Category Archives: NHS Management

Unite national officer for health Colenzo Jarrett-Thorpe said: “At this time of national emergency caused by the coronavirus pandemic, it is right that the legal protections covering whistleblowers in the NHS are highlighted.
“Unite, which has 100,000 members in the health service, will be monitoring the situation very closely in the weeks ahead and will give maximum support to any member who may face disciplinary procedures as a result of raising legitimate concerns, for example, the lack of personal protective equipment (PPE).
“The current legislation protecting whistleblowers has been further underpinned by the NHS Staff Council statement of 28 February and the English Social Partnership Forum statement on 1 April.
“Any NHS worker that suspects they are being victimised for whistleblowing should contact their ‘freedom to speak up’ guardian which every trust in England should have in place. If they are a union member, they should contact their workplace representative or local union office.
“There have been anecdotal stories on social media that some NHS bosses may have been clamping down on those wishing to expose failings in the system and improve the well-being of patients. If we discover concrete evidence that this is happening, we will act immediately to support our members.”

The NHS Staff Council statement of 28 February 2020

https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/NHS-Staff-Council—Guidance-for-Covid-19-Feb-20.pdf?la=en&hash=70C909DA995280B9FAE4BF6AF291F4340890445C&hash=70C909DA995280B9FAE4BF6AF291F4340890445C

English Social Partnership Forum Joint Statement on Industrial relation – 1 April 2020

https://www.socialpartnershipforum.org/media/166314/SPF-Covid-19-statement-final-and-formatted.pdf

Protection for whistleblowers in the UK is provided under the Public Interest Disclosure Act 1998 (PIDA).The PIDA protects employees and workers who blow the whistle about wrongdoing.

For more information please contact Unite senior communications officer Shaun Noble

Email: shaun.noble@unitetheunion.org

Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
Leave a comment

COVID-19 and the NHS – “a national scandal”, comments the Lancet.

“The gravity of that scandal has yet to be understood.” Reports Richard Horton in the Lancet 28 March 2020 :

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come.”

Please read the full article here. You can download the pdf at this link.
1 Comment

The Socialist Health Association (SHA) published its first Blog on the COVID-19 pandemic last week (Blog 1 – 17th March 2020). A lot has happened over the past week and we will address some of these developments using the lens of socialism and health.

  1. Global crisis

This is a pandemic, which first showed its potential in Wuhan in China in early December 2019. The Chinese government were reluctant to disclose the SARS- like virus to the WHO and wider world to start with and we heard about the courageous whistle blower Dr Li Wenliang, an ophthalmologist in Wuhan, who was denounced and subsequently died from the virus. The Chinese government recognised the risk of a new SARS like virus and called in the WHO and announced the situation to the wider world on the 31st December 2019.

The starter pistols went off in China and their neighbouring countries and the risk of a global pandemic was communicated worldwide. The WHO embedded expert staff in China to train staff, guide the control measures and validate findings. Dr Li Wenliang who had contracted the virus, sadly died in early February and has now been exonerated by the State. Thanks to the Chinese authorities and their clinical and public health staff we have been able to learn about their control measures and the clinical findings and outcomes in scientific publications. This is a major achievement for science and evidence for public health control measures but….

Countries in the Far East had been sensitised by the original SARS-CoV outbreak, which originated in China in November 2002. The Chinese government at that time had been defensive and had not involved the WHO early enough or with sufficient openness. The virus spread to Hong Kong and then to many countries showing the ease of transmission particularly via air travel. The SARS pandemic was thankfully relatively limited leading to global spread but ‘only’ 8,000 confirmed cases and 774 deaths. This new Coronavirus COVID-19 has been met by robust public health control measures in South Korea, Taiwan, Hong Kong, Japan and Singapore. They have all shown that with early and extensive controls on travel, testing, isolating and quarantining that you can limit the spread and the subsequent toll on health services and fatalities. You will notice the widespread use of checkpoints where people are asked about contact with cases, any symptoms eg dry cough and then testing their temperature at arms length. All this is undertaken by non healthcare staff. Likely cases are referred on to diagnostic pods. In the West we do not seem to have put much focus on this at a population level – identifying possible cases, testing them and isolating positives.

To look at the global data the WHO and the John Hopkins University websites are good. For a coherent analysis globally the Tomas Peoyu’s review  ‘Coronavirus: The Hammer and the dance’ is a good independent source as is the game changing Imperial College groups review paper for the UK Scientific Advisory Group for Emergencies (SAGE). This was published in full by the Observer newspaper on the 23rd March. That China, with a population of 1.4bn people, have controlled the epidemic with 81,000 cases and 3,260 deaths is an extraordinary achievement. Deaths from COVID-19 in Italy now exceed this total.

The take away message is that we should have acted sooner following the New Year’s Eve news from Wuhan and learned and acted on the lessons of the successful public health control measures undertaken in China and the Far East countries, who are not all authoritarian Communist countries! Public Health is global and instead of Trump referring to the ‘Chinese’ virus he and our government should have acted earlier and more systematically than we have seen.

Europe is the new epicentre of the spread and Italy, Spain and France particularly badly affected at this point in time. The health services in Italy have been better staffed than the NHS in terms of doctors/1000 population (Italy 4 v UK 2.8) as well as ITU hospital beds/100,000 (Italy 12.5 v UK 6.6). As we said in Blog 1 governments cannot conjure up medical specialists and nurses at whim so we will suffer from historically low medical staffing. The limited investment in ITU capacity, despite the 2009 H1N1 pandemic which showed the weakness in our system, is going to harm us. It was great to see NHS Wales stopping elective surgical admissions early on and getting on with training staff and creating new high dependency beds in their hospitals. In England elective surgery is due to cease in mid April! We need to ramp up our surge capacity as we have maybe 2 weeks at best before the big wave hits us. The UK government must lift their heads from the computer model and take note of best practice from other countries and implement lockdown and ramp up HDU/ITU capacity.

In Blog 1 we mentioned that global health inequalities will continue to manifest themselves as the pandemic plays out and spare a thought for the Syrian refugee camps, people in Gaza, war torn Yemen and Sub Saharan Africa as the virus spreads down the African continent. Use gloves, wash your hands and self isolate in a shanty town? So let us not forget the Low Middle Income Countries (LMICs) with their weak health systems, low economic level, weak infrastructure and poor governance. International banking organisations, UNHCR, UNICEF, WHO and national government aid organisations such as DFID need to be resourced and activated to reach out to these countries and their people.

  1. The public health system

We are lucky to have an established public health system in the UK and it is responding well to this crisis. However we can detect the impact of the last 10 years of Tory Party austerity which has underfunded the public health specialist services such as Public Health England (PHE) and the equivalents in the devolved nations, public health in local government and public health embedded in laboratories and the NHS. PHE has been a world leader in developing the PCR test on nasal and throat samples as well as developing/testing the novel antibody blood test to demonstrate an immune response to the virus. The jury is out as to what has led to the lack of capacity for testing for C-19 as the UK, while undertaking a moderate number of tests, has not been able to sustain community based testing to help guide decisions about quarantining key workers and get intelligence about the level of community spread. Compare our rates of testing with South Korea!

We are lucky to have an infectious disease public health trained CMO leading the UK wide response who has had experience working in Africa. Decisions made at COBRA and announced by the Prime Minister are not simply based ‘on the science’ and no doubt there have been arguments on both sides. The CSO reports that SAGE has been subject to heated debate as you would expect but the message about herd immunity and stating to the Select Committee that 20,000 excess deaths was at this stage thought to be a good result was misjudged. The hand of Dominic Cummings is also emerging as an influencer on how Downing Street responds. Remember at present China with its 1.4bn population has reported 3,260 deaths. They used classic public health methods of identifying cases and isolating them and stopping community transmission as much as possible. Herd immunity and precision timing of control measures has not been used.

The public must remain focused on basic hygiene measures – self isolating, washing of hands, social distancing and not be misled about how fast a vaccine can be developed, clinically tested and manufactured at scale. Similarly hopes/expectations should not be placed on novel treatments although research and trials do need supporting. The CSO, who comes from a background in Big Pharma research, must be seen to reflect the advice of SAGE in an objective way and resist the many difficult political and business pressures that surround the process. His experience with GSK should mean that he knows about the timescales for bringing a novel vaccine or new drugs safely to market.

  1. Local government and social care

Local government (LAs) has been subject to year on year cuts and cost constraints since 2010, which have undermined their capability for the role now expected of them. The budget did not address this fundamental issue and we fully expect that in the crisis, central government will pass on the majority of local actions agreed at COBRA to them. During the national and international crisis LAs must be provided with the financial resources they need to build community hubs to support care in the community during this difficult time. The government need to support social care.

COVID-19 is particularly dangerous to our older population and those with underlying health conditions. This means that the government needs to work energetically with the social care sector to ensure that the public health control measures are applied effectively but sensitively to this vulnerable population. The health protection measures which have been announced is an understandable attempt to protect vulnerable people but it will require community mobilisation to support these folk.

Contingency plans need to be in place to support care and nursing homes when cases are identified and to ensure that they can call on medical and specialist nursing advice to manage cases who are judged not to require hospitalisation. They will also need to be prepared to take back people able to be discharged from acute hospital care to maintain capacity in the acute sector.

Apart from older people in need there are also many people with long term conditions needing home based support services, which will become stressed during this crisis. There will be nursing and care staff sickness and already fragile support systems are at risk. As the retail sector starts to shut down and there is competition for scarce resources we need to be building in supply pathways for community based people with health and social care needs. Primary health care will need to find smart ways of providing medical and nursing support.

  1. The NHS

In January and February when the gravity of the COVID pandemic was manifesting itself many of us were struck by the confident assertion that the NHS was well prepared. We know that the emergency plans will have been dusted down and the stockpile warehouses checked out. However, it now seems that there have not been the stress tests that you might have expected such as the supply and distribution of PPE equipment to both hospitals and community settings. The planning for COVID-19 testing also seems to have badly underestimated the need and we have been denied more accurate measures of community spread as well as the confirmation or otherwise of a definite case of COVID-19. This deficiency risks scarce NHS staff being quarantined at home for non COVID-19 symptoms.

The 2009 H1N1 flu pandemic highlighted the need for critical care networks and more capacity in ITU provision with clear plans for surge capacity creating High Dependency Units (HDUs) including ability to use ventilators. The step-up and step-down facilities need bed capacity and adequate staffing. In addition, there is a need for clarity on referral pathways and ambulance transfer capability for those requiring even more specialised care such as Extracorporeal Membrane Oxygenation (ECMO). The short window we now have needs to be used to sort some of these systems out and sadly the supply of critical equipment such as ventilators has not been addressed over the past 2 months. The Prime Minister at this point calls on F1 manufacturers to step in – we wasted 2 months.

News of the private sector being drawn into the whole system is obviously good for adding beds, staff and equipment. The contracts need to be scrutinised in a more competent way than the Brexit cross channel ferries due diligence was, to ensure that the State and financially starved NHS is not disadvantaged. We prefer to see these changes as requisitioning private hospitals and contractors into the NHS. 

  1. Maintaining people’s standard of living

We consider that the Chancellor has made some major steps toward ensuring that workers have some guarantees of sufficient income to maintain their health and wellbeing during this crisis. Clearly more work needs to be done to demonstrate that the self-employed and those on zero hours contracts are not more disadvantaged. The spotlight has shown that the levels of universal credit are quite inadequate to meet needs so now is the time to either introduce universal basic income or beef up the social security packages to provide a living wage. We also need to ensure that the homeless and rootless, those on the streets with chronic mental illness or substance misuse are catered for and we welcome the news that Sadiq Khan has requisitioned some hotels to provide hostel space. It has been good to see that the Trade Unions and TUC have been drawn into negotiations rather than ignored.

In political terms we saw in 2008 that the State could nationalise high street banks. Now we see that the State can go much further and take over the commanding heights of the economy! Imagine if these announcements had been made, not by Rishi Sunak, but by John McDonnell! The media would have been in meltdown about the socialist take over!

  1. Conclusion

At this stage of the pandemic we note with regret that the UK government did not act sooner to prepare for what is coming both in terms of public health measures as well as preparing the NHS and Local Government. It seems to the SHA that the government is playing catch up rather than being on the front foot. Many of the decisions have been rather late but we welcome the commitment to support the public health system, listen to independent voices in the scientific world through SAGE and to invest in the NHS. The country as a whole recognises the serious danger we are in and will help orchestrate the support and solidarity in the NHS and wider community. Perhaps a government of national unity should be created as we hear much of the WW2 experience. We need to have trust in the government to ensure that the people themselves benefit from these huge investment decisions.

24th March 2020

Leave a comment
All hospital car parking charges for NHS staff in England should be abolished this week as they combat the coronavirus, Unite, Britain and Ireland’s largest union, said today (Monday 23 March).
Unite, which has 100,000 members in the health service, said that NHS trusts in England were charging employees an estimated £50-to-£200 a month for the privilege of parking at their place of work.
Unite contacted shadow Labour health and social care secretary Jon Ashworth this afternoon asking him to raise the issue of abolition of the parking charges for NHS staff for the duration of the coronavirus emergency with his Conservative counterpart Matthew Hancock.
Unite said such a move, ideally this week, would remove the additional worry for NHS staff concerned about travelling on restricted public transport networks.
Unite national officer for health Colenzo Jarrett-Thorpe said: “It is a long-standing Unite policy that NHS staff should not be charged to park their cars for coming to work to look after the sick, injured and vulnerable.
“This is even more important and relevant, given that NHS staff are already risking their lives round the clock to save those suffering from COVID-19.
“We have been in touch with Labour’s shadow health and social care secretary Jon Ashworth this afternoon asking him to raise this with his counterpart Matthew Hancock as a matter of urgency.  
“NHS staff don’t need the additional worry of parking, especially when there are restrictions on public transport and it is safer in these times to drive to work than risk infection on trains and buses. 
“Many NHS staff are not well-paid and the fact that NHS trusts in England  are charging them £50-£200-a-month to park in normal times is wrong – in this exceptional period of national emergency, it is doubly so.”
Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
Leave a comment
All the Tory contenders to be prime minister should categorially rule out the NHS being part of any future US/UK trade deal, Unite, Britain and Ireland’s largest union, said today (Wednesday 5 June).
Unite, which has 100,000 members in the health service, said the new prime minister ‘should not offer up the NHS as a sacrificial lamb to US president Donald Trump’.
Unite national officer for health Colenzo Jarrett-Thorpe said: “The Tory prime ministerial contenders need to put the national interest – in this case, the safeguarding the NHS from US privateers – before the personal ambition of getting their hands on the keys to 10 Downing Street.” 
Concern about what a US/UK trade deal could mean for the NHS has heightened this week following remarks by Donald Trump and his ambassador in London, Woody Johnson about the NHS being included in a future US trade deal
Colenzo Jarrett-Thorpe added: “The NHS is the UK’s greatest achievement – but for Trump and his ilk, who despise the very idea of universal healthcare free at the point of delivery, all they can see is the money to be made from the sick, frail and vulnerable. 
“This was made obvious by the US ambassador’s very frank comments about his country’s intentions towards the NHS in any future US/UK trade deal, a point that was again made by Trump himself. The president’s comments today are not reassuring in any way. Unless the government categorically says that the NHS is not for sale, then patients and staff will face increasing uncertainty and worry.
“The Tory leadership hopefuls need to state categorially to the British public that the NHS is not up for sale to profit hungry US private healthcare companies as part of a future trade deal.
‘Leading Tories and their cheerleaders in the media may think that the US offers a blueprint for how a post-Brexit Britain should be – however, it should not be forgotten that millions of Americans don’t have any health insurance which does not inspire confidence.
“We strongly believe that the NHS should not be offered up as a free trade sacrificial lamb to the mercurial whims of Donald Trump – our sick, frail and vulnerable deserve so much better.”

 

Leave a comment

Security staff at Southampton General Hospital being attacked in the A&E department is key to an industrial dispute over pay and sickness pay.

Unite, Britain and Ireland’s largest union, said its 21 security staff members were being attacked on a regular basis by members of the public either under the influence of drink or drugs, or with mental health problems.

Unite is currently holding a ballot for strike action or industrial action short of a strike of its members, employed by Mitie Security Ltd, at Southampton General Hospital over pay and conditions. The ballot closes on Wednesday 15 March.

Unite said that Mitie Security was refusing to provide adequate personal protection equipment (PPE), such as stab vests and  safety restraints, even though knife-related incidents are increasing.

Unite lead officer for health in the south east Scott Kemp said: “With cuts to the police force and mental health services, there is a tendency for those suffering from various conditions to be dropped off at the hospital and left to the security guards. 

“The statistics are not easily available as to the number of our members who have been injured. There has been a lack of proper investigation into the incidents over a considerable period.

“The guards report incidents that have occurred on every shift, but the bosses at the University Hospital Southampton NHS Foundation Trust and Mitie Security will only investigate when someone is injured.

“Our members are very concerned over incidents occurring right across the Tremona Road site when there has been little or no support from the police who are under pressure because of government cuts.

“Our argument is that we should not have to wait for someone to get injured before a full investigation is instigated.

“That is why the sick pay arrangements are really important. At present, if the security staff are injured at work, and if the resulting investigation finds in their favour, they get two weeks’ full pay and then two weeks’ half-pay. After that, it is the statutory minimum.

“We have members getting beaten up and then having to return to work after two weeks, when they are clearly not fit to, as to drop down to half-pay would mean missing mortgage or rent  payments and significant financial hardship.

“What we want is enhanced sickness payments for those off work due to being injured protecting patients and hospital staff; proper and transparent investigations into all attacks; and our members having the necessary personal protection equipment.

“Our members are seeking six months’ full-pay, followed by six months’ half-pay for all sickness absences. We don’t think those are unreasonable requests, given the level of violence in today’s society generally.”

Unite said that the demand for an increase in pay from the current £8.64 an hour reflected the stress of the job. The security staff are seeking £10.50 for security officers and £12.16 for supervisors, with additional payments of 50p per hour on night rates; £1 an hour on Saturday and double time on Sunday.

Scott Kemp added: “Our members are at the forefront of providing security and a safe environment for staff, patients and visitors – that’s why Mitie’s management needs to get around the table and negotiate constructively.

“There is now a good window of opportunity for such talks before the ballot for strike action closes on 15 March.”

Leave a comment

The Health & Care Professions Council (HCPC) delivered a snub today (Thursday 14 February) by pushing ahead with an ‘extortionate’ registration fee hike, despite receiving a 38,000-signature petition protesting at the 18 per cent increase.
Unite, Britain and Ireland’s largest union, led the protests at the increase from £90 to £106 a year – on Monday (11 February) the union handed in the petition to HCPC chief executive Marc Seale calling for the rise to be scrapped.

Unite lead professional officer for regulation Jane Beach said: “Today the views of the 38,000 mainly health professionals who signed the petition have been ignored which is very disappointing, given the cogent arguments we put forward that NHS pay has stagnated in real terms while the cost of living has raced ahead.

“The HCPC has given a massive snub to our members’ legitimate concerns about any fee hike.

“We consulted widely with our members who have to register with the HCPC in order that they can work professionally – and they gave the proposed increase a resounding thumbs down. Now they have been given a financial kick in the teeth by the HCPC.”
Unite argued that the increase from October 2019 would be another financial blow to hard-pressed NHS staff, such as biomedical scientists, paramedics and speech and language therapists, who have seen the fees increase by 40 per cent since 2014.

1 Comment

Following the Judicial Review in London in July, NHS England quietly launched its promised public consultation on the Integrated Care Provider (ICP) Contracts on 4 August. The consultation closes on 26 October.  If the appeal granted at the other Judicial Review called for by 999 Call for the NHS in Leeds is successful, this ICP contract may yet be unlawful, but it is nonetheless essential that we respond to the feedback.

The ICP consultation document is a daunting read for most of the public. However, Health Campaigns Together (HCT) has provided expert answers to all 12 points in the public feedback document. 

HCT’s aim in providing these answers is to prevent flawed plans being adopted. They are seeking to prevent long-term contracts being signed that will undermine our NHS. This is in order to preserve any hopes of achieving a genuine integration of health and social care as public services, publicly provided free at point of use – and publicly accountable.

 

A reminder on what’s happened so far: There have been two judicial reviews on the Accountable Care Organisations and these Integrated Care Provider (ACO/ICP) contracts. And the courts found in favour of the NHS. But one of the campaign groups, 999 Call for the NHS, has now been granted permission to appeal. 

This is some very good news. But it also means NHS England is consulting on an ACO/ICP contract that may be unlawful. 

NHS England knew full well that an appeal was a possibility. Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the ACO/ICP contract. The consultation says that the Judicial Reviews had ruled in their favour. This consultation runs until 26 Oct.

 

We all know that this ICP consultation needs to be combatted and stopped. But in the meantime, here’s all the information you need to fill in the consultation feedback.

As stated, the judge in the London NHS Judicial Review said that the ACOs (now ICPs) should not be enacted until a lawfully conducted consultation was held, and any eventual ICP contract would have to be lawfully entered into.

Since then, NHS England have moved swiftly and stealthily into gear, and you will find their monstrous ICP ‘consultation’ document at this link.

And here is Health Campaigns Together on the subject at this link.

As you see, the consultation document includes 12 points for feedback and Health Campaigns together has provided suggested responses to these points – very good responses too, I think. You’ll find them at this link.

When you’re ready here is the direct link for public feedback to the document, just copy and paste from the Health Campaigns Together link above.

As stated, there is a move afoot to get the consultation suspended until after the appeal granted to the 999 for the NHS has been concluded, but it’s very important to counter what will definitely be lots of responses from the allies of NHS England. Otherwise they will be able to hail the result as a democratic mandate.

Health Campaigns Together say that it is OK to copy and paste HCT’s responses into the feedback boxes on the questionnaire, although if possible, it would be good if respondents could add a few tweaks of their own.

Leave a comment

National Health Service (Co-Funding and Co-Payment) Bill

2017-19

Type of Bill:

         Private Members’ Bill (Presentation Bill)

Sponsor:

         Mr Christopher Chope

Progress of a Bill

House of Commons

First reading, Second reading, Committee stage, Report stage, Third reading

House of Lords

First reading, Second reading, Committee stage, Report stage, Third reading

Consideration of the Amendments

Royal Assent

This Bill is expected to have its second reading debate on Friday 26 October 2018.

This Bill was presented to Parliament on Tuesday 5 September 2017. This is known as the first reading and there was no debate on the Bill at this stage.

Details of the Bill

National Health Service (Co-Funding and Co-Payment) Bill (HC Bill 37)

A

BILL

TO

Make provision for co-funding and for the extension of co-payment for NHS services in England; and for connected purposes.

Be it enacted by the Queen’s most Excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal, and Commons, in this present Parliament assembled, and by the authority of the same, as follows:—

1.    Amendment of section 1 of the National Health Service Act 2006

  (1)      The National Health Service Act 2006 is amended as follows.

  (2)     In section 1 (Secretary of State’s duty to promote comprehensive health  service), in subsection (4)—

           (a)   the words “the making and recovery of charges is expressly provided for by or under any enactment, whenever passed” become paragraph
                  (a), and

                 (b)   after paragraph (a), insert or

                 (b)   the charges form part of an agreement in England for co-funding or co-payment.

2.  Other amendments of the National Health Service          Act 2006

  (1)       The National Health Service Act 2006 is amended as follows.

  (2)      After section 12E (Secretary of State’s duty as respects variation in provision of  health services), insert—

                                       ““Co-Funding and Co-Payment

  12F                Co-Funding and Co-Payment: England

  (1)            For the purposes of this Act, co-funding of NHS care shall be permissible in England when NHS-commissioned care is proposed to be partly funded—

                     (a)         by a patient, or

                     (b)      on behalf of a patient

  (2)           Co-payments permitted by virtue of this Act shall, in England, include payments made through co-funding as provided for in subsection (1)

 3             Extent, commencement and short title

  (1)          This Act extends to England and Wales.

  (2)          This Act shall come into force at the end of the period of two months after the day on which it receives Royal Assent.

  (3)          This Act may be cited as the National Health Service (Co-Funding and Co-Payment) 2018.

2 Comments

What can it be like to lose the life of a loved one to an institution?

Clinical care is currently running the risk of burying its head in the sand of less than adequate regulators, and being dehumanised in a swathe of bureaucracy.

It struck me recently that the 6Cs of nursing, which arose from NHS England’s “Compassion in practice”, can be, to some extent, applied to patients as well as clinicians.

 

[graphic source]

The 6Cs are: care, compassion, competence, communication, courage, and commitment.

One of my issues is that, while the 6Cs are elegantly branded and themselves slickly marketed, they can, at worst, trivialise what are important issues for the entire health and social service. The issues are inherently more complex than might first appear.

I’m not one of the brigade who believes that everything in healthcare can be measured. One of the problems I have with the adage, ‘If you value it, measure it’, is that you can do inadvertent damage by measuring the wrong ‘key performance indicators’, or skew the discussion unfairly in a particular way.

Arguably, the 6Cs are the sorts of things which ‘you recognise when you see it’, and the same sort of thing can be said for some long term conditions such as dementia and frailty. But merely eyeballing the issues may be necessary but not sufficient. What is the right level of a competence? What would you rate as ‘good enough’ in the standard of clinical care you’d expect from a Specialist Registrar, such as #BawaGarba?

As it happens, I have been thinking a lot about how ‘courage’ applies to healthcare, not least because I have just written a book, jointly and equally with Rebecca Myers. We both had complementary but not identical views about courage in healthcare, from the perspectives of being a service user/patient, leader, manager or clinician.

As it happens, I am still not entirely sure of what the exact definition of courage is. What I do know is that the #BawaGarba case rumbled on, such that the GMC felt it appropriate to bend over backwards in removing a senior junior Doctor from the register of medical professionals. That was courageous, as it was a pretty ubiquitously unpopular decision in the light of organisational learning and ‘just culture’. One can only also imagine the huge courage needed to the parents of the child, or #BawaGarba herself in the face of a media and regulatory lynching.

When writing this book, I myself had substantial health problems. During last year, during the stress of my personal independence payment being refused despite being clearly physically disabled with mobility problems. I had a haemorrhage in my eye.

This meant my visual acuity went from cloudy, to ‘counting fingers’ to only seeing light, over a period of months.

I had an eye operation on January 25th 2018, but unfortunately I soon afterwards had a post-operative bleed, which meant my vision rapidly worsened. I then had a ‘repeat’ operation, called a vitrectomy, which cleared up my vision, meaning I can type this piece on my laptop computer with the affected eye without any difficulty.

Whenever I would hear people who are blind on LBC talking about their disability, I’d think, ‘That could be me’. In fact, despite being on the medical register currently, I had never viewed the patient experience through that prism. But it is very educational, if you believe me like me that the NHS should be comprehensive, universally available and free at the point of need or use.

Because I could not see, I actually fell over on a book in February 2018, which meant I had been rushed into hospital in the back of an ambulance inhaling Entonox like a pregnant mother in labour pains. I had dislocated my shoulder, and was in agony. At 2 am, the Specialist Registrar could not reduce the dislocated humerus bone back into joint, and at 9 am I was in theatre, under a general anaesthetic (which I had never had before).

At roughly the same time, my mum was admitted to hospital, living with dementia, but experiencing a horrific delirium. This is an emotional experience which will have a lasting effect for me forever.

All of these ‘patient experiences’ were deeply emotional. They’re not the sort of experiences which would be box office in a conference, such as promoting the joys of self management, or saying how wonderful the ‘dementia friendly communities’ kite mark is.

But nearly going blind mattered to me. Being in agony due to my shoulder (still healing) made me realise my own vulnerability. And when I used to go into hospital to see mum asleep (hypoactive delirium), I would wonder when or if she would ever wake up; she did, and massively improved when discharged out of hospital.

About 11 years ago, I suffered a cardiac arrest, and then spent six weeks in a coma due to meningitis. Actually, it brought my alcohol dependence syndrome to an end, but those were definitely the worst days of my life (and had a worse effect on others.) The thing is, I had no ‘feeling’ for what it was like to have any of these conditions as a junior doctor or medical student.

Whilst I do not subscribe to the idea that you have to be living with a condition to practise in it clinically, I think there are advantages of having sympathy, even if not complete empathy, with a patient’s experience as a doctor. Kay Redfield Jamieson, professor of psychiatry at John Hopkins, has openly written and spoken about her experiences with bipolar affective disorder.

So when I read terms such as ‘affected by dementia’, I find it quite trite to be honest. It’s really marketing. I could be ‘affected by dementia’ in the same way I am affected by herpes labialise, a cold sore, on the top of my lip, or ‘affected by a verruca on my big toe’.

Being both a clinician and a patient/service user is a highly emotional experience, and one thing I learnt from doing this book, essentially which I learned from Rebecca, is that courage is not solely a personal trait, as a lot depends on your vulnerability and strength within the rest of the system.

Take, for example, the courage Dr Chris Day must have had in challenging whistleblowing protection for patient safety, essentially himself as a whistleblower, putting him at total odds with the medical profession, who as usual protected themselves but not Day. The corpses of careers of people within health and social care are, unfortunately, widespread, and, if ‘lessons have been learned’, things can only get better?

Courage, like the other 6Cs, may trip off the tongue, but certainly does merit scrutiny. Whilst it can be very positive, giving you the strength to face an operation, it is telling you might need to have extraordinary amounts of it waiting for example on a hospital trolley in a corridor with chest pain.

 

@dr_shibley

 

 

 

 

Tagged , , | Leave a comment

By  Ian Kirkpatrick, Andrew Sturdy and Gianluca Veronesi

Few topics have provoked as much debate and controversy in many western societies as the growth in public spending on management consultants. In the UK’s public healthcare sector, the National Health Service (NHS), this spending more than doubled from £313 million in 2010 to £640 million in 2014. Understandably, it is under constant scrutiny and there are considerable pressures to cut the use of management consultants, but spending remains high.

Management consultants provide advice on strategy, organisation, financial planning and assist with the implementation of new information technology. Frequently, they promise significant improvements in efficiency. According to the main industry body in the UK, the Management Consultancies Association (MCA), for every £1 spent on consulting fees, clients can expect £6 in return. However, as shown in a study we conducted recently, published in Policy & Politics, the use of management consultancy in English NHS hospital trusts is more likely to result in inefficiency.

A key question centres on why public sector (or indeed any) organisations use management consultants. On the one hand, it is clear that the growing size and complexity of the NHS has generated a demand for expert advice and support which cannot always be provided in-house. However, critics argue that management consulting firms have fuelled unnecessary demand through sophisticated selling techniques and backstage deal-making with politicians (the so-called ‘revolving door’). A recent example is the development of ‘Sustainability and Transformation Partnerships’ in the NHS which are said to have ‘created an industry for management consultants’.

To date, it has been hard to evaluate these competing claims about the value of management consultants. According to David Oliver, most NHS organisations have been either unable or, for political reasons, unwilling to engage in formal evaluation, resulting in an absence of ‘rigorous, peer reviewable, transparent data’. In this regard, our own study breaks new ground.

To estimate consulting use, we collected data on ‘consulting services’ expenditure from the Annual Reports of acute care hospital trusts in England for four years (2009/10 to 2012/13). In 2013, the 120 hospital trusts included in the sample had a cumulative cost of hiring management consultants of nearly £600 million. This meant an average annual expenditure on consultants of around £1.2 million per trust (although this varied from zero to £5.6 million).

Using pooled time series regression analysis, we looked at the relationship between this spending and the efficiency of each hospital trust over time. The results of this analysis were undoubtedly revealing. While in some cases spending on management consultants did improve efficiency, overall consulting use generated inefficiency, thus making the financial situation of clients worse. In monetary terms, these losses were not great – on average £10,600 for each hospital trust per annum. However, this is in addition to the £1.2 million fees already paid annually to management consultants on average by each trust for little or no gain.

To conclude, these findings suggest that while efficiency gains are possible through using management consultancy, they are the exception rather than the norm, as one would legitimately expect. Overall, the NHS is not obtaining value for money from management consultants and so, in future, managers and policymakers should be more careful about when and how they commission these services. More thought could also be given to alternative sources of advice and support, from within the NHS, or simply using the money saved on consulting fees to recruit more clinical staff.

Of course, when drawing this conclusion, it is necessary to strike a note of caution. From the available data, it is not possible to explain exactly why management consultants are having such a negative impact on efficiency. Part of the problem may be their lack of in-depth understanding of healthcare organisations or disruption caused by having too many consulting projects. However, some responsibility for inefficiency should also sit with politicians and NHS managers who make poor procurement decisions and then fail to implement the advice (even the good advice) they receive. These caveats suggest that more research will be needed in future. Nevertheless, our study is a useful first step in strengthening the evidence base and challenging the myth that management consultants generate efficiency in the NHS.

This article was originally published on Policy and Politics and is republished with permission

6 Comments

Mad Management: Leaders (not) learning the lessons of history, especially in the Public Sector 

“Good morning, good morning!” the general said, when we met him last week on the way to the line.

Now the soldiers he smiled at are most of ’em dead, And we’re cursing his staff for incompetent swine. 

“He’s a cheery old card”, grunted Harry to Jack as they slogged up to Arras with rifle and pack . . .

But he did for them both by his plan of attack.

This was Siegfried Sassoon’s bitter poem about the World War I battle(s) of Arras. By this time 700,000 British men had died: equivalent to wiping out Sheffield and Hathersage. It is the Arras 101st anniversary this month. In fact, the plan was so bad that Sassoon amended the last line to read “But he murdered them both…”

Rightly, we need to remember and honour all those who died; but we also need to understand why they died in such numbers at Arras and how this ultimately led to the defeat of the British at the second battle of the Somme a year later – and to learn some lessons. The Lloyd George government had been steadily draining the fighting men from the front, leaving exhausted veterans of the first battle of the Somme to carry the burden instead of being reinforced. By the end of 1917 the fighting force had decreased by 7 per cent. The infantry alone was 80,000 short, and was projected to be close to half a million short by October 1918. Then came the second battle of the Somme, 100 years ago this year.

Guess what? From March to August that year 544,000 troops were somehow found and sent to France! The war ended in November. By this time 700,000 British men had died: the equivalent of wiping out the populations of Sheffield and Hathersage. Many, many of the deaths were unnecessary, caused by the outdated “plan of attack” and staff incompetence, and by government interference.

Does not this sound like a forerunner of our infamous Austerity policy? Admittedly the horrific scale and utter tragedy of the war bears no comparison, but the dynamics have some real parallels with today, especially in the withholding of resources (Treasury finance) and treatment of much of our workforce in the private sector, and the NHS and Social Care. Note, I am talking of the employees, not the customers or patients. First of all, the Treasury has systematically starved the public services of funding, for no other reason than the Chancellor could. This policy clearly displayed the contempt Osborne holds for the British people, as does Cameron. It is the act of a bully, as befits a Bullingdon alumnus.

We know what the impact has been for Sheffield. David Blunkett, now chair of the Partnership Board said in the Sheffield Telegraph last year that “austerity has dealt a terrible blow to our area”. Too right, and austerity continues to deal terrible blows to the one institution that we are most proud of, the NHS, achieving above average outcomes, with below average funding and below average staff numbers.

It was estimated to require £30 billion by 2020 to meet predicted demand, leaving it £2.45 billion in the red, while record numbers of nurses are leaving and GP practices closing down. There is no valid reason for this. It can only be that government wants it to fail, then, a bit like that doyen of the business world, Sir Philip Green, Jeremy Hunt can sell it for a pound to a USA health company. In the meantime, just like the workers in the gig economy or on zero hours, those in the NHS are increasingly insecure, underpaid and demoralised. And, we are talking about 1.3 million dedicated people.

This is our Somme, with Jeremy Hunt way, way behind the lines plotting the strategy, and, as Siegfried Sassoon wrote: “He did for them (all) with his plan of attack”.

How do the private and educational sectors meet the challenge David Blunkett has laid down, i.e. to regenerate and grow Sheffield? Well, I believe there is a step before we can work together as he urges us to do, and that is first to put our own houses in order. Do we pay our providers and suppliers on time? Have we minimised waste in our production and delivery systems, or are workers constantly having to rework and correct, just the way the government has done on almost every new plan it devised, from IT failures in the NHS, Defence and Welfare to Universal Credit to privatising probation services.

The May Council elections will be an opportunity to remind them. If not then, then do not expect any rise in productivity or increase in cooperation. Herzberg pointed out 60 years ago in his famous study on motivation: if people don’t feel they are paid enough, or are supervised badly or feel insecure then they will underperform. This means that unless these basic conditions, called Hygiene Factors, are fulfilled, you can forget about trying to apply Motivation Factors for productivity.

The second challenge is: To pay our staff enough, and give them some sense of security and belonging. For far too long too many firms have been disloyal to their staff, for example, Sports Direct and the banks. This is an opportunity to change that. I suggest that our universities blaze the trail with no more zero hours contracts.

First published on the JCAshby blog

Tagged | Leave a comment
%d bloggers like this: