27 September 2011

Block the Bridge. Block the Bill.

"The National Health Service is the most important institution we have ever had in this country."

"It's not theirs to sell."

26 September 2011

A doctor's touch

18 September 2011

Closing NHS hospitals

"Every year, demand for NHS health care – mainly from the greater number of older people – increases. Over the next five years it will grow by about 20 per cent, yet financing will increase by only one per cent. This is no longer viable."
The solution according to Paul Corrigan is to close hospitals. Yes. You read that correctly. The solution to 20% more old people needing more healthcare is to close hospitals - at least 40!

Dr Grumble would be the first to admit that the NHS estate needs rationalising and he would agree that the more you do of one thing the better you get at it but to imply, as Professor Corrigan does, that general hospitals should become specialist centres with one hospital doing one thing and another another is arrant nonsense.

Dr Grumble's masters used to teach him about the unifying diagnosis. The patient presents with various symptoms and signs and the key is to put them all together and find the single diagnosis that accounts for them all. It can work well. Previously fit young people who are acutely unwell are unlikely to have more than one thing wrong with them but it is not the case for the elderly.

It's no good being in a hospital that specialises in the treatment of heart disease and fancy ablation treatment for atrial fibrillation if your heart disease causes a stroke which is treated elsewhere. Or, if you are elderly and need a hip replacement, you do not really want to go to a slick privatised specialist hip replacement centre if you also have diabetes and heart failure as well as your arthritis. You need to be in a large general hospital where there is the right expertise available to cope with every contingency. You need specialist care for your hip but you may well also need specialist care for your heart and for your diabetes and any number of other possible complications. These scenarios are not unusual. In an increasingly elderly population they are the norm.

Paul Corrigan is right. Though he doesn't quite say so, the NHS estate is in a mess. The problem has remained, despite the NHS being a planned service, because politicians have always fought shy of any hospital closure. We can manage with fewer hospitals. But please lets not have small specialist hospitals with ring-fenced work. We need fewer but bigger strategically-placed hospitals with specialists doing sufficient work to do their jobs well with other specialists alongside them.

If demand is increasing by 20% over five years and financing by 1%, hospitals will have to close because there just won't be the money to pay for them. This is a financial solution forced on us by the marktet. But let's not kid ourselves that this is any sort of a solution to the clinical problems we face. What is to happen to all the increasing numbers of frail elderly people for whom there will simply be no hospital beds? Can they really be looked after in the community? Will this be any cheaper? Or does care in the community mean less care or, perhaps, no care?

03 September 2011

Still time to save the NHS?

Dr Grumble's reader has been in touch with him to find out why he has not been posting recently. The answer is that he has been worn down. The progressive changes that have been taking place to the NHS are approaching their zenith. Always inexorable they are now unstoppable. The faux listening exercise and the apparent response has silenced the dissent. For Grumble it is very sad. The service that he has devoted his working life to is on the verge of destruction. The NHS the public loves will be no more. Not, anyway, in its present form.

That is the negative view. Others, like the redoubtable Clare Gerada, take the alternative view. Clare, or St Clare as Dr Grumble likes to call her, takes the view that all is not lost. Is she right?

Mrs Grumble has noticed the depths of Grumble's depression over the reforms. She took Grumble back to the time of the Iraq war when millions protested and reminded him that he stayed at home that day and left others to waste their time demonstrating. And she reminded him that this is a decision that he now regrets. Not, of course, that it made a blind bit of difference. Is there any point in simply registering a protest when it's clear that it's not going to alter anything?

Is a masked man ever trustworthy?

What puzzles Dr Grumble most about major governmental decisions is just how wrong they can be. You just would not think that any committee of sensible people could get things so utterly wrong. Committees do make mistakes but not on the scale the government does. There must be a reason for this.

What is the reason when it comes to the NHS? There is evidence that relatively dispassionate parliamentary committees, after listening carefully to the evidence, can actually see the truth. Here's what Kevin Barron, Health Committee Chair, said about commissioning:

"It is a sorry story if, after 20 years of attempting to operate commissioning, we remain in the dark about what good it has actually done. The Government must make a bold decision: if improvements fail to materialise, it could be time to blow the final whistle."

The final paragraph of his Committee's report reads:

A number of witnesses argued that we have had the disadvantages of an adversarial system without as yet seeing many benefits from the purchaser/provider split. If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.

So there you have it. The problem is not with committees. The problem is at the highest level of government where decisions are made based on a prevailing dogma driven by intense outside financial interests. The latter have enormous resources at their disposal and they use them to maximum effect. They are very clever, clever enough to defend the indefensible. Only this week Grumble nearly crashed his car as he heard somebody from KPMG extolling the virtues of PFI. The piece was masterly. But wrong. All the pros came across but none of the cons. It didn't take Grumble long to find evidence of a vested interest.

What interests Grumble are the drivers to the government's NHS reforms. Why have successive governments got it so wrong? How is it that the ConDems are able to press on with their misguided plans to essentially sell off our NHS against the wishes of the electorate? Read Liberating the NHS: source and destination of the Lansley reform to find out more.