Thursday, 28 June 2012

Money and health are inextricable.

There are two big news stories in the UK this week. (Three actually if you count the shocking news that David Beckham has been omitted from team GB Olympic football squad)

The two main stories that I want to discuss are not about health but about money. It was announced this week that the South London Healthcare Trust is on its financial knees with unsustainable debt and no means of reversing of £69m in deficit on an annual turnover of £424m. As money and quality are so often linked, the hospital is also performing badly on key indicators such as waiting times for surgery and accident and emergency treatment. The Trust cites the heavy burden of an existing PFI (Private Finance Initiative) arrangement which funded previous building works and the debt repayments account for 14% of the Trusts’ income.

Andrew Lansley, Secretary of State for Health, is now likely to take the unprecedented step of appointing an administrator to sort out the financial mess, with the unenviable challenge of maintaining acceptable quality of care in the process.

This Hospital Trust is not alone – with an estimated 20 more Trusts facing economic meltdown. The news isn’t even a surprise as warnings of unsustainable balance sheets were flagged at least 12 months ago.

This must now be a priority for the government to sort. What a pity more attention wasn’t paid to the coffers of the major healthcare institutions while Lansley’s Health and Social Care Bill fiddled and tweaked with the niceties of power shifts, administration reshuffles and a blatant disregard for the deal-breaking issues. Like making sure that Hospital Trusts can actually afford to deliver treatment and care to the local community they serve.

As I have quoted my wise old Dad in the past – ‘stop putting good money after bad’.  The legacy of financial burden from badly designed PFI’s and crippling interest rates must be addressed, the slate cleared and Trusts given a chance to function at the appropriate level of quality within budget. The benchmark should be simple – these trusts must be financially and clinically viable to continue to receive NHS funding and where a Trust can demonstrate that it’s worth saving, the powers that be should step in to provide fiscal support.

The other news story? Barclays Bank has been fined £291 million for illegally manipulating bank lending rates. Several other banks are currently being investigated for this cynical behaviour and hopefully further mega-fines will be collected. Talking of banks – the word ‘bailout’ springs to mind and it is frankly shocking and disappointing to the extreme that these institutions should continue to operate on the edges of morality and legality. But while we are talking bailout – what better way of spending some newly found capital?

I can think of several worthy recipients of a share of that £291million windfall - maybe the South London Hospital Trust should be one of them?

Thursday, 21 June 2012

A summer solstice that has done no good for anyone – neither doctors nor patients.

June 21st is the longest day of the year in the Northern Hemisphere – with more daylight than any other. 8% of doctors, members of the British Medical Association, chose not to put this extra time to good use. For the first time since 1975, medical practitioners were on strike. They are striking about their pensins and the extended retirement date. They are not striking about NHS reform, patient care or the NHS budget.
The build-up to this event has been remarkably muted since it was announced a few weeks ago. Perhaps the BMA realised they had scored an own goal – and speaking of goals – maybe Euro 2012 has engaged the public more than some petulant clinicians.

To add to the PR disaster for these doctors, the comedian Jimmy Carr (for my overseas readers – a comic who, with a constantly straight face, spends a large proportion of his act criticising corporate greed and the banking community) was lambasted by David Cameron for his personal tax avoidance activity. Why one performer should be singled out for his accountants’   legal methods to protect their client’s income remains to be seen, but it is interesting to note that this was the lead story for most UK news bulletins today. (Is that why you did this David? To divert attention from the open wound that is the NHS?)

Back to the revolting doctors….. What was achieved today by this action?

Nothing. Really – nothing. Well, nothing positive anyway. To say that patients’ lives were not put at risk is frankly ridiculous. Doctors, and all related professions, are not in business just to save lives. They work to help people stay healthy, to improve their quality of life, to avoid or alleviate suffering.

I have no idea if anyone will die as a result of today’s action, but many people will have been inconvenienced, distressed, or even put at risk by the very people who purport to care for them.

According to the Department of Health, 2,000 GP surgeries were working on an ‘emergency only’ basis, 19,000 ‘routine’ appointments were cancelled and 2,700 ‘non urgent’ operations cancelled. Many cancer and heart disease diagnoses follow a ‘routine appointment’. Some ‘no-urgent’ operations such as hip replacements and cataract surgery are life changing. How can a G.P or surgeon really justify prolonging this suffering?

It was interesting to listen to a radio phone –in programme today. There was a striking G.P and a non-striking surgeon. The GP was frankly a little hysterical, suggesting that the government wants doctors to work longer, hastening an early death so the pension burden won’t be as great. The surgeon agreed that, yes, doctors who work for longer under stressful conditions do die sooner after retirement, but he was not comfortable with interfering with patient care by withdrawing his labour.  I suspect that most professions would observe similar events and I’m sure that there are many GP’s who share the surgeon’s view and vice versa.

I have enormous respect for GP’s, surgeons and physicians. I work with them often, with pleasure and sometimes even awe. I know they work hard, in difficult circumstances and under great stress. But to sit in your GP surgery or turn up to your hospital department and refuse to see patients for appointments or routine surgery seems unbelievably callous. What about the man with spinal injuries who was waiting for his MRI results today and now has to wait another week? What about the old lady who took two buses to her GP surgery only to find out that even though the doctor was there, her blood pressure problem would not be discussed? What about the man who has been waiting for 18 weeks for his cataract operation so he can see well enough to drive again to visit his wife with Alzheimer’s’ in her nursing home 30 miles away, but now has to wait another month or maybe more?

The daylight may have shone longer today – but the view isn’t pretty.

Saturday, 9 June 2012

The patient at the heart of everything we do? Yes please.

The Department of health has announced that the results of the GP Patient Survey will be published on NHS Choices website shortly. This is a welcomed development but bets are already being hedged by the rider…

‘Important note about the 2011-2012 Survey Results
Please note that due to the changes to the questionnaire design and survey frequency, as well as the change to the weighting methodology, no results from 2011-12, when published on 15th December 2011 (wave 1) and 14th June 2012 (wave 2) can be compared to previous years, even where questions remain the same.’

I guess that means that the results are expected to reflect a growing level of dissatisfaction of patients with their primary care services. As with any of these surveys, we know that it is normally the most unhappy customer that bothers to provide feedback, so I shall read the results with a liberal dose of salt. However, if the whinging masses are increasing in number then this could be significant. I suspect that there will be two major areas of concern – out of hours cover and availability of GP appointments.

Speaking of which - tales from the front line continue to wear a path to my door and I must put on record that for every bad experience that I hear, I’m sure there are literally tens of thousands of examples of excellent care being given nationwide. But…

Here alas I have another tale from the front line. I’m hoping that the reality of this flaw in the service will be reflected in the survey results. As usual, this is a simple story of country folk, subtitled –‘Why can’t things be like the old days when we could see a GP when we needed to?’

A friend, suffering from a bladder infection (or a touch of the Duke of Edinburgh’s as it is now known) called her GP at 4.30pm. It was a Friday afternoon and my friend, let’s call her Elizabeth, who has a history of such infections knew that it would be very unwise to leave this condition untreated over the weekend. She was also feeling very unwell and was in considerable discomfort. She was told by her surgery that no appointments were available although they ‘might be able to fit her in to an emergency session tomorrow morning’.

By 8pm Elizabeth was in considerable pain so she called the out of hours doctor. Some time later, after a 20 minute car journey, she was prescribed the antibiotics she needed by an efficient and kind doctor working with the out of hours contract. She then faced the challenge of finding a pharmacy still open and was advised that she needed to travel another 25 minutes by car to the out of hours pharmacy. Unfit to drive, with a temperature and in bad pain, Elizabeth was only able to make this journey because she was accompanied by her husband.  By that time, she was in desperate need of a loo. Anyone who has had a bladder infection will know the meaning of ‘desperate’ in this case.

While the pharmacist was filling the prescription, Elizabeth asked to use the pharmacy toilet and was told ‘no’ because he wasn’t sure if his insurance covered patients using the facility. Nice.

So – if the GP had been able to squeeze her in, if the out of hours service was closer, a 40 mile round trip in the car and much distress could have been saved.

I hope that the latest patient survey will, like the results from the last one, demonstrate that the area of most concern to patients is accessibility of GP services including extended opening hours and local cover to avoid unnecessary delay or trips to casualty.

Forget commissioning, we need GPs to continue to provide vital front line local services in and out of hours.

Is that really too much to ask?