-free environment; and few things are more stressful for an addict than depriving them of the thing to which they are addicted when they are ill and vulnerable in hospital.

In summary, Mr Coutts, your method of running the business you are entrusted with sucks!

PS/ And don't get me started about this latest piece of nonsense in the inefficient socialist-run NHS! I speak of course about the apparently loss-making Patienline, the monopoly provider of communications services for patients in hospitals which wants to increase its charges for outgoing and incoming call by huge amounts. I think there has to be something wrong with their 'business' model, don't you?