Recommended Posts

I'd like to see this one defended then.  28% of children referred to mental health services were refused treatment, including 9000 with life-threatening conditions.  This doesn't even include those who have been put on waiting lists that are over six months in length and even then usually result in rationed treatment.  Imagine a child turning up at A&E with a broken leg and being told, "sorry, we won't help you" or "come back in six months and we might do something but won't promise to be able to help".  And this is a system that prioritises children, adult services are an order of magnitude worse.

 

The ONLY defence the current government have is that they've promised some extra money but nowhere near enough to resolve the problem.  It'll just go to private providers who charge 3-4 times what it costs the NHS to keep a patient as an inpatient or provide therapy services. The government needs to commit to reverse the ridiculous cuts to inpatient child and adolescent mental health beds, that needs to come from multi-year commitments to invest in building new hospitals and wards plus the same commitment to funding psychologist training.

Share this post


Link to post
Share on other sites

Just been in the most depressing meeting of my NHS career so far. The meeting was to approve bringing in lawyers to review a contract to get the best terms for us at the best price. Pity it was a contract between two wholly owned subsidiaries of NHS England paid for by NHS England and with the lawyers' bills of both sides paid for by the NHS.

The era of goodwill in service deals in the NHS is now dead.

Share this post


Link to post
Share on other sites

Just been in the most depressing meeting of my NHS career so far. The meeting was to approve bringing in lawyers to review a contract to get the best terms for us at the best price. Pity it was a contract between two wholly owned subsidiaries of NHS England paid for by NHS England and with the lawyers' bills of both sides paid for by the NHS.

The era of goodwill in service deals in the NHS is now dead.

Shameful

Share this post


Link to post
Share on other sites

Then when the private company wins they ask for more money to cover every vague point that they insist is in their favour or they threaten to walk. Happens almost every time. I saw one major contract covering a large multi county area do exactly that over the first few months of this year and the NHS had to buckle as they'd disbanded the losing NHS organisation.

One that should be announced today in the media is a Trust up north taking a service back in house after the private company won it, took all the staff on then said "give us double the money or we walk as this is unviable". Unfortunately for the private company it didn't bank on the Trust saying "no" and meaning it.

Share this post


Link to post
Share on other sites

Just been in the most depressing meeting of my NHS career so far. The meeting was to approve bringing in lawyers to review a contract to get the best terms for us at the best price. Pity it was a contract between two wholly owned subsidiaries of NHS England paid for by NHS England and with the lawyers' bills of both sides paid for by the NHS.

The era of goodwill in service deals in the NHS is now dead.

 

 

Absolutely. The rule used to be that you write the service specification using goodwill rules where it's assumed everything is written to be mutually beneficial where it's vague. That allows good give and take plus also avoiding lawyers.

Now though, private companies are challenging virtually every deal that goes to a NHS bidder with the contract being used to prove it's not commercially robust claiming therefore the tender should be rerun with the NHS bidder barred.

It's costing us an absolute fortune in both time and fees and has also introduced conflict into every arrangement rather than working to mutual benefit.

 

 

Then when the private company wins they ask for more money to cover every vague point that they insist is in their favour or they threaten to walk. Happens almost every time. I saw one major contract covering a large multi county area do exactly that over the first few months of this year and the NHS had to buckle as they'd disbanded the losing NHS organisation.

One that should be announced today in the media is a Trust up north taking a service back in house after the private company won it, took all the staff on then said "give us double the money or we walk as this is unviable". Unfortunately for the private company it didn't bank on the Trust saying "no" and meaning it.

 

Craig, have you thought about a bit of 'whistleblowing' and passing the details over to someone who can hold NHS, DoH and HMG accountable for this farce?

Share this post


Link to post
Share on other sites

Craig, have you thought about a bit of 'whistleblowing' and passing the details over to someone who can hold NHS, DoH and HMG accountable for this farce?

No need to whistle blow. It's a properly approved commercial process that was brought in by our government very deliberately.

Private companies can't operate easily in goodwill structures so the rules were changed to make it work for them. Pity that means the internal competition of the NHS needs to follow the same faux commercial rules that do nothing but add stupid costs.

This isn't new by any means and has been shouted enough by those who know what they're on about more than I do but it's roundly ignored by everyone as "stop complaining, at least you're not as badly affected as councils are"

Share this post


Link to post
Share on other sites

No need to whistle blow. It's a properly approved commercial process that was brought in by our government very deliberately.

Private companies can't operate easily in goodwill structures so the rules were changed to make it work for them. Pity that means the internal competition of the NHS needs to follow the same faux commercial rules that do nothing but add stupid costs.

This isn't new by any means and has been shouted enough by those who know what they're on about more than I do but it's roundly ignored by everyone as "stop complaining, at least you're not as badly affected as councils are"

 

 

Have the NAO not shown any interest in this? It seems like something they should be involving themselves in and passing over to the PAC. Maybe they have and I've missed it.

Share this post


Link to post
Share on other sites

Have the NAO not shown any interest in this? It seems like something they should be involving themselves in and passing over to the PAC. Maybe they have and I've missed it.

Why would they be interested? This is a best practice commercial arrangement. Seriously. Nothing to investigate. In private industry this is standard practice and lawyers are routine because it's expected that each side will screw each other over if they can.

Share this post


Link to post
Share on other sites

Why would they be interested? This is a best practice commercial arrangement. Seriously. Nothing to investigate. In private industry this is standard practice and lawyers are routine because it's expected that each side will screw each other over if they can.

 

 

Surely the NAO and PAC are interested in anything that costs the public purse more than it could do.

Share this post


Link to post
Share on other sites

A different example of NHS inefficiency at work.

 

Last month, we were advised by our regulator that the timetable for reporting financial information to them each month would be shortened by nearly a week, meaning that the submission has to go to them prior to our Board meetings, meaning it hasn't gone through a proper governance process. Despite this, they still haven't managed to send us the template as yet that we'll have to complete, so I can't say with certainty what information will be required, or in what exactly what format. Doesn't help with preparation, when the deadline for submission is now in 9 working days.

Edited by gazza77

Share this post


Link to post
Share on other sites

A different example of NHS inefficiency at work.

 

Last month, we were advised by our regulator that the timetable for reporting financial information to them each month would be shortened by nearly a week, meaning that the submission has to go to them prior to our Board meetings, meaning it hasn't gone through a proper governance process. Despite this, they still haven't managed to send us the template as yet that we'll have to complete, so I can't say with certainty what information will be required, or in what exactly what format. Doesn't help with preparation, when the deadline for submission is now in 9 working days.

"Give us information, we won't tell you what we want or what it's being used for but you'll be judged and publicly shamed if it's wrong."  Heard that one a few times so far this financial year.

Share this post


Link to post
Share on other sites

Surely the NAO and PAC are interested in anything that costs the public purse more than it could do.

No, not really.  Is it commercial good practice?  If so, that meets the brief.  The days where people in Westminster cared about the NHS being deliberately made inefficient so to make it better for commercial takeover are long gone.  If there's a practice in the NHS, or in public sector generally, that makes it more difficult for a private company to compete then the public sector organisation will be pushed to change, even if it costs far more money and is grossly inefficient.  It's a lost battle, even the current Labour shadow cabinet don't complain about it and they're probably the furthest left opposition we'll see again.

Share this post


Link to post
Share on other sites

"Give us information, we won't tell you what we want or what it's being used for but you'll be judged and publicly shamed if it's wrong." Heard that one a few times so far this financial year.

Wouldn't surprise me. I know pretty much what will be expected, however they have a history of changing formats and classifications subtlety with next to no notice. Add in that what takes a day to produce and be reviewed now has to be done in such a tight timescale is getting rediculous.

Another example is that we're a Vanguard organisation. Two months into the financial year, we haven't been told formally what funding we'll be getting, but it is available online for the world to see. Funding for the schemes has also been slashed.

Share this post


Link to post
Share on other sites

Wouldn't surprise me. I know pretty much what will be expected, however they have a history of changing formats and classifications subtlety with next to no notice. Add in that what takes a day to produce and be reviewed now has to be done in such a tight timescale is getting rediculous.

Another example is that we're a Vanguard organisation. Two months into the financial year, we haven't been told formally what funding we'll be getting, but it is available online for the world to see. Funding for the schemes has also been slashed.

We were asked to bid to help Vanguards nationally with their strategies.  We were given 6 weeks to do every one in England.  We got some blank looks when we told them that not all Vanguards are the same and it'd take 6 weeks to simply meet all the relevant people and say hello, never mind actually find out what each local Vanguard needed to succeed.  I genuinely think that there are some very senior people who believe an acute focussed Vanguard is the same as a community focussed one and that one-size-fits-all on their strategy and governance.

Share this post


Link to post
Share on other sites

We were asked to bid to help Vanguards nationally with their strategies. We were given 6 weeks to do every one in England. We got some blank looks when we told them that not all Vanguards are the same and it'd take 6 weeks to simply meet all the relevant people and say hello, never mind actually find out what each local Vanguard needed to succeed. I genuinely think that there are some very senior people who believe an acute focussed Vanguard is the same as a community focussed one and that one-size-fits-all on their strategy and governance.

We're a Care homes vanguard. We get asked for information and detailed financial modelling with sometimes only 48 hours to turn it round, then surprise when some of the detail at best is sketchy. Still, launched to huge fanfare about what they'd bring and the new ways of working and the funding for them was for over 5 years. Less than 12 months in, funding slashed, and I'd bet they're gone at the end of this year. What a waste of potential.

Share this post


Link to post
Share on other sites

We're a Care homes vanguard. We get asked for information and detailed financial modelling with sometimes only 48 hours to turn it round, then surprise when some of the detail at best is sketchy. Still, launched to huge fanfare about what they'd bring and the new ways of working and the funding for them was for over 5 years. Less than 12 months in, funding slashed, and I'd bet they're gone at the end of this year. What a waste of potential.

STPs are the Vanguards of this FY.  If you can fit the magic word of "interoperability" into your plans then you'll keep some senior people in NHSE happy.

Share this post


Link to post
Share on other sites

Tonight, of the ten hospital trusts in the east of England (Essex, Suffolk and Norfolk), five are on red alert meaning they are starting to not treat seriously ill patients within 8 hours of arriving at A&E due to not having enough beds to treat them, five are on black alert meaning they have fewer beds than seriously ill patients who require one in the entire trust, including in A&E, and can no longer deliver comprehensive emergency care.  Two of those five on black alert have declared Internal Critical Incidents where they can no longer deal with all very seriously ill patients who turn up at A&E.  By very seriously ill, that usually means people might die and they're having to divert patients to other hospitals.  Pity there are no hospitals in the region with any capacity for them.

 

On a Monday night.  In June.  With nothing going on, no major incidents, no seasonal illnesses, no extreme weather, no staffing pressures (such as a strike) and nothing else out of the ordinary for a quiet Monday night in early summer.

 

In any other government in my lifetime, regardless of government politics, a Health Minister would be out of a job with statistics like that.  Out of a job and it treated as a national disgrace.

Share this post


Link to post
Share on other sites

One of the odd things we turned up when we were doing some analysis work for NHS Scotland last year was that at times of severely bad weather A&E numbers actually fell. The thinking was that those with minor ailments were put off from going to A&E when it was more difficult to get there, i.e. the busses were off or the pavements were difficult to negotiate because of snow etc. 

Share this post


Link to post
Share on other sites

One of the odd things we turned up when we were doing some analysis work for NHS Scotland last year was that at times of severely bad weather A&E numbers actually fell. The thinking was that those with minor ailments were put off from going to A&E when it was more difficult to get there, i.e. the busses were off or the pavements were difficult to negotiate because of snow etc. 

Yep, a well known thing down here as well.  What has been practice for a while though, and we've helped roll a few out, is putting out-of-hours GP practices either in A&E or very close-by.  For example, Ipswich Hospital's out-of-hours GP practice is under 50m from the A&E doors.  When the board turns red or black, a GP or A&E consultant will man the A&E doors doing triage with those classed as less than seriously ill routed either to the out-of-hours practice or to other community resources.  Last night, all hospitals showing black status were refusing at the doors anything that could be treated by out-of-hours primary care resources, most red status ones were doing the same, the only ones who didn't are those with no nearby out-of-hours GP surgeries or walk-in centres.

Share this post


Link to post
Share on other sites

Yep, a well known thing down here as well.  What has been practice for a while though, and we've helped roll a few out, is putting out-of-hours GP practices either in A&E or very close-by.  For example, Ipswich Hospital's out-of-hours GP practice is under 50m from the A&E doors.  When the board turns red or black, a GP or A&E consultant will man the A&E doors doing triage with those classed as less than seriously ill routed either to the out-of-hours practice or to other community resources.  Last night, all hospitals showing black status were refusing at the doors anything that could be treated by out-of-hours primary care resources, most red status ones were doing the same, the only ones who didn't are those with no nearby out-of-hours GP surgeries or walk-in centres.

 

Of course that begs the question of why so many people turn up at A&E who really shouldn't be there in the first place? Is it lack of GPs? The lack of education and information? Is it that people don't trust their own judgement to make decisions on minor health issues to treat themselves with the assistance of their local pharmacy for example? 

Share this post


Link to post
Share on other sites

Of course that begs the question of why so many people turn up at A&E who really shouldn't be there in the first place? Is it lack of GPs? The lack of education and information? Is it that people don't trust their own judgement to make decisions on minor health issues to treat themselves with the assistance of their local pharmacy for example? 

Now, there's the important point.  There are multiple points of failure in the system: 

 

- no-one has faith in our out-of-hours GP system.  In Suffolk, it's run by Care UK and they'll only turn up if you know this week's magic phrase or the GP is bored and fancies a run around in their car.  Quite often you get very concerned people taking their family members to A&E for what is clinically minor but is very concerning for the patient/carer because they're not clinicians and don't know what the otherwise concerning symptoms mean, they call for out-of-hours GP assistance and get told to "take two paracetamol and see your GP tomorrow/on Monday".

- community and mental health care are in a desperate state now, they simply don't have the resources to deal with urgent issues meaning patients have to go to A&E if they're in trouble.  Most counties have no effective Crisis team in place and most are running at under one place of safety bed per million patients (these are the places the police can take acutely ill mental health patients while they wait to be assessed).  Over half of police forces will have at least one sectioned mental health patient in their cells awaiting assessment for over 72 hours because there's nowhere else for them to go.

- NHS Direct was replaced by 111.  A nurse-fronted organisation who could offer good triage advice was replaced by one that is fronted by low-paid telephone operators, they have to send people to A&E, or at least send an ambulance, if it doesn't fit their script.  To save a few beans per call in this triage resource is costing far more down-stream in the A&E ward and waiting room.

- even during working hours, most GP surgeries can't do same-day, short-notice appointments and will send you to walk-in centres or A&E if they can't cope.

- the government funded quite big capital funding projects last year through the Prime Minister's Challenge Fund.  Pity it only offered one year's worth of funding and expected the local areas to pick up ongoing funding.  I've seen hugely valuable out-of-hours GP hubs set up using this capital funding last year then the local CCGs scratch their heads over who will pay for it this year, I will not be surprised to see 50%+ of them closed down later this year.

 

This isn't a party political point, many of the above points were started under Labour, especially the GP contract idiocy back in 2002.  It does need to be fixed though.

 

There simply isn't management at the political level.  It's manage by statistics and spin.  For example, hospital trust Chief Execs are being patted on the head for reaching their 4 hour A&E target regardless of consequences; one trust I know simply turns away anyone deemed less than seriously ill, even if there are no available other medical resources available.  Technically, the hospital is right but then the patient is out on their own, nowhere to turn for what they feel is a serious enough illness that they'd happily wait for hours in an A&E to get treated.  From an overall patient perspective, this is shameful, the NHS should treat patients rather than turn them away.  If that needs more funding to the overall system so it fixes the primary care disgraceful state then it should do so, explaining to the electorate that taxes must rise to make the NHS work properly.

Share this post


Link to post
Share on other sites

A&E threatened with closure due to some really unacceptable practices.

 

What does Hunt have to do to be shamed into resigning?  The emergency and urgent care bits of the NHS are hanging on by very sore fingertips and require more than a few well spun soundbites to fix.

 

 

Nothing matters right now.  EU and/or bust.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recently Browsing   0 members

    No registered users viewing this page.


League Express Yearbook 2018/19 - Order Now


Rugby League World - Nov 2018

Rugby League World - Nov 2018



League Express - Online Now

League Express - Every Monday