Hearts and Minds again

The Safe and Sustainable programme to reorganise child heart surgery just 19 years after the Eye broke the story of the Bristol heart scandal is running in to difficulties. There are currently around 30 consultant heart surgeons who operate on children spread across 11 surgical centres in England.  All signed up to a process that was likely to recommend a reduction in the number of centres so specialist expertise and resources can be concentrated in fewer, safer centres better equipped for training and expansion. This process was made all the more urgent by the Oxford scandal (Eye 30.7.2010) and a report last year that found that 76 ‘excess deaths’ had occurred in just four centres between 2000 and 2008 (Oxford, Leeds, Guys and St Thomas’s and Leicester). This was the same methodology used to count the excess deaths at Bristol.

The Children’s Heart Federation, which exposed the Oxford scandal, has now written to the Care Quality Commission asking them to urgently investigate the high number of reoperations that appear to be occurring in the Leeds unit, and any damage associated with them. Meanwhile, Yorkshire MPs have this week secured a Commons’ debate to try to

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CQC – Can’t Quite Cope

The Care Quality Commission’s failure to stop the torture of patients at Winterbourne View Private Hospital in Bristol, despite the repeated pleadings of a whistleblower, is yet more evidence that it isn’t fit for purpose. And the CQC knows it. Last month, the Health Service Journal published minutes of a recent CQC board meeting, which acknowledged it faced ‘three major areas of risk, all of which were likely to happen.’ ‘1. Failure to effectively identify or deal with non compliance leading to persistently poor quality care for users. 2. Lack of volume and/or type of resource to meet the demands placed on it, leading to unacceptable levels of performance. 3. Failure to operate in line with required standards of probity and value for money.’

A key issue is whether the CQC should be both an investigator and a regulator. As the Eye argued 12 years ago (Eye November 1999), the NHS needs a lean and fast independent inspection team in every region, staffed by experienced clinicians, rather than ex-policemen, that can go into any hospital or GP surgery after one unexpected death or serious injury, complaint or staff concern, rather than wait for a whole

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Britnell’s Got Talent

At Prime Minister’s Questions on May 15th, David Cameron claimed had not heard of one of his health advisers, Mark Britnell, until he’d Googled him on Sunday. His interest was provoked by The Observer’s report of a speech that Britnell, Global Head of Healthcare at KPMG, gave to a group of private health companies in New York last October. According to a brochure summarising the conference, Britnell said: “GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer…The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.” Britnell responded by saying that the quotes ‘did not reflect the discussion that took place.’ But in the same month, he launched a KPMG sponsored GP Commissioning Academy at the National Association of Primary Care conference attended by health secretary Andrew Lansley and health secretary in waiting Stephen Dorrell.

Cameron’s desire to distance himself from a member of his kitchen cabinet of NHS experts, assembled by his health

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Dismembering the NHS

Heath secretary Andrew Lansley’s muted apology to nurses – I’m sorry you seem incapable of understanding my reforms – may not be enough to save his career as the Lib Dems demand his head on a pole. But what’s spooking NHS staff far more than Lansley’s apparent inability to get his message across is the breathtaking insensitivity of Monitor’s new chair, ex-McKinsey man David Bennett. In March, Bennett gave an extraordinary interview to The Times, likening the NHS to a utility company. Now he’s trampled over the toes of NHS chief executive David Nicholson by suggesting that the NHS is heading for financial meltdown and many Trusts will have to make far bigger savings than the 4% predicted.

The notion that the NHS is going to be fed to the market and asset-stripped is something Lansley has been very keen to deny but Bennett’s comments are all the more potent because – if the Health and Social Care Bill goes through – Monitor is set to assume enormous power as the economic regulator for both health and adult social care. It will license providers of NHS services in England, regulating prices and promoting competition. So it’s absolutely vital

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Pause for Debt

Andrew Lansley’s one month pause to consider the 353-paged Health and Social Care Bill may at least give us the chance read it (12 pages a night is the maximum safe dose), but many appear to have made up their minds without bothering. 99% of delegates at the Royal College of Nursing conference gave him the thumbs down and now Nick Clegg has weighed in with ‘five key demands’ which are ‘non-negotiable’ 1. Competition should be driven by quality, not price. 2 GPs should not commission services alone. 3. GP consortia must not go ahead in 2013 if they are not ready. 4. The principles of the NHS constitution must be protected and 5. GPs must work local with councils.
If Clegg had digested the Bill and its hundred amendments, he’d know that these pledges have already been met, at least on paper. What happens in practice is anybody’s guess. Lansley’s original intent was to be ‘permissive’ and ‘local’. Strategic Health Authorities and Primary Care Trusts would go, leaving GP consortia free to decide their own size and make-up, and free to buy services from ‘any willing provider’ without too much in the way of accountability.

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