Kevin Lewis column
 

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Kevin Lewis column

 

Kevin Lewis column

Kevin Lewis contemplates the financial pressures NHS Trusts are now under, but questions the value of hiring all those ‘experts’ in pinstriped suits.

The report published in mid-October by the Healthcare Commission, regarding the health of the NHS, did not make happy reading. It would have done wonders for the sales of anti-depressants, if only the National Institute for Health and Clinical Excellence (NICE) hadn’t already declared them too expensive.

The old ‘star ratings’ system had become discredited by the widespread evidence that it was being manipulated on a grand scale, not least in terms of the waiting list targets that had featured so prominently. You have to worry about a system where a galaxy of 420 trusts were being given two or three stars (the maximum) and held up as role models, while a mere 24 found themselves on the dark side, with not a single star in their sky.

With financial deficits hitting the headlines on a regular basis, it was not entirely surprising that financial performance and resource management should assume a more central role in the new system of assessment.

Growing concerns over hospital hygiene/cleanliness, and startling statistics on the prevalence of MRSA infections, also made it inevitable that this topic would be moved up the agenda. The new targets are a combination of ‘core’ performance across now-predictable areas – including waiting lists – but also include use of resources, management and ‘developmental’ targets that all Trusts should be aspiring to.
The NHS may be sickly, but the Pareto (80/20) principle seems to be alive and well. One group of 60 or so trusts is said to account for 70% of the overall NHS deficit, and (from a different source) one learns that barely 70 trusts account for 90% of the deficit. On the other hand, as many as one in five of all NHS organisations are predicting some kind of deficit for the current financial year. The government points to the huge additional investment it has made in the NHS in recent years and, in the absence of improvements which are commensurate with the scale of this investment, its conclusion is that the budget is sufficient, but management effectiveness is lacking.
My attention was drawn to a recently advertised position for a ‘Transformation Director’ for an NHS Trust. It was not – as I first suspected – looking for a surgeon to head up the gender-reassignment department. Instead, a six-figure basic salary was offered in return for someone with a proven capability for change-management and the turnaround of failing businesses. It didn’t mention whether the ability to drive a bulldozer was an essential requirement, but it comes to something when we start using terminology like this. Presumably the ‘Modernisation Director’ and the ‘Access & Choice Co-ordinator’ are moving out? It does seem from reports up and down the country – although the variations within the same regions are also striking – that frontline staff including doctors and nurses are being shed while new groups of specialists are moving in.
Transformation Directors are not the only people who can be assured of a place in the executive car park, it seems. Financial consultants are being parachuted in to assist failing trusts in balancing their books, as part of ‘Turnaround Teams’. The cost is spiralling; £3 million was spent between April 2005 and March 2006, with another £7 million between April and July 2006. One statistic recently released is that these ‘deficit consultants’ and financial management gurus had been paid well in excess of £10 million in the past two years. That strikes me as a lot of nurses. The Hammersmith Hospital NHS Trust shelled out in excess of £75,000 per month, on average, over the past 18 months. Not to be outdone, Nottingham University Hospitals Trust has paid out over £600,000 since April alone. That strikes me as a lot of calculator batteries and pinstriped suits.
The prevailing emphasis upon coming in on budget is one which should strike a chord with general dental practitioners. The GDS had always delivered extraordinary productivity, efficiency and value for money. The competitive market in which NHS general practitioners operated also gave the patient (and the government) an extremely good deal in the scheme of things. The government’s dilemma was that our budget was effectively being set at the end of the year, retrospectively, and it was set by dentists and patients in surgeries without a civil servant or beancounter in sight. Not exactly the game plan in today’s NHS.
But isn’t it slightly odd that at the very moment when the Healthcare Commission tells the NHS that it isn’t all about measuring output and waiting list targets, but about the quality of patient care along the way, that the new dental contract takes its eye off the ball of patient care and quality, and concentrates instead upon output? UDAs measure patient charge revenue and (in very crude terms) the number of patients seen and the amount of treatment they receive. But for the first time in over 50 years, there is no longer any detail of the actual treatment the patients are receiving. If there was a medical equivalent of Band 2 it would encompass everything from an in-growing toenail up to a hip replacement or kidney transplant. If Band 2 extended to gender-reassignment, only the appliances would take it into Band 3.
The Healthcare Commission’s report won’t do much to generate a feel-good factor anywhere in the health service. The Trusts certainly won’t like it. The morale of NHS employees won’t be helped by it (as stated by the NHS Confederation) and the government won’t like it at all. Indeed, Patricia Hewitt has given failing trusts just one month to come up with an action plan. Again.
The one bit of good news about the new quasi-devolved NHS is that the government is placed in the happy position of being able to take credit for the exploits of the top-performing Trusts (‘our policies have made this possible’), while tut-tutting about the underperforming trusts and saying publicly that ‘they’ must get their house in order pretty damn quick. So instead of ‘Tries hard, could do better’, the half-term report for the NHS probably reads ‘Very trying. Can’t get much worse.’ I’m not so sure about that. Maybe Patricia Hewitt should not be holding her breath just yet. Just a week after the Healthcare Commission’s report came revelations in The Times that seven times as many community hospitals have closed, or are under threat, in constituencies held by opposition MPs, than in constituencies held by Labour MPs.
The Human Tissue Act, which came into force only in September to facilitate a huge increase in the number of organ transplants, has floundered on the fact that over 25% of the positions for transplant surgeons in NHS hospitals around the country remain vacant and while budgets rule ok, they may remain so. The British Medical Association is warning of major dislocation in respect of positions for junior doctors, and Lord Harries (the interim chairman of the Human Fertilisation & Embryology Authority) has stated that the NHS doesn’t even implement the IVF guidelines issued by NICE. If the scoreboard is still looking like this by next April, the Transformation Director could well be making way for applicants from the Magic Circle.

 Posted on : Wed 8th - Nov - 2006

 

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