Lansley’s Chaotic Legacy

There are few more exciting summer reads than the NHS Commissioning Board’s ‘Overarching Programme Update’ (19/7/2012). You can marvel at the ‘CB Operations Directorate’ and the ‘Clinical commissioning group authorisation draft guide for assessors undertaking desktop review.’  The ‘intelligence needs’ of commissioners are discussed, along with the obligatory ‘solutions roadmap.’  And there’s even ‘a revised ready reckoner tool to help CCGs calculate the costs and implications of how they will carry out their functions….’

But most of the fun comes from the latest version of the risk register.  Andrew Lansley still refuses to reveal the original, but it now seems most unlikely that the NHS Commissioning Board  Special Authority will be fully staffed and functioning by the target of April 2013. It needs nearly 4000 staff, but many of the best and most experienced  managers have either been sacked or taken a handsome redundancy package. Recruitment currently has ‘a very high risk of failure’ which would have a ‘level 5’ impact. All this was predicted by Lansley’s critics, including the Eye, but the board is doing its best to disguise the panic in ‘wonk’ speak:

‘There is a (very high) risk that the NHS Commissioning Board (NHS CB) may fail to populate its organisational structure by March 2013. This risk has a number of causes: 1. there may be delays in finalising the NHS CB organisational design, reducing the time available for recruitment; 2. there may be delays resulting from disagreements with sending organisations regarding the nature of functional transfers; 3. the NHS CB may fail to secure sufficient capacity to manage the large volume of recruitment required at the necessary pace; and 4. Trade Unions may challenge elements of the transition process if processes are not properly agreed and implemented.’

As MD is tired of repeating, the last thing the NHS needed in tough times was massive structural upheaval, and the chaos at the centre is such that experienced managers are walking away. This may have been Lansley’s master plan all along – to create space for the private sector to take over commissioning – but in the meantime, frontline care is suffering.  According to the ‘NHS safety thermometer’ (sic), launched in April, nine per cent of all NHS patients suffer ‘avoidable harm’ and in some trusts the figure is more than 20%.  The Department of Health had a target to deliver “harm-free care” to 95 per cent of patients “by 2012”.

In the first 6 months of this year, 66,845 patients waited between 4 and 12 hours for a bed once a decision had been taken to admit them, according to the DH. This is an increase of 31 per cent on last year, and patients are back to waiting in corridors or on trolleys. A+E is getting so crowded that NHS Suffolk posted this helpful message on its website. “Do you seriously think you’re dying? If the answer is no, then it’s likely you shouldn’t be at A&E looking for medical treatment”. The message has sadly now been taken down, but the Mid Staffs inquiry will have taken note. Parts of the NHS are currently too busy to be safe.

There are still job vacancies in the NHS, and not just on the commissioning board. Central and North West London NHS Foundation Trust has advertised for an Assistant Psychologist. ‘We are seeking an enthusiastic and committed individual to join a community service within the Addictions & Offender Care Directorate. You must be willing to work with individuals with substance misuse problems, many of whom also have complex mental health needs. You must possess the relevant skills and attributes to facilitate service users to engage in the service. You must have a strong commitment to teamwork and be able to work sensitively within a culturally diverse environment…. Please Note: These are UNPAID positions.’ Alas the closing date has passed, but more ‘unpaid NHS internships’ are sure to be along soon.

MD