Well it’s just about enough to get the old bile flowing again. I have just watched the oleaginous (former Marxist) SoS for Health lie fluently to give a classic demonstration of central credit and local blame. He was absolutely clear that the failings at Stafford Hospital were nothing to with any government policy whatsoever, and everything to do with poor local management. Yes, all the blame is already being directed straight at the chief execs, who will of course nobly take the hit for the DoH.
“The trust was more concerned with hitting targets, gaining Foundation Trust status and marketing and had 'lost sight' of its responsibilities for patient care, the report said.”
Well of course they were. It’s what the DoH operating protocols had told them mattered. The talk about local flexibility, and patient centeredness and other such bollocks is the mood music. But DoH protocols have so many binding sub clauses that local managers have to enact as part of their statutory duty. So let’s not pretend that “bad local management” is the problem- the problem here is top down, from the centre outwards.
Here in one crystallised example is everything that we have said is wrong with the NHS on this very blog.
- The mismatch between targets and what actually matters.
- The mismatch between management agendas and any form of good treatment for patients.
- The mismatch between “high quality foundation trust status” and “basically competent patient care.”
- The mismatch between “we need clinical engagement” and any willingness of management to actually engage with clinicians.
- The mismatch between government rhetoric and medical and patient reality.
The NHS had gone a bit quieter in 2009, and it’s to Postman Pat’s credit that he’s kept it off the front pages for so long whilst his evil henchmen Dastardly Darzi and Mutley Bradshaw rile GPs and prepare to destroy the only vaguely reasonable bit of the service.
Well, Patsy Fuckwit has now gone, and is this when Postman Patsy starts to earn a new delivery run?
Like the country, the NHS urgently needs new management.
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Despite huge job losses and mounting financial problems, the NHS is enjoying "its best year ever" according to Health Secretary, Patricia Hewitt (April 2006)
http://news.bbc.co.uk/1/hi/health/4935358.stm
Ahhh, it only seems like 5 minutes ago that all was well in the NHS garden.
Keep a big enough gap between the mandarins and grunts and the managers will get up to all sorts of shenanigans - we can all tell our stories about one problem or another.
Presumably certain tensions must have arisen in Stafford between saving dosh and looking after patients - with the holy grail of Foundation status fueling the schism ?
Of course, anybody who draws attention to lapses in care is informed "the NHS is enjoying its best year ever" before being invited to the next available fitness to practice hearing - the life of an NHS whistle blower is never an easy one.
I wonder if future health scandals (under Cameron's stewardship) will follow similar patterns or can we expect new forms of abuse ?
New forms of abuse will come. The only thing new about them will be the reforming spin that goes with the territory.
Although I overall agree with Dr R's view of mismanagement by government...I certainly can't see how a hospital killing off it's patients warrants Foundation Status (then again Foundation Status is another layer of bureaucratic pap of no use to patients)..I also think CEO's need to take responsiblity....for doing their master's bidding.
I have yet to hear of CEO's revolting against what is being done to the NHS. In fact, I think they are doing rather nicely out of it and usually, certainly locally, when the going gets tough (and accountability raises its head) they fekk off but not before trying to dummy the stats.
By all media accounts the Staffordshire Hospital, in question, is doing marvellously now. Would be interesting to get the patient feedback on what they think of that.
In all of this double bluffing, am slightly pleasantly surprised that the Healhcare Commission did the job that patients need it to do. However, perhaps the arm was forced when the skeletons refused to stay in the cupboard. Hmmm
Government ministers are 'evil' but not your GP leaders, Meldrum of the BMA and one of the top dogs at the Royal College of GP who both signed lucrative contracts for a brand new poly themselves Dr Rant?
I haven't heard 'one' GP criticise those! I wonder if 'you', outspoken as you are, would?
Sam
The reason why we haven't been openly critical of Hamish Meldrum or other doctors who have bid for Polyclinic contracts is simple.
They are not 'lucrative'. They take an immense amount of effort to bid for and run, they duplicate services already provided, and they break even at best cost/profit wise.
The doctors in question were faced with the alternative of letting a faceless corporate entity come in feck things up, and possibly using the polyclinic as a loss leader to muscle there way in and screw the traditional local practices.
The only way a 'polyclinic' can make money is by replacing doctors with nurses and pocketting the difference.
We were faced with the same choice round here. I decided not to get involved, but I understand and support the local GPs who have.
Better than having Beardy Branson as a neighbour.
Polyclinics are frothy irrelevances in the grand healthcare scheme of things - they are however trojan horses for the privatisation of the bit of the NHS that works best (although no well enough everywhere).
Frank
hewitt leicester west mp
vaz leicester east mp
if they put up an arsehole next election would the electorate vote for it.
have they already done so? I couldn't possibly comment
hughev
"They are not 'lucrative'. They take an immense amount of effort to bid for and run"
Of course they are, otherwise nobody would have gone for them, let alone your own leaders! Nobody embarks on a new business and as you say, all the troubles attached unless they know they will make a living out of it .. at least. Then again, won't these centers be guaranteed their income for the first two years? A luxury compared to others who venture into private business if you ask me!
And I don't believe in your logic for why your leaders went for those centers either, again, no one goes into business 'knowing' the will lose.
Dr Rant, it is simple, GPs are not used to competition and therefore think that by the introduction with such little competition, this with sign and seal the end of general practice in this country. This, to those of us who are churned by competition on a daily basis, know this is not true. All you have to do is for good docs like yourself and I do believe you are a good compassionate doc, is to provide good service and control cost. As you and I know, many GPs out there dont. Those are the ones who need to clean up their act or go down .. and it would be just if they did.
And I'd jump in head first if you can direct me to where can I find a business opportunity that will guarantee my income for two whole years! .. the notion does not exist in the 'real' jungle out there .. again .. ask me!
Have a look around, the travel industry, the airline industry .. only 20 odd years ago, those two were classified as one industry! Have a look at what is happening to 'both' now! Think what do yourself do when you want to book a flight to anywhere! .. This 'is' competition! Not the misre 150 polys!
Excuse my spelling mistakes :-)
Oh yes! .. and bearded Branson would have been kinder to his staff as well as his fellow GPs, much more so than your own U turned guys and simply because he is well covered and can afford to! Wait and see!
I spoke to my own GP who is committed to retain a traditional surgery, and he admitted that running a polyclinic was more lucrative for the doctors concerned. I have to agree with Sam. What worries me is that these GP-led polyclinics will mean that more services will be cascaded down to practice nurses because the GPs will be spending more time on administration. Far better to let someone like "beardy Branson" run outfits like these, employing GPs to do what they do best, i.e. looking after patients.
What worries me is that these GP-led polyclinics will mean that more services will be cascaded down to practice nurses because the GPs will be spending more time on administration.
You've got it the wrong way round:
That's what will happen in Beardy's polyclinics! You will see a nurse. The presence of a doctor (propably not an experienced one) in the building will be used to legitimise the enterprise. You will not have the right to opt to see that doctor.
"The presence of a doctor (propably not an experienced one) in the building will be used to legitimise the enterprise. You will not have the right to opt to see that doctor."
Where did you get this information Dr Rant?
And those 'inexperienced' GPs, don't they have the right to a job? Instead of currently being unemployed after 'fully' qualifying as GP, a process that took them 10 - 11 years? It seems their only hope is those new centres since their fellow senior GPs out there do not want to offer them partnerships anymore! .. and no one cares about their dilemma either! Not even their royal college or the BMA!
And I wouldn't call those young GPs 'inexperienced' since GP training is 'fully' hands on. Those are 'fully qualified' GPs and should be recognised and respected as such. BTW, the new centre that opened in Bedford has 10 GPs and the number is rising.
I thought you were on the side of the juniors Dr Rant, why not those young GPs too?!
Pull your thumb out of your arse for a change.
Darzi centres are only profitiable if the proportion of doctor appointments to nurse appointments is reduced. The GPs will be largely newly qualified, because no one with more than half a brain would chuck in a stable partnership to take a job in one.
One inexperienced GP (without on site senior or even peer backup) is all that will be available in our local Darzi.
Recently trained GPs lack experience in actually running a practice (a distinct ommision from VTS training programmes) but also in GP as a whole.
It's not what you know, it's how you apply it. You can either benefit from the wisdom of others, or you can find out by trial and error.
A full time GP sees 5000 patients per year. After a decade that's 50,000 patients more experience than a newly qualified GP. Anyone with any experience of anything relevant will know this means a hell of a lot with all else being equal.
Don't fall in to the Zanu-labour trap of think 1=1 therefor everything is equal.
The best way for a newly qualified GP to mature is within traditional mutually-supportive partnerships. This is not what Darzi and other privatisations are about (I know becasue I do some work outside GP for such a private organisation).
Workforce planning has cocked up again. There are too many newly qualified/married/mother young GPs chasing part time salaried jobs as well as those looking for partnerships.
I have heard rumours that companies like Virgin will submit very cheap tenders (to begin with) accepting that they will make a financial loss in the first few years.
On this basis they will be able to muscle out NHS bidders, then, once they have established a foothold in the market, will have much greater freedom when it comes to shaping future services.
Why just the other day I was told that being an ENP with so much experience made me "a valuable commodity in the current climate" - all of these arguments are playing out at our place and Dr Rant is absolutely correct, there is far too much emphasis being placed on nurses and inexperienced or unsupported doctors.
We need to slow down and stop, while we think all of this thing through - the NHS needs a period of stability and chance to reflect on what (if anything) is actually working properly..
Which ever we go, though, I am very doubtful that Holly-clinics will provide any sort of long term solution to some of the problems in primary care.
The majority of those centres have been won by GP consortiums alread7, hence, there will always be seniors on site.
Of course young GPs would prefer a partnership but those and no longer available because many senior GPs out there want to keep the business to themselves and hence, only offer those salaried part time positions you are talking about .. hardly a fair situation.
And I do not resource to 'expressions' such as those you use so please do the same, unless your intention is to push me out of 'your' debate Dr Rant, is it?
The majority of those centres have been won by GP consortiums alread7, hence, there will always be seniors on site.
Wrong. Plain Wrong
The SLAs (service level agreements) neither stipulate nor fund a senior GP (or even more than one GP) on site. Our Darzi is run by a GP consortium.
The PCT agree that the concept is bollocks, and are trying to spend as little as possible on it and are desperate not to destabilize the local practices because they recognise that the system as it stood works, and the imposition of the 'Islington solution' in our Shire town is a total waste of money and effort.
For the money we could have reorganised and rehoused 2 or 3 existing practices in new buildings - making a huge improvement in service capacity and accessability .
The Darzi will initially be capped at about one patient every half hour.
dr rant is correct in everything he says.i am a gp(in an equal partnership--and i as the senior profoundly believe in this equality and agree that the modern trend to 'salaried gps' is essentially just returning to the bad old days of exploitation and is extremely mean minded and short sighted).
i never cease to be astounded by the infinite incompetence, duplicity and corruption of this completely disgraced 'government'.
i am afraid the only solution is its complete utter and total annihilation asap before they do more damage.i do not exaggerate..they are worse than hopeless with an endless list of incompetencies.....and by wasting billions on idiocies they are directly responsible for many deaths and much suffering..despite their original good intentions.At the same time all strategic health authorities should be abolished and 90 per cent of pct employees sacked...the money saved to go into frontline healthcare.(including their 'bonuses'--ie performance related pay to meet inane central targets).This is OUR health service not a toy to play childish games with..At the same time i think the nhs would run far better and more efficiently if 99 percent of central nhs ''management'' were sacked..plus 100 per cent of all the absurd useless quangoes with their underexperienced vastly overpaid arrogant crony undemocratically appointed leaders.
As for dafti's utterly idiotic polyclinic scheme--i thought such superannuated nonsense was discredited in the ex soviet union 30 years ago..note he has now left department of health to spend more time in a paid relationship with one of the private providers he held secret meetings with;also he has time to continue as a 'lord'--suits him now we know of the extreme greed and corruption demonstrated so often recently in that sorely abused house of parliament. farewell dafti--when you are on your death bed i hope you are still tormented by your disgraceful unprofessional corrupt antidemocratic arrogant ignorant record that is ending in absolute and complete failure with yet more wasted money...i hope you are haunted by the people who may die because you have diverted money away from REAL health care ie drugs clinicans beds..i doubt you would recognise real quality health care if it hit you in the face.good riddance to bad rubbish.
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