Thursday, 19 May 2011

NHS Futures Forum ‘engaging and listening’ seminar (2)

How do you fit 7 presentations into a 500 word blog? The answer is – I couldn’t but I shall take you on a whistle stop tour of the packed agenda of the NHS Future Forum I attended on 18th May (see previous posting)

I’m not sure how I found my way onto the guest list, possibly because of this blog, maybe because I am one of the many hundreds who posted a comment about the Health and Social Care Bill on the Department of Health website. Either way, it was a good opportunity to hear what was being said, with political, personal and professional views in abundance.

The Rt Hon. Stephen Dorrell MP: The Chair of the Health Select Committee was first up. I was pathetically grateful that he didn’t launch into Lansley-speak ‘patient at the heart of everything we do – nothing about me without me, etc etc’. I was the first person to pose a question to the former Secretary of State for Health and I thanked him for sparing us the political rhetoric normally offered by his successor. This brought one of the few laughs of the morning. Mr Dorrell spoke briefly about the fact that the goal of producing a 4% efficiency gain for 4 years running in the context of a 4% increase on demand for health services year on year, is a holy grail ‘never achieved by a health system anywhere’. He believed this is achievable through the ‘greater integration of services we deliver’.

I asked Mr Dorrell if he felt that by handing 80% of the budget to only one part of the service delivery pathway would lead to bias, hindering integration rather than encouraging it. He felt that the government’s plans had been badly positioned (with the inference that he would have handled the whole thing differently) and that GPs would not have the level of power that people perceive. He stressed that GP led consortia must be ‘publicly accountable’.

Dorrell continued that too much time had been spent on ‘form’ and not ‘function’. This issue has been at the heart of the majority of criticism aimed at the Bill. I shall await the content of the select committee report, due to be published early next month, with eager anticipation. Pity he left after only half an hour though.

Julie Moore and Dr Kathy McClean: Representing the NHS Future Forum as Education and Training Lead and Clinical Advice and Leadership Lead respectively. Both speakers basically said they were here to listen. Fair enough.

Dr Michael Dixon: Chair, NHS Alliance. Oh dear oh dear oh dear. I must be very careful how I put this but Dr Dixon’s presentation fuelled my worst fears about the effect of these NHS Reforms. He started his talk with ‘I am an independent contractor, like a plumber’. I could imagine David Cameron squirming if he ever reads the transcript of the presentation. Nice home goal – so the lion share of the NHS purse IS going to private contractors then?

Dr Dixon undoubtedly has good intentions but I do not agree that a GP normally knows what is best for his patient when it comes to specialist care. He made no secret of the fact that a desired outcome of the reform and GP led commissioning was to migrate services away from Hospital Trusts. He continued – and I quote, as near as my notes allow, ‘I’ll be moving stuff from hospital to my practice and I’ll get money for it, therefore there needs to be total transparency’.  Baroness Young (the chair of the event) was brilliant as a devil’s advocate with her careful wording. She asked Dr Dixon his view on the fact that many patients, especially those with long term conditions do not wish to be ‘discharged’ from the care of their specialists to be handed over to a general practitioner. Not sure we got an answer to that one.

Neither did we get an answer to my question. Dr Dixon quoted a figure that 30% hospital admissions are avoidable. Confusing, as the statistic quoted by Stephen Dorrell earlier was 40%. I asked Dr Dixon if perhaps that figure could be due to the fact that patients couldn’t get in to see their GP and how would GP commissioning improve this state of affairs. For a moment I thought he had morphed into Andrew Lansley as the question was effectively side stepped. When I queried the impression that he didn’t want specialists on ‘his’ commissioning board, he clarified that he doesn’t want hospital specialists on the board who are ‘trying to protect their budget’.  A phrase that springs to mind includes ‘pot and ‘kettle black’.

I fear that this interpretation of ‘control’ given to GP consortia will disenfranchise the hospital consultants and the Foundation Trusts. They are, and must continue to be, crucial in the delivery of a major part of many care pathways.

But the coup de grace was delivered just before Dr Dixon finished speaking. Referring to his desire for autonomy and lack of interference, he said ‘GP’s don’t want to be managed – we want to be seduced’

Mmmm – same goes for all of us doesn’t it?

More on the event tomorrow, when I shall summarise the rest of the speakers.


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