Christmas Massage

We all know what’s wrong with the NHS. There are too many hospitals swallowing too much money, and too many patients swallowing too many calories. Labour got NHS funding above £100 billion a year, cut waiting times and improved patient care and satisfaction overall. But they failed to get healthcare closer to home, failed to get people to take more responsibility for their health, failed to spot and stop appalling health scandals and failed to narrow the gap between rich and poor. So now it’s the Coalition’s turn to fail.

There are some good ideas in the White Paper, most notably that clinical staff should have more responsibility for planning services and rationing healthcare, but it’s being done at ridiculous speed. The perceived wisdom of NHS reform is that you spend the first year blowing everything out of the water and then next four picking up the pieces. Abolishing strategic health authorities and primary care trusts may be the right thing to do, but doing it all at once sends NHS management into free-fall just at a time that it’s supposed to be making huge savings.

The NHS budget has increased year on year for decades, allowing it pay off its debts with next year’s increase. Now the budget is flat-lining, debt will rise sharply unless unprecedented £20 billion ‘efficiency savings’ can be made, something the Coalition has cleverly branded ‘the Nicholson challenge’ to ensure the NHS chief executive takes the blame when it all goes tits up. PCTs are already feverishly rationing care to balance the books this year, and patients are either being denied treatment or having to wait more than the NHS constitution’s meaningless pledge of 18 weeks. The financial squeeze will kick in over the Autumn, and the cuts in social care will inevitably hit the NHS as the desperate pitch up to GPs and casualty. Next winter could be a bad time to get sick.

Whether GP consortia will have made an impact by then is anybody’s guess, and an anxious Treasury has stopped the Health Bill appearing before Christmas. GP commissioning can only work if the consortia have the money to develop community services, the balls to stand up to hospitals and the openness to involve the public in any changes. The premise is that it takes a thief to catch a thief. Doctors are the best people to find other doctors who’ll do it better for less.

Dr Kosta Manis, a South London GP, has designed a rapid access chest pain clinic in the community at a cost of £800 a patient compared to £1,500 charged by local hospitals. In the first seven months of the year he saved £300,000 by forming partnerships between GPs and specialist centres. Consultants from Guys and St Thomas’ run clinics in four local surgeries and, if needed, the patients get door to door transport to the European Scanning Centre on Harley Street for a state of the art scan that uses only a fifth of the radiation of conventional scanners. It’s faster, safer, cheaper and more convenient than going to the local DGH, and all on the NHS.

Bexley Clinical Cabinet (sic) is one of 54 ‘pathfinder’ consortia that health secretary Andrew Lansley has given the go ahead to prove his point that GPs can be trusted to manage £80 billion of the NHS budget. But who will be holding them to account? A colleague who asked to read the board minutes of Stockport Managed Care was told they were ‘for board members only’. Secrecy in the NHS is strangling trust. All GP consortia need to publish the minutes of their meetings in full, without patients and the press having to issue tedious FOI requests. Accounts of how every penny is spent need to be published. First class rail trips to London and fact finder missions to America must feel the force of public scrutiny. NHS Hospitals still buy the silence of whistleblowers to bury bad news. If GP consortia continue this secrecy, they are doomed to fail. When you wish your GP Merry Christmas, ask him how much he or she earns. It’s your money, after all. (MD is on £50 an hour, no holiday pay or sick leave.)

Quote of the Year
‘This Inquiry was only established because of the articles in Private Eye and, had it not been for them, the issues would have continued to be ineffectively addressed.’

Bristol Pathology Inquiry Report (The full report, comments and a list of GP Pathfinder Consortia are at www.drphilhammond.com

Below are the 54 GP Pathfinder consortia who are apparently leading the way in GP commissioning. The plan is that GP consortia will eventially manage £80 billion of NHS funds, which seems an awful lot. So it’s important to keep them on their toes. Ask to see the published minutes of all their meetings and accounts for how the money is being spent. You may, rather depressingly, have to file a Freedom of Information request to get them. Let me know how you get on.

East of England:

CATCH (Cambridgeshire)

East Suffolk Federation

Fortis Group

Health East CIC, Great Yarmouth and Waveney

Hunts Health

Ipscom (Ipswich)

The Red House Group Hertfordshire

East Midlands:

Principia

Bassetlaw Commissioning organisation

Nene Community Interest Company

London:

Bexley Clinical Cabinet

Ealing Commissioning Consortia

Great West Commissioning Consortium

Kingston Consortium

Newham Health Partnership

Redbridge

Southwark Health Commissioning

The Sutton Consortium

North East:

Newcastle Bridges GP consortia

Langbaurgh

County Durham

North West:

Cumbria Senate

Salford PBC Consortium

Stockport Managed Care

Manchester (three consortia: north, central and south)

West Cheshire Consortium

Wirral GP Consortium

Eastern Cheshire Commissioning Consortium

Trafford Commissioning Consortium

Fleetwood Community Commissioning Group

Wirral NHS Alliance

South Central:

Buckinghamshire

South East Hampshire

Bracknell Forest

South Reading

Basingstoke

Oxfordshire

South East Coast:

North West Sussex Association of Commissioning Consortia

Coastal West Sussex Federation

Surrey Health

Thames Medical

Guildford and Waverley

Dartford, Gravesham and Swanley

South West:

Baywide GPCC Ltd

Sentinel Healthcare Southwest Community Interest Company

Wyvernhealth.com

South Glos Consortium Ltd

West Midlands:

South Birmingham integrated clinical commission consortium

Dudley GP Commissioning Consortium

Herefordshire GP Commissioning Consortium

Yorkshire and The Humber:

Doncaster Commissioning Consortium

North East Lincolnshire Commissioning Consortium

Buying Silence with Public Money

Should the concerns of whistle-blowing NHS staff who’ve signed silencing deals with their employers now be made public? In 2008, a staff survey by the Healthcare Commission found that Liverpool Women’s NHS Foundation Trust (LWNFT) had the second highest national rate for bullying of clinical staff by management, with a high percentage of staff wishing to leave their jobs. In 2009, after a long freedom of information battle, it was revealed that the Trust had signed twelve silencing deals (or ‘compromise agreements’) with staff over ten years, at a cost of £392,000. All contained gag clauses preventing the staff from going public with any concerns they may have had about medical care or mismanagement.

The agreements were drafted and negotiated by Liverpool solicitors, Mace & Jones. Since 2006, the Chairman of Mace & Jones has been Roy Morris, who has also been a non executive director of the Liverpool Women’s trust since 2005. He denies any conflict of interest. Mace & Jones were instructed by the Trust to ensure that any names of silenced employees are not revealed under information law, a view challenged in a recent Information Tribunal hearing1.

The trial heard evidence from Peter Bousfield, a consultant gynaecologist at LWNFT and a former medical director of Fazakerley hospitals. He had been concerned about staffing levels, lack of proper equipment and lack of ITU at LWNFT. After a bruising battle, he was paid £160,000 to retire and keep silent. He has since been threatened with an injunction by Mace & Jones if he raises his concerns with his local MP or anyone outside the NHS. In his witness evidence, he said he was truly horrified by this prospect and viewed it as a ‘disgraceful bully boy abuse of power’. He also revealed that the trust is now subject to a £20 million negligence action, despite the doctor in question raising concerns about his own practice.

Also in the witness box was David Ednay, a former superintendent sonographer, who had become concerned about nurses doing intrusive ‘HyCoSe’ scans to investigate infertility. When he raised his concerns, he was accused of bullying and suspended by the Trust. An independent assessor, Philip Orme, was brought in. The Trust initially refused to disclose the Orme report but Mr Ednay eventually obtained it under data protection law. It found that his suspension “could be regarded as wholly unwarranted even vindictive” and could “create the impression of a witch-hunt”. As a result, Mr Ednay was offered money with a gagging clause but refused, preferring to speak freely. In sympathy with Mr Ednay, seventeen sonographers resigned and moved on. In the witness box, Mr Ednay said he had formed the view that the Trust was essentially ‘corrupt.’

In court, the Trust claimed that only two of the compromise agreements referred to doctors. One was Mr Bousfield, and the Trust produced a letter from the other doctor refusing to give consent for his name to be made public, as he is still reliant on the Trust for references. Without knowing his identity, the Information Tribunal ruled that it could not be proved that this doctor was a whistleblower, and any concerns he may have had about standards of care remain a secret. So much or an open, transparent and safety-first NHS.

Bill Cash MP, who was instrumental in securing the Mid Staffs public inquiry, has argued for a new law to overturn all gagging clauses, allowing previously silenced doctors to voice their concerns about patient care. At the very least, Health Secretary Andrew Lansley should now insist all Trusts publish detailed information on all compromise agreements, including any patient safety concerns, to ensure taxpayers’ money is no longer used to buy the silence of whistle-blowers.

MD
1 www.informationtribunal.gov.uk/DBFiles/Decision/i457/Bousfield_v_IC_and_LWHNHS_(0113)_Decision_11-10-2010_(w).pdf