Burying Bad News No 789

The repeated refusal of the Government to publish its ‘risk register’ for the Health and Social Care Bill is unsurprising given the culture of secrecy and cover-up in the NHS. Information commissioner Christopher Graham has now judged that the document should be published, but health secretary Andrew Lansley is likely to sit on it for 28 days before deciding whether to launch an appeal. The Bill is littered with risks, most notably that billions of pounds will be spent on another massive, rapid, ill thought-out restructure that ends up roughly where we started but with staff demoralised and patients neglected.

As one GP commissioner put it: ‘We were initially told we could choose the size of our consortium, so we went small so we could be flexible. Then we were told we had to be much bigger to have any clout so we merged with other local consortia, which was a huge hassle.  Now we’ve been told we’re the wrong shape and have to mirror the local authority boundary. That’s three reorganisations in under a year. Are they making it up as they go along?’ The GP consortia (now renamed clinical commissioning groups) will be

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The Mother of All Gags?

The most keenly awaited NHS employment tribunal in years has ended in secrecy, making a mockery of the government’s commitments to transparency, accountability, patient safety and the protection of whistleblowers. Gary Walker, the former chief executive of the United Lincoln Hospitals Trust (ULHT), lost his job in February 2010 after blowing the whistle on how government targets were harming patient care.  The trust claims he was sacked for saying ‘fuck’ nine times over 2 years¹.

The tribunal was important because Walker had blown the whistle both to his SHA chief executive, Barbara Hakin – now the DoH’s Director of Commissioning – and the NHS chief executive David Nicholson. The allegation that the two most senior managers in the NHS may have played a role in the destruction of Walker’s career whilst failing to address patient harm should have been dissected under oath but the NHS legal machine ensured the claim was ‘settled’ on the eve of the tribunal.

Walker is now not able to speak about the case. Ever.  Neither can any of his many witnesses who were prepared to testify about serious cases of patient harm, fiddling of figures, the bullying

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Passing the Buck

Andrew Lansley’s vision of an NHS Commissioning Board, independent of the Secretary of State, sounds superficially convincing. The constant political meddling of his predecessors as they tried to micromanage the NHS from the centre was generally counter-productive. But in divorcing himself from the Board, Lansley must not divorce himself from accountability for the state of the NHS and the effect his Health and Social Care Bill has on it.

Lansley admitted on BBC1’s Question Time that ‘all government Bills are incomprehensible’. We simply have to trust in him that it will do what he claims it will. Lansley is publically certain that the NHS will improve with free market competition, that clinical commissioning groups headed by GPs will have the expertise and resources to deliver the toughest multi-billion pound challenge the NHS has ever known and that European competition law won’t stand in their way.

But no reforms can flourish without winning over the staff and patients, who are culturally very resistant to the idea of health as a commodity and need to see evidence that Lansley’s approach will work. There are no randomised controlled trials of health reforms but no reason why NICE shouldn’t provide

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The Nicholson Challenge Part 2

The Health and Social Care Bill may just about stagger through the Lords but its ability to improve the NHS is crucially dependent on the support of NHS staff, and it just isn’t there. The vast majority of managers, consultants, GPs, nurses and other clinical staff are either against much of it, don’t think it’s doable with the current level of resources or are just ignoring it because another health secretary with a different set of reforms will be along soon. 

Supporting the Bill are ten percent of GPs, who have already made impressive improvements in the care of the elderly, mentally ill and patients with chronic diseases by treating them closer to home.  Clearly what Lansley needs is an NHS chief executive who believes in the reforms and can win over the hearts and minds of the rightly sceptical and ‘reformed-out’ staff. Unfortunately for Lansley, that chief executive is David Nicholson.

Nicholson is a civil servant and supposedly limited by what he can say in public. He is also the most astute ‘politician’ in the Department of Health. As Lansley was trying to reassure the public and staff that the reforms were evolutionary and

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Wake up in Wakefield

Last week, MD chaired a clinical commissioning meeting in Wakefield where Dr James Kingsland gave a blunt summary of the NHS reforms: ‘It’s simply about making clinical staff financially as well as clinically accountable.  Every clinician has to question every decision he or she makes to ensure it’s the best use of NHS resources. We have to make £20 billion in efficiency savings. There is no plan B.’

Kingsland is a senior GP partner and the ‘national clinical commissioning network lead’ at the Department of Health. He’s in a consortium covering 7 GP practices and 40,000 patients, and told of his frustration that one of his patients had gone straight to hospital with cellulitis, where he was admitted for nine days on intravenous antibiotics at a cost of £5000. The infection could have been treated equally effectively – and far more pleasantly – at home with tablets. ‘There are 8,300 GP practices in England and if we all stopped someone like that going to hospital every week, that’s £2.5 billion saved.’

It’s a fair point but you don’t need a Health and Social Care Bill of bewildering complexity just to ensure patients don’t go to, or

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