Lansley’s real fight
David Blackburn 9:21am
Yesterday was a rare good day for Andrew Lansley: the Health Bill survived its trial in
the House of Lords. But there are no fanfares in this morning's press for the near-moribund health secretary. The Times, The Telegraph, The Independent and The Mail all lead with the story
that 50 per cent of English hospitals fail elderly patients according to the Quality Care Commission. Lansley may have thought that
his struggle was with nit-picking peers, who are determined that he, as the secretary state, remains ultimately accountable for the NHS in the letter of the law. But, maintaining the standard of
NHS care is his real battle.
The irony of the recent squabble between the government and the Owenites is that today’s headlines suggest it was needless. Who is the public most likely to blame for a general picture of rising waiting lists, crowded wards and uncompassionate nursing? Why, the secretary of state of course. Lansley will have to fight to ensure that such a picture does not emerge and his controversial reforms will be central to that effort; at least, that is what he implied on the Today programme this morning when he said that the reforms will give "patients an active voice" to drive up standards.
This morning’s Telegraph leader column argues that the story on its front page is proof of the need for NHS reform, and it is hard to disagree. The NHS has to find both a way of managing ever-rising costs and the means to arrest years of falling productivity. The question is whether Lansley’s reforms address those aims. It’s no secret that vast swathes of the medical professional are sceptical. Conduct an experiment when you next visit a GP: ask him if he agrees with Lansley. My GP gave an interesting answer, albeit one suffused with so much irony he became slightly glib. Yes, he said, because the last thing we want is an accountable NHS run by patients. The Times’ Camilla Cavendish explains (£) what I think he meant:
'[The NHS BILL] was never going to make much difference to patients. It does nothing to turn the NHS into a 24/7 operation, rather than one where you dread falling ill out of hours. It will not close failing hospitals. It doesn’t address the shocking standards of nursing care in some hospitals. Worse, it is an exasperating distraction from the explosion in chronic diseases and old age that could bankrupt the NHS while people argue about the difference between “promoting” and “providing” a service. ...There is nothing transformational in the Bill that requires primary legislation. Competition and GP commissioning were not invented by Andrew Lansley, the Health Secretary; they began under Labour.’
In other words, the bill is a bureaucratic consolidation, a top-down reorganisation costing more than £1.7 billion that the NHS can ill-afford to waste at present.
UPDATE: For those who want further reading, the Taxpayers' Alliance has released a report into the UK mortality rates in comparison with other European countries. Its key findings are that substantial investment in the health service appears not to have had a discernable impact on the rate of improving mortality, and that improvements which have been made appear to be slowing in an increasingly constrained . These figures suggest that low productivity remains a key challenge for the NHS.
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ButcombeMan
October 13th, 2011 9:43am Report this commentSlightly tangential but relevant. I am having to visit a major hospital in one of our cities where a friend has cancer.
Much of what I see is good but the most striking thing is going there on a saturday morning. The place is deathly quiet, staff car parks almost empty, plainly much of the work of the hospital suspended until Monday morning.
Why does this matter? Well as Michael O'Leary of Ryanair would tell you, utilisation, constantly, is the key to reduced overall costs.
A hospital with all the facilities it contains, is just like an air liner. It needs to be kept working.
Quite plainly that is not happening. Gerry Robionson in his TV programme also noticed the same thing. Operating Theatres closing early on a Friday afternoon.
It seems clear to me that the malaise in the management of the NHS goes very deep.
The moral? Do not get sick at a weekend.
Heartless Perry
October 13th, 2011 9:56am Report this commentAs with so many other public 'Services' - cut out whole swathes and levels of expensive meeting-engrossed ineptitude.
Either send these people to perform useful work on the shop floor, - or boot them out.
Also, insist that Nurses WASH hands, CARE for patients, and NOT WANDER around the town square in uniform!
Simples!
Grigori
October 13th, 2011 9:56am Report this commentAn inspired and original piece of journalism, daring to break the news that the NHS is centralised and bureacratic. Bottom-up reorganisation is the way forward, clearly. I look forward to reading your blog of your experiences as you play a central role in transforming the NHS while enjoying your new job as a hospital porter.
anne allan
October 13th, 2011 10:05am Report this commentThis where localism could come in.
Return to cottage hospitals; most elderly need basic nursing care, as near their family and friends as possible. It would be difficult for useless nurses to hide behind the anonymity of giant sickness factories when their patients and kin lived in the next street.
Before 1948, hospitals were largely local institutions, in which everyone had a vested interest.
Magnolia
October 13th, 2011 10:14am Report this commentWhat's shocking about the shocking standards is how clueless those whose responsibility it is to sort it out sounded on the radio this morning.
What we are witnessing is the death of professionalism by rules and regulation.
This is the legacy of the Labour years.
Give the nurse in charge of a ward the power to do everything the way he or she wants and to fire staff who don't perform well and we would soon see a difference.
Is this not also a reflection of the way that the elderly are viewed by the media and the rest of society?
dorothy wilson
October 13th, 2011 10:28am Report this commentMagnolia: Those in charge must also be made accountable for the standards in the areas for which they are responsible. Currently accountability seems to be totally lacking.
Dennis Churchill
October 13th, 2011 10:34am Report this commentThe NHS model can’t work in the 21st century.
The Soviet style free at the point of use universal health care is simply impossible to fund properly. Not only is it supposed to give unlimited treatment to the British population but increasingly to anyone who arrives in the country.
We need to move to a mixed private/ public funding system with incentives for people earning above the national average wage to take out insurance.
No other comparable country has attempted to copy the NHS and we should ask why.
When it was brought in penicillin was a cutting edge drug and Britain was a homogenous society. Now we have treatments that are beyond anything that could have been imagined even 20 years’ ago and we are likely not to even speak the same language as the patient in the next bed---or the medical staff.
mrs M L Bonwick-Jones
October 13th, 2011 10:50am Report this commentThe NHS needs urgent surgery it has been failing for many years! when 1 in 5 hospitals are breaking the law in the way it treats the elderly the most vulnerable people in the country then it has truly failed, so much for labour's the NHS is only safe with us!
Labour have for years burdened some Hospitals with PFI deals they could not afford allowing years of bailouts to become one bog huge dept, some hospitals can just about afford to go on, and Labour turned a blind Eye to poor preformance and quality. Doctors actively encourage patents to have private treatment!
Labour still wishes to stop progress! The Lords will scrutinize the bill at committee stage and amendments may be made, so please stop the scaremongering , The peers and others will be wrong to undermine the bills wish th create a more efficient, modern,free and people friendly NHS.
2trueblue
October 13th, 2011 10:53am Report this commentOn the money side it is wrong to collect NI and not set aside sums to cover costs. The actual quality of care has to do with the quality of training and ensuring that standards are maintained. I trained in 1967 and we had less staff but the care was better. It baffles me totally. One thing that is missing is actual care. Tending to anothers basic needs, how difficult is that? Too many excuses.
larkforsure
October 13th, 2011 10:57am Report this comment[ SOS ] Complaint with Human Rights Violations by IBM China on Centennial
Please Google:
Tragedy of Labor Rights Repression in IBM China
or
How Much IBM Can Get Away with is the Responsibility of the Media
or
IBM detained mother of ex-employee on the day of centennial
Lonesome Dave
October 13th, 2011 11:04am Report this commentEnvy of the world? Hardly. No-one else has an NHS.
I spent five months in hospital in 2008. The nine weeks in ICU, care was high quality. On to the general ward and I caught C.Diff (dreadful!)and MRSA (bearable) very quickly. The foreign nurses were, with few exceptions, good to very good; the British nurses were, with few exceptions, average to dreadful - using every excuse available to avoid patient contact.
Let the Doctors and Nurses run hospitals? Most of them couldn't run a bath!! Business management is a skill that these people neeed, want nor have.
It needs radical overhaul leading to full privatisation asafp.
ps: I wouldn't wish C.Diff on anyone.
Heartless (Romantic) Perry
October 13th, 2011 2:35pm Report this comment@ Lonesome D. – agree with you in general, - but please, - no more ‘Courses’ – in business management or any other! The ‘nurses’ already drip with bits of useless paper suggesting they have this or that diploma + of course a surfeit of ‘Evidence Based Practice’!
Please let’s have straightforward no-nonsense skills, - old fashioned if you like – but things that work, - like CLEAN wards, CLEAN staff, and DUTIFUL care.
Sad to read of your own distress at the hand of the ‘World’s Envy’.
Lonesome Dave
October 14th, 2011 8:32am Report this commentPerry, I don't want 'courses' per se but 'horses for courses'. I want ALL medical staff away from the management process of the NHS. I wouldn't dish out drugs on the ward so I would resent Doctors telling me how to manage. It needs good (minimal) private sector management which will take bold decisions, implement tough procedures and punish the useless.
In short a harsh prescription.
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