Saturday, 24 November 2007

Forging ahead

The government continues to rapidly change the way in which health care is to be delivered, and yet another reform is being steam rollered through in front of our very eyes. Do we trust the 'Commercial Directorate' to do this job properly? Does rapid rushed reform result in the best long term results? I'll leave that for you to answer.

Dr Grumble reiterates the worrying lack of consultation that has taken place regarding the lowering of the burden of proof in doctors' fitness to practice cases. It turns out that this highly controversial change is included in the government's legislative programme, this can be read here:

"13. Health and Social Care Bill
The purpose of the bill is to:

create a new integrated regulator for health and adult social care, Ofcare, bringing together existing health and social care regulators into one regulatory body;

reform professional regulation to enhance public and professional confidence and strengthen clinical governance as part of the Government’s response to the Shipman Inquiry; and

• include provisions to make a one off payment to all expectant mothers from the 29th week of pregnancy.

The main benefits of the bill are:

• to assure patient safety and apply a consistent approach to regulation for all types of provider through a new registration regime, requiring providers of health services and adult social care to be registered;

• to implement the 2006 Budget commitment to bring together existing health and social care regulators into one body (‘Ofcare’). This will operate with a significantly lower budget than the existing bodies and be established in 2008; and

• to implement, following the inquiry into the case of Harold Shipman, the manifesto commitment to strengthen clinical governance; and to ensure professional activity is more accountable to the public.

The main elements of the bill are:

To establish a new, integrated health and adult social care regulator Ofcare,from existing regulators; to define the functions of the new regulator in the areas of safety and quality assurance, information and performance assessment and safeguarding the rights of detained mental health patients; and to update the system of registration that applies to providers of health and adult social care services and extend this to include NHS providers.
To introduce legislation to use the civil, rather than criminal, standard of proof for all healthcare professional regulatory bodies; to create an independent adjudicator to undertake independent and objective formal adjudication for the professional regulatory bodies; and to ensure that all healthcare organisations employing or contracting with doctors appoint a ‘responsible officer’ with personal responsibility to work with the GMC to identify and handle cases of poor professional performance by doctors."

This government is not one to do things by halves. This government seems to think that legislation and reorganisation will automatically result in improvement to services, we have seen time and time again how the exact opposite is true. Endless reorganisations in the civil service has led to numerous scandals that could have easily been avoided, such as the missing data on the 25 million for example. Reorganisation without thought and with far too much speed is not necessarily a good thing. The token useless gimmicky policy is present with the one off payment for pregnant mothers, something else to encourage single mums to procreate, but what a great soundbite for our politicos to use in their regular propaganda delivery sessions.

DK and Dr Rant have been covering the slightly underhand efforts of a certain PCT in trying to force work in the direction of an ISTC. Choice (TM) as Dr Rant calls it seems to be the very opposite of genuine choice. Dr Ray covers the complete failure of yet another botched DoH attempt to improve efficiency by involving the private sector.

I particularly enjoyed this piece by Dr Rant that neatly describes the reality of MTAS, it puts the words of Donaldson et al into context; Donaldson's pride in the DoH's salvage job is a bit like George W Bush being proud of the mess that Iraq has been left in.

The recent rank incompetence exhibited by HMG is neatly summarised by Barry Monk, it really is hard to understand how these idiots think ID cards are such a good idea, when they repeatedly fail to deliver with much smaller schemes. This old piece by SJ Howard amazingly tells the story of how the government chooses to reward failure and rank incompetence with juicy new contracts; the makers of MTAS, Methods Consulting, appear to be profiting from their lack of skill. While on the subject of incompetence, Dr Grumble talks of a scandal that shows how the government will privatise anything, seemingly oblivious to the dangerous long term consequences of this; nothing new there then, short term gain and more long term pain.

The Witch Doctor is obviously more than a little sceptical of HMG's deep clean, I have to say I agree with him and when one sees that there has been another Clostridium Difficile outbreak in Maidstone right after their 'deep clean'; it certainly adds evidence to our argument. Another piece of misinformation present in the media is the constant lies about doctors' salaries. Chez Sam's points out that junior doctor's are relatively rather feebly rewarded given their training and expenses. Some rather salient facts are listed that make the financial rewards of nursing look relatively generous in comparison.

The rather grim reality of nursing in the NHS is spelt out by militant medical nurse, I can see why frontline nurses such as herself are considering fleeing to lands afar. Nurses are frequently left with far too much on their plates, as our many frontline doctors; and when the shit hits the fan, it's never the manager who gets the blame, even though they had been warned about the dangerously low staffing levels. It will be the doctors and the nurses who take the hit. This topic was touched upon fairly recently by Advanced Practitioner here.

Something that is sure to be in the news a lot in future weeks, is the rather worrying shortage of acute beds in the NHS. It's amazing that after so many billions invested in reform and reconfiguration bed numbers are falling year on year. Couple this with increasing immigration and an increasingly elderly population, and you have a recipe for disaster. Anyone working in the NHS will tell you that many problems such as MRSA are propagated by this shortage of beds and the need to run at almost 100% bed occupancy levels all the year round, most places I've worked at are full to bursting at even the most quiet times of year.


jayann said...

'increasing immigration'? Because there's (if there is) a larger net population (entitled to NHS treatment)? Aren't immigrants more likely to be young?

(I agree we need more beds. Do you think we should also look into refusal of full medical access to EU migrants -- as France is doing?)

Garth Marenghi said...

that was my point:

we have an increasing population with large amounts of immigration from the EU

we also have our current population which is becoming more and more top heavy- this is set to continue for several years

Garth Marenghi said...

ps in answer to your second point- I think it should be considered and it might well be a good idea

jayann said...

Yes I got the point, I just wasn't sure whether the number of immigrants exceeded the number of emigrants. (As the figures won't be accurate anyway, it's a bit difficult to know.) also,

we also have our current population which is becoming more and more top heavy

wherefore, young immigrants might be thought necessary

(Refusal of access is slightly complex, we may not have same the type of EU-retiree population as France. But it's worth looking into.)