Sir

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What now for the NHS?

David Nicholson’s cheery goodbye to the NHS – he resigns as chief executive of NHS England on March 31 – was a step up from Liam Byrne’s parting shot as chief secretary to the Treasury (‘’I’m afraid to tell you there’s no money left.’) Not only has Nicholson’s NHS spent all the money (£110 billion a year), but he believes the government will need to spend billions more on reform or the NHS will face ‘a managed decline in the quality of care.’

Nicholson wants the NHS to ditch its reliance on expensive hospital based services, centralise  highly specialist care on a massive scale and transfer much of what is currently done in hospitals closer to the home in much better resourced community-based care. These ideas have been around as long as Nicholson has been chief executive of the NHS, and the fact that he didn’t manage to implement them and is now pleading for them as he goes through the exit door is telling.

In all Western health systems, 20% of patients – those with multiple chronic diseases (heart disease, lung disease, diabetes, cancer, depression, dementia) – use up 80% of the resources. The

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No Surprises at Alder Hey and Morecombe Bay

Alder Hey Children’s Hospital in Liverpool as “potentially unsafe” after failing to meet four in five standards of quality and safety in an unannounced inspection by the Care Quality Commission will come as no surprise to readers of the Eye. The CQC acted after it was contacted by operating theatre staff, and found failures to report serious adverse incidents, near misses, very worrying staff shortages, and problems with essential equipment.

Alder Hey, which now has the highest risk rating the CQC can award, also had a low rate of reporting safety incidents, and its staff were uncertain which types of incidents to report, airways monitoring equipment was not in place and the emergency call alarm system in the day surgery theatre was faulty. The theatre department had a high staff sickness level, staff sometimes had to work long hours and operation schedules often overran, with ‘potentially unsafe’ staffing of the recovery area. An internal review by the trust’s own director of nursing that found “shortcuts being made to safety processes that have created high risk activity.”

The safety concerns are very similar to those outlined by the trust psychologist Dr Alan Phillips

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Data wars

The plan by NHS England to upgrade its patient data system is eminently sensible. Without accurate data, the NHS is flying blind and has no chance of delivering the highest quality care and spotting unsafe care, and the opportunities to use the data for research to benefit patients are potentially huge. So why has it met with such opposition?

The simplest answer is that the government and NHS England aren’t universally trusted to keep such large volumes of confidential  medical information safe or not to sell it off for commercial gain. The government promised no major top down reorganization of the NHS and then imposed the largest in its history, leading many to conclude the resultant chaos is simply a Trojan horse for privatization. Selling patient data – identifiable or not – onto private companies just amplifies the mistrust even if it is claimed to be for patient benefit.

The default option is ‘opt in’ (you have to tell your GP if you don’t want your data to be used) but the choice  is ‘all or nothing’ – you can’t select where your data might end up but have to trust the NHS to make

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Hunt’s Law

Hidden away near the back of the government’s Care Bill, which is supposed to be about improving the care of the most vulnerable patients, is an incendiary clause that could give enormous power to the Health Secretary, via one of his Trust Special Administrators (TSAs), to reorganise failing hospitals and their neighbours without much in the way of consultation. Ironically, this could jeopardise the care of the very patients the Care Bill aims to protect.

Clause 118 is seen by many as payback for Jeremy Hunt’s failure to push through the downscaling of Lewisham hospital to bail out a neighbouring South London healthcare trust (SLHT), a failing hospital with huge debts, mainly as the result of a Private Finance Initiative mortgage with unaffordable interest payments. (Eyes passim)  TSA Matthew Kershaw and Hunt tried to downgrade the thriving and solvent Lewisham hospital to take some of the pain for its failing neighbour. But the High Court and Court of Appeal found using such an approach – where one hospital is used as collateral damage for another, when it had no connection to the cause of the debt – to be unlawful.  So Hunt is trying to change

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