Specialist care crisis

Amidst the political posturing over the NHS, few MPs dare mention the crisis in specialist care. This has been on MD’s radar since the Eye broke the story of the Bristol heart scandal in 1992. I have argued over 23 years that highly specialised complex care such as child heart surgery needs to be reorganised into fewer, larger, more sustainable units where training and resources can be concentrated. The fact that it hasn’t happened is down to the usual toxic mixture of political and professional self-interest, and patients suffer and die as a result. It’s pointless exposing these recurring stories because nothing changes, and whistleblowers get shot.

The NHS does, however, listen to money. Specialist hospitals are in financial crisis not just because they only get paid a third of what it costs them to treat the surge in emergency department traffic, but because tariffs for specialist care are also being slashed. Indeed, they have never reflected the complexity and cost of what treating the critically ill patients demand. For patients that cost more than £100,000 to treat, specialist hospitals now lose over £80,000 per patient. If NHS specialist care was a business, it would long ago

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The NHS is a political minefield for all sides

David Cameron’s decision not to put the NHS in his top six election priorities, having placed it number one in the previous election, is either a political masterstroke or an act of gross ineptitude to rival the Health and Social Care Act itself. The masterstroke argument is that the NHS should be depoliticised. Andrew Lansley’s vision for his reforms was that he would become the serene Secretary of State for public health, with day-to-day running of the service devolved to NHS England, Clinical Commissioning Groups and Foundation Trusts. The Health Secretary would no longer be accountable or responsible for, the unfortunate shortcomings of the service even in the countdown to an election. Lansley’s replacement Jeremy Hunt has rather scuppered this plan by being one of the most interfering health secretaries in history. He knows where the buck stops.

The idea that you could put £110 billion worth of taxpayers money into a service not be held accountable for it was always laughable, but politicians on both sides have at least united around the ‘five-year forward view’ of NHS England’s chief executive Simon ‘the Messiah’ Stevens. After five years of flat-line funding

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Election Ennui

The countdown to May 7 promises to be both tough and tedious for the NHS. Tough because no health system in the world has managed five years of little or no real growth without hitting a wall and, although the NHS has done remarkably well in the circumstances, it’s now really struggling to meet patients’ needs as well as performance targets. Tough also because the government, the department of health and NHS England are very adept centralising praise and devolving blame. Bullying and fear get passed down the NHS from the top, and those managers who fail to hit their targets are given brutal dressings down, and some are sacked.

In a snappy publication called ‘Operational resilience and capacity planning for 2104/15’, NHS England, Monitor, the Trust Development Authority and Adass (the association of directors of adult social services in England) give the absurd order that ‘there can be no trade-off between finance and performance’ in the NHS and social care system. If money must not affect performance, why has the department of health bunged £700 million to emergency departments where waits for admissions are rising sharply? For all the catch-up funding Labour ploughed into the NHS, we

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Choosing Where to Have a Baby

The latest NICE Guidance on childbirth suggests that straightforward births are safest in a midwife lead unit, and that for ‘low risk’ women having their first baby, there is a ‘small increase’ in the risk of serious medical problems, such as death and brain damage. These occur at home in 9 per 1000 of first time births, compared to 5 per 1000 births in an obstetric unit. The risks are small but the outcome can be catastrophic. So how is a mother supposed to choose?

Many NHS obstetric units are creaking at the seams which is why a home birth sounds so tempting. As one midwife told MD: ‘We know what we could do to give families brilliant care and we desperately want to do it. But we just don’t have the staffing levels. So the service has become a production line where we try to deliver a minimal safe standard of care where mother and baby survive unharmed, but we don’t have time to put into building up meaningful relationships, getting breastfeeding off to a brilliant start, making sure the stitches are okay, etc. You know the parents want to ask

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Here’s a letter from Jeremy Hunt to Dr Kim Holt pledging his support for NHS staff who speak out about poor care or wrong doing. It also announces the Francis review of NHS Whistleblowing which should have reported by the end of November. If it is delayed until after the election, I shall be very annoyed and saddened, but not surprised.

Jeremy Hunt letter to Dr Kim Holt June 2014