The Chairman’s Voice

Dr Tony Clarke, Chairman, CMS

There are many problems with being in opposition. The most frustrating is watching an incompetent Government destroying things which they of all people should have protected and nurtured.

New Labour came to power on a promise to the British people that theirs would be a new type of politics, sleaze-free, devoted to investing in and improving public services and helping everyone to reach their full potential. A decade later we see more ministers than you can shake a stick at having to resign for every indiscretion imaginable, huge sums wasted on ridiculous projects like the NHS IT programme, record debt within the NHS and appalling low morale of many of the staff in the NHS, schools, police forces, the prisons and the Job Centres, to name but a few.

We have a Government that seems to know nothing of rural Britain and is prepared to raid year on year pension funds, while selling honours for cash. Add to this, little items like Iraq, the Millennium Dome, ID cards and a disaster area called the Home Office and that frustration becomes understandable. Another frustration is knowing how many of the problems could be solved. This is made worse by knowing that if the solutions are made public, then the government will steal them and then distort them. Having principals is not New Labour’s strong suit.

Oppositions however tend to frustrate their supporters if they do not come up with policies. David Cameron has already put his mark on the Party, widening its appeal to the electorate. He has established a number of groups to examine important areas of policy, including health and social security. We are now beginning to see the results of these consultations: David Cameron, Andrew Lansley and Stephen Dorrell held a briefing meeting in Bristol in late January to discuss the mid-term health plans. The CMS had put in a major discussion document in response to the preceding consultation and we were delighted to see just how much of our ideas have been adopted within those plans.

Simply put the Conservative Party rejects the present destructive target culture, the micromanagement and the endless reorganisations and gimmicks which have done so much to waste the so-called investment of so much public money. Instead:

• We will have only high level targets related to outcome, not process.
• We will seek to reduce mortality and morbidity of the major causes of ill health, such as cardiac disease and cancer, but will not describe or proscribe the exact methods that will be used to achieve those high level targets.
• Rather, we will give the professionals, both clinical and managerial, within healthcare the freedom to develop the systems to deliver those outcomes.
• We will restore public health to its proper place to protect our citizens against health risks of all types.
• We will encourage the spread of best practice.
• We will look to move significant funding into primary care, where the majority of healthcare takes place.
• We will, of course, look to a plurality of provision, but from the perspective of a level playing field. Foundation trusts will be the norm – they will be able to show how good they can be at providing high quality, timely and cost-effective care rivalling anything in the independent sector.

New Labour, in the shape of Tony Blair, said “24 hours to save the NHS”. It was a silly, hollow promise, which ten years later highlights the overall failure of this Government. His refusal to step aside, despite the fact he is now discredited and ineffective, shows just how much he has lost touch with the electors whom he so enchanted and to whom he offered so much. Maybe he realises just how disastrous Gordon Brown will be for the country. We need a Conservative Government and we need it sooner rather than later. Who else is going to save the country’s great public services and put back the pride in Britain?

How to put patients in the driving seat

Article by John Baron MP, Shadow Health Minister, from the current issue of the CMS Bulletin

Delivering ‘patient-centred care’ is one of the great ambitions of today’s NHS, but this important goal cannot be achieved without an effective system of patient and public engagement.

Putting patients in control of their care as much as possible has become a familiar mantra of the modern NHS. However, for patient-centred care to be a reality, patients and the public need a much stronger voice in the design of services – and in holding the NHS to account. That is why Conservatives in Parliament have been putting the spotlight on patient and public engagement.
Of course, successful engagement should not be seen as confrontation between the public and medical professionals. Patients and NHS staff often have an intuitive understanding of each other’s needs and concerns. Where patient and public engagement is most successful, doctors and nurses see patients’ groups as a partner against the regional health service management charged with implementing Patricia Hewitt’s agenda of targets, initiatives and reconfiguration – or cuts.

It is therefore little surprise that Labour has repeatedly failed to give patients the powerful mechanisms for engagement they deserve. Ministers abolished successful community health councils (or ‘CHCs’) only four years ago, replacing them with a myriad of fragmentary new bodies. The cornerstone of the new system was patients’ forums, but these were inadequately supported, which is why they did not have the best of starts – despite the hard work and dedication of members.

The Government is now pushing through legislation to abolish patients’ forums and replace them with new local involvement networks (or ‘LINks’) but these plans have spectacularly failed to engage the respect or enthusiasm of existing volunteers – a situation not helped by the legislation not having the word ‘patient’ in the title, while being tagged onto the end of the local government Bill, almost as an afterthought. Many volunteers intend to walk away from the NHS, disgusted that forums are being replaced after all the hard work committed to them. I am therefore concerned that another tier of expertise in the health service is about to be lost.
Our objections to the new proposals are numerous, ranging from the loss of expertise to the lack of independence and statutory powers. For one thing, the specialist knowledge and skills of patients’ forums attached to mental health and ambulance services risk being lost.

Secondly, for any system of engagement to be credible, it must be independent. However, I am concerned that local authorities will have an undue influence over the new arrangements. LINks will be financially accountable to the council, and yet will be expected to hold to account some of the services provided or commissioned by it. Money for these LINks will not be ring-fenced, and so is liable to be top-sliced by cash-strapped local councils – hence the conflict of interest.

Thirdly, where patients’ forums have been successful, the power to enter and inspect NHS premises has often been key. However, the Government’s Bill contains only a watered-down version of that power. The words ‘inspect’ and ‘inspection’ do not appear. I fear that, without strong powers, there will be little incentive for volunteers to serve.

The Government’s proposals also fail to create a national voice for patients, or even the capability for regional networking of LINks. Nor does the Bill give patients a direct role in the regulation of health and social care.

That is why we have already consulted on proposals for ‘HealthWatch’ – an independent, national voice for patients, which would combine the traditional investigative and representative functions of patient engagement with those of a modern, consumer-style public services watchdog.

HealthWatch would be a voice for patients on all NHS issues and would provide a mechanism through which informed public opinion can influence the regulation of healthcare. It would have the power to make visits and acquire information, and would pursue and refer individual or collective patient complaints.

HealthWatch would be a national body – a strong, independent brand – but with a local presence and significant bottom-up elements. Until the Government joins us in embracing this concept, patient and public engagement in the NHS will continue to suffer from a poverty of ambition, and patient-centred care will remain an elusive dream.

Doctors Chaos "is worst crisis to hit NHS"

From the the Daily Telegraph

Doctors chaos 'is worst crisis to hit NHS'
By Celia Hall, Medical Editor Daily Telegraph

The chaos created by a new training system for young doctors is the "biggest crisis to hit British medicine", a leading surgeon said yesterday.Prof Gus McGrowther: 'This is the biggest crisis to hit British medicine since the start of the NHS'The new system, being investigated by the Royal College of Surgeons, has left thousands of junior doctors without jobs as trainee consultants.Their current posts will end in August and fears are growing about how hospitals will cope.The despairing and increasingly angry doctors have set the date for a London protest march and are taking legal advice about the equity of the new system. A fighting fund has been set up.On Monday all the medical royal colleges will meet to discuss the crisis.Hundreds of junior doctors, who have spent many years and thousands of pounds on training, have inundated The Daily Telegraph website to tell of their despair.
Rob Henderson, a senior house officer, said: "Hospitals run because of the goodwill of the doctors, evidently this has now been shattered and with it patient care."Sarah Cregan, wrote: "I have spent 10 years training to be a doctor and have invested not just my own time and money but that of my family's including grandparents. I feel very let down."The fury of scores of young doctors came as Prof Gus McGrowther, professor of plastic and reconstructive surgery at Manchester University, said he was profoundly concerned about the effect of the new system on patients as well as on medicine."This is the biggest crisis to hit British medicine since the start of the NHS," he said. "We are sacrificing thousands of young doctors who are partially trained and committed to a career in the NHS."We have 200 doctors who would like to be plastic surgeons and 50 jobs. Of these 150 are already very well qualified and already members of the Royal College of Surgeons."They have spent an enormous amount of money creating this new system and the whole thing is spiralling into chaos. It is quite immoral to inflict this on motivated young doctors. I cannot find a single doctor who is happy with this flawed process and ultimately it is the patients who will suffer."Bernard Ribeiro, the president of the Royal College of Surgeons, wrote to all members on Thursday listing five "fundamental difficulties" in the system.There have been 30,000 applications for 22,000 consultant training jobs under the Modernising Medical Careers scheme, accessed by the website called the Medical Training Application Service."For 18 months I have tried to get this system modified and the number of surgery places expanded," Mr Ribeiro said. "I have not succeeded. This system must be reviewed urgently."One problem is the website, which is open to the whole world. Anyone can apply. But the application forms are designed to be so unbiased that you could quite easily get an EU candidate offered an interview when a better qualified, British trained doctor is ignored."In the new structure doctors do two years of "foundation" training and then apply for consultant training to become specialist registrars. The first foundation trainees are now ready to move to the registrar stage but they are clashing with the senior house officers from the old system.There is also an unknown number of EU and overseas doctors in the mix. Mr Ribeiro said the heavily criticised application forms might be suitable for the foundation trainees but took no account of the experience and qualifications of the older SHOs."We need a different system for the SHOs as the new system is phased," he said.Problems listed by the royal college are: "woolly" questions on the application forms; concern that qualifications have not been taken into account; concern about the adequacy of training for assessors; inconsistent rating and errors in reporting the results.The fury of scores of young doctors came as Prof Gus McGrowther, professor of plastic and reconstructive surgery at Manchester University, said he was profoundly concerned about the effect of the new system on patients as well as on medicine. "This is the biggest crisis to hit medicine since the start of the NHS," he said. "They have spent an enormous amount of money creating this system and it is spiralling into chaos."A spokesman for the Department of Health said: "It would be irresponsible to halt the interview process at this late stage. We cannot know whether the wrong people were invited for interview until they are interviewed."Tony Blair's official spokesman sought to play down the crisis, saying: "The main thing is the overall number of doctors, as with nurses, has gone up."

75% of GPs condemn Government as poor

Nearly 75% of British GPs say the Government is doing a poor or very poor job according to GP Magazines European Barometer.


Asked which Party GPs felt closest to

44% Conservative
22% Lib-Dem
17% Labour

Conservatives Take Initiative on Health

Tories to scrap NHS targets and give more freedom to doctors
Most newspapers cover the Conservative plans to scrap the complex system of targets with which Gordon Brown has attempted to micromanage the NHS. In place of centralised targets, doctors would be given their own budgets and would be rewarded for the individual health outcomes of their individual patients. The Times gives the example of breast cancer. Conservatives believe that better care would be delivered "if the NHS abandoned its target of a two-month waiting time to first treatment and concentrated on improving the five-year survival rate."
The Telegraph notes Shadow Health Secretary Andrew Lansley's view that waiting time targets are distorting clinical judgments:
"We've reached the absurd situation where waiting time targets are being turned into a minimum wait so you've got local NHS bodies telling the hospitals that they can't treat patients before, say, 20 weeks because they can't afford to pay for it and because the waiting time target says they should be seen at 20 weeks."
Recent opinion polls have suggested that the Tories are now most trusted to run the NHS - Labour's traditional number one area of policy. David Cameron put the NHS at the heart of the Tory agenda in his party conference speech - pledging to put it at the front of the queue when it comes to public spending priorities.

Information technology in the NHS

Computers were first used in hospitals for patient services in the United Kingdom forty years ago. Pilot studies were undertaken and at the London Hospital, for instance, there were computer terminals on every ward. From these terminals it was possible to do such things as check the pathology results and examine the waiting lists. The technology was simple by today’s standards, but it worked and was clinically relevant. Four decades later, the systems available, especially in the hospitals, have hardly changed, especially as far as communication between healthcare providers is concerned. In primary care the picture is much more encouraging, with the vast majority of general practitioners (GPs) using computers for the patient’s clinical record, writing prescriptions and for data collection.

Like many public service computer projects, the National Health Service (NHS) has been subject to disasters and scandals, such as the Wessex Computer Programme, and the Clinical Terms Project, both of which sucked up huge sums of public money with little evidence of benefit. The Labour Government launched its NHS Information Technology (IT) Programme in 2003. The programme was meant to revolutionise the way information, especially that relating to the clinical care of patients, was handled and communicated. Four years later, with virtually none of the original targets having been achieved, this programme too looks doomed.

It is important to realise that the programme is required and eventually it must be made to work. As medicine becomes more complicated and as the numbers of healthcare providers increases the need for fast, accurate and accessible clinical information becomes more and more important. Clinical audit, safe prescribing and evidence-based practice all require good IT systems. In a consumer-led environment the patient should have access to the information stored about him or her and also be able to make rational decisions on where and who can provide the best treatment for them.

The sadness about IT in healthcare is that a simple set of decisions made thirty years ago would have led to a universally workable and reliable system. What was needed was the formulation of ‘industry standards’ for IT. These would have included the need for all local systems to talk to one another, the requirement to be updateable to include changes in technology and a reasonable degree of confidentiality. After all, we have this type of requirement in the broadcast media and in such things as the compact disc.

It is not worth crying over spilt milk. Many systems have grown up, especially in primary care, and order and structure needed to be put into the system. Most hospital doctors cannot access pathology results from the hospital down the road. GPs in most areas cannot use computerised communication for the flagship programme ‘Choose & Book’, the patient having to make a telephone call, using a long booking number, to get their appointment. The idea of a centrally-driven programme is attractive, with economies of scale in procurement and the certainty that there will be system-wide compatibility. Richard Grainger, reputed to be the highest paid civil servant in Britain, is head of the programme and certainly appears to have delivered on the procurement issue. The deals struck with the computer companies are said to be the best ever negotiated in the history of the NHS and put most, if not all, defence projects to shame. Some parts of the programme, most noticeably the PACS imaging system, look successful and are being rolled out quite quickly.

So what has gone wrong? Firstly the time scales have been hopelessly short. The whole of the programme should have been rolled out a year ago, yet most potential users are yet to see any advance, especially in the hospitals. Secondly, there are many good existing (or so-called ‘legacy’) systems already in existence and many of these just appear to have been dumped, without the useful functionality transferred to the new system as it develops. Thirdly, and most significantly, there has been minimal clinical engagement in the programme. IT has taken on a life of its own, the provision of the system being seen as a stand alone product. No one appears to have explained to Mr Grainger that IT is a tool to assist clinicians and managers and that if the users are not involved in every stage of its introduction, then failure will follow. In simple terms, if the IT system does not offer major benefits to the doctors, nurses, physiotherapists, etc. who have to use it, then they will not use it. Most GPs use their systems because they are easy to use, generate prescriptions, call up review patients and keep details of those procedures that attract additional funding. Most GP practices have had input into the specification and development of their systems – they have ownership. For them the new national system potentially threatens to remove that ownership and for the hospitals the almost total lack of clinical engagement has led to something like 75% of hospital doctors having little or no faith in the system.

What can be done now? Firstly ‘Choose & Book’ should be suspended forthwith until the electronic system is fully in place. The present hybrid computer and paper system is amazingly time consuming, inefficient and wasteful. Secondly those legacy systems that are in existence or where in the latter part of development when the programme was launched should be allowed to continue and funds made available from central funds to enable them to interface with the new system. Thirdly, a major initiative should be launched to get full clinical engagement and again central funds should be made available to release clinical staff to ensure that local implementation is fit for purpose.

M.P.s might like to approach their local Trusts, both hospital and PCTs, and ask some or all of the following questions.

· When will the full implementation of the National programme occur within the Trust?
· Are clinicians involved in the implementation?
· If clinicians are involved, what percentage of the clinical staff have input?
· Are sufficient funds being made available for the implementation of the programme?
· Is ‘Choose & Book’ improving the patient experience?
· What percentage of outpatient appointments is now being made by ‘Choose & Book’?
· Has the PACS imaging system been introduced locally?
· If so, is it proving efficient and effective?
· Does the Trust routinely use an electronic patient record in all departments? – (for Hospitals)
· Does the Trust use routinely collected electronic patient data for clinical audit and clinical effectiveness studies?
· Does the Trust use electronic care pathways for the management of patients and if so how many and in what clinical areas?
There are many other questions that could be put, both to Trusts and, of course, to Ministers. If NHS IT were a patient then we would probably say that it was in a critical condition. At the moment it is not terminal but urgent treatment needs to be applied. That treatment must be provided by the professionals who know what needs to be done – the clinicians

Labours Hospital Hypocrisy

"Labour faced fresh charges of hypocrisy as a health minister admitted he was fighting cuts to a hospital in his constituency. Ivan Lewis, whose local maternity unit at Fairfield Hospital in Bury is threatened with closure, said he was opposing the plans... Party chair Hazel Blears appeared on a picket line at her hospital in Salford just week after Tony Blair and Patricia Hewitt had stressed how important it was for services to be merged into regional centres to improve care." - Daily Mail