Google puts power in patients’ hands 19 June 2015 The death of teenager Bronte Doyne from cancer after she was told to stop googling her symptoms exposes how many professionals want to ignore the advances of the information age and cling to the old power relationship between doctors and patients. Bronte begged doctors to listen to her after online research on an authoritative US website convinced her that her rare liver cancer had returned. She died 16 months after being told she would survive. Just days before her death she wrote: “Can’t begin to tell you how it feels to have to tell an oncologist they are wrong. I had to, I’m fed up of trusting them.” Her mother described doctors at Nottingham University hospitals NHS trust as aloof and evasive. Of course, there are times when Google can be something of a curse to doctors. GP Clare Gerada, while speaking eloquently on the Today programme about the need to listen to patients, also pointed out that Google had helped convince one of hers who was suffering from a cold that the real problem was dengue fever. But the ubiquitous availability of medical information is irrevocably putting more power in the hands of patients. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Who has the answers to NHS funding? 9 June 2015 The big news at this year’s gathering of the NHS Confederation at Liverpool’s docks was the announcement by NHS England chief executive Simon Stevens of the massive intervention in the three failing health economies of north Cumbria, Essex and northern, eastern and western Devon. Western Devon’s clinical commissioning group is already predicting a deficit this year of almost £80m. By way of justification Stevens pointed out that every other approach – such as firing chief executives and providing short- term bailouts – has been tested to destruction in these areas. While the euphemistically titled “success regime” has been discussed for some time, the scale and intensity of it marked a significant ramping up of NHS England’s use of hard power. This was not creating the conditions for success, but a wholesale takeover by NHS England of a significant chunk of the health service. It felt like the sort of thing his predecessor, Sir David Nicholson, would have done. This will make the central bodies – and to a significant degree, Stevens personally – responsible for redesigning services in areas with sometimes decades of poor performance. The implication is that if this intervention doesn’t sort them out, then the NHS has run out of ideas on how to turn round system failure. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Stevens gambles on hospital chains 22 May 2015 The announcement on Wednesday by NHS England chief executive Simon Stevens of the development of hospital chains is a huge gamble. The idea of hospital chains is to make smaller hospitals clinically and financially sustainable, by linking them with a major regional centre. It builds on last year’s review of different ways of running hospitals led by Salford Royal chief executive Sir David Dalton. In the current financial climate it is a bold move. Stevens is calculating that hospital chains will help the NHS achieve the barely-credible target of £22bn in efficiency savings over the next few years while avoiding the need to burn up huge amounts of political capital in local battles to close hospital services. It marks a decisive change of direction from the era of his predecessor, Sir David Nicholson, who attached far greater importance to the concentration of services in fewer, more clinically and financially effective centres. Hospital chains is a beguiling idea, which plays to that peculiar algorithm of public service improvement that if you lump together a good institution and a bad one you end up with two good ones. As similar experiments in schools have demonstrated, that is not always the outcome. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Hunt can’t keep ducking tough decisions 12 May 2015 Jeremy Hunt mark 2 faces a tougher job as health secretary than in the last parliament. Politically he did well to distract the public from the folly of Andrew Lansley’s upheavals by relentlessly focusing on the Mid-Staffordshire scandal and ramming home the message that there have been real-terms spending increases, however slender. Now he can no longer postpone high-risk decisions over money and services – as well as having to meet election promises to extend access to primary and mental health care. The overwhelming priority is to stabilise the financial system. The Conservatives were fortunate to get over the electoral finishing line without the rapidly deteriorating NHS balances becoming a campaign issue. But the promise of an extra £8bn above inflation by 2020 will not avert a crisis in the next two years unless a substantial proportion of that is frontloaded and the NHS delivers barely credible productivity targets. Prompt action, however difficult, will be less painful for the government than waiting until the problems are entrenched and they are accused of letting the NHS slide into crisis. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Inside the murky world of NHS rationing 24 April 2015 This week’s survey by HSJ revealing that 39% of clinical commissioning groups it contacted were considering rationing care to save money in the coming year highlights one of the murkier areas of health policy and raises a number of difficult questions. Rationing is nothing new, of course. When waiting lists stretched to many months and even years, treatment was often rationed simply by the patient dying before they reach the operating table. Heart surgery was a striking example of this. The long waits in A&E departments acted as another form of rationing. Labour’s all-out assault on waiting lists and eventual introduction of the 18 weeks referral-to-treatment target ended this backdoor workload management system. Now the NHS Constitution gives the impression that clinical need and conformity with Nice guidelines are all that stand between the patient and treatment, while the purchasing decisions of commissioners should ensure that any rationing is open to public scrutiny. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Facing truth about the funding crisis 21 April 2015 The intervention by former NHS England chief executive Sir David Nicholson in the election debate on the NHS exposes the chasm between manifesto rhetoric and funding reality. Nicholson pointed out that the political parties are promising extra services while the Five Year Forward View from NHS England—on which the widely accepted additional funding need of £8 billion a year is based—makes hugely optimistic assumptions about efficiency savings simply to get the service repositioned for sustainability, without heroic promises about more and better care. The Five Year Forward View provides three funding scenarios, the most optimistic of which is that the NHS gets the extra money to enable it to invest quickly in new care models, which in turn deliver efficiency gains worth between 2% and 3% each year. The Conservatives and Liberal Democrats have promised to provide a real terms increase of £8 billion a year by 2020. But, for example, the Conservatives claim that this will fund seven days a week, 12 hours a day access to GPs; full seven day working in hospitals; and a substantial expansion of mental healthcare—as well as the reforms in the Five Year Forward View. Read the full article at BMJ.com ____________________________________________________________________ Managers are more than bureaucrats 9 April 2015 David Cameron’s insulting portrayal of NHS management in last week’s leaders’ election debate as “a bureaucrat with a clipboard” shows how little is understood about the vital role of managers in running the health service. As the next parliament looms, managers’ skills will be tested as never before. Will they pass? The skills which got many managers to the top in the past will no longer be sufficient as the health service landscape becomes ever more complex and demanding. The ebbing of central prescription to make way for a greater variety of commissioning and care models, coupled with the huge financial stresses, means managers are having to think and work in new ways. Collaborating across the local health economy is now imperative. Even the biggest institutions are unable to operate as discrete organisations. But systems thinking is still perilously weak in an NHS bent out of shape by an excessive focus on competition. Read the full article on the Guardian Healthcare Network ____________________________________________________________________