LATEST ARTICLES
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
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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
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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
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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
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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
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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
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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
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April to June 2015
Public Policy Media
Richard Vize