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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

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Good News and Bad News

Is the tide finally turning for NHS whistleblowers?  Health Secretary Andrew Lansley has ordered the Care Quality Commission to keep its whistleblowing non-executive director Kay Sheldon on the board, despite CQC chair Dame Jo Williams asking for Sheldon to be sacked. Sheldon’s ‘crime’ was to speak up against the culture of the CQC at the Mid Staffordshire Inquiry last November, describing the strategy as “reactive” and driven by “reputation management and personal survival”.  Sheldon contacted the Inquiry herself, and told chair, Robert Francis QC:  “My main concern is the organisation is badly led with no clear strategy. The chair and the chief executive do not have the leadership or strategic capabilities required.” She was also concerned that the CQC kept repeating the same mistakes and did not consider whether it had sufficient capacity to do annual inspections.

Sheldon told the Inquiry that she had emailed chief executive Cynthia Bower with her concerns and received a phone call from a “quite angry” Williams, asking her whether she “knew what impact this email would have on Cynthia.” On the day Sheldon gave evidence, Williams wrote to Lansley asking for her removal. Instead, Bower handed in her notice

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The Coalition’s Creature

Well done Nick Timmins. The ex-FT public policy editor has written an insightful account of the Health and Social Care Act, from its Ken Clarke origins over 20 years ago to the incorporation of the Blair reforms and onto the political train crash it’s now become. And it’s free¹. Much is old news to Eye readers, except the extent to which Lansley was apparently gagged by George Osborne before the election.  As Lansley claims:  “I can remember it being said explicitly to me that ‘our presentation will be radical reform on education and reassurance on health’. And the reassurance was about spending.” According to some of his advisers, when Lansley protested that “he was not being allowed to set out his stall and that might lead to trouble,” he was over-ruled.

The justification for this lack of political honesty and mandate is beautifully encapsulated by an (unnamed)  senior health department official:  “Talking about reform almost seals its fate. The public hate this discussion. Going on the Today programme to talk about commissioning or economic regulation of health, is a) fundamentally boring, and b) not what people want to hear … people don’t want you to

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It’s the culture, stupid

Culture, according to Henry ford, eats strategy for breakfast. No amount of regulation or reform can protect patients from harm if the culture remains sick. Healthcare staff, politicians, civil servants, regulators and the pharmaceutical industry have to want to be open and accountable, rather than ordered to be. Which means owning up to and learning from mistakes when they happen, not burying them for years and being retrospectively contrite when an inquiry finally pushes them out into the open.

GlaxoSmithKline (GSK) agreed to pay a fine of $3billion last week, the largest healthcare fraud fine in US history, but just the latest in a long line (Ely Lilly $1.42 billion, Pfizer $2.3 billion, Astra Zeneca $.52 billion, Merck $.95 billion, Abbot $1.5 billion). GSK was found guilty of mis-selling the antidepressant Paxil to children, making claims about a diabetes drug (Avandia) unsupported by evidence, failing to disclose safety data about Avandia and lavishing hospitality on doctors to influence their opinions and prescribing. The company claimed that these various frauds were a decade old and had been sorted. In 2003, they promised to make outcome and safety data from all their clinical trials freely available. But

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