To most being told to make efficiency savings means you would look at how things work, can you buy things more cost effectively, if you rearrange a process would it take less time and hence less man hours to do. Not so though it seems for NHS managers who apparently believe that making efficiency savings equates to just cutting the amount of work they do.
As reported in the Telegraph today:
"managers, who are already rationing surgery for cataracts, hips, knees and tonsils, say they must restrict treatment as the NHS is under orders to make £20 billion of efficiency savings by 2015."
Restricting treatment isn't making an efficiency saving, it's just doing less. It's like saying the way we'll save money in a manufacturing business is to make less stuff because then we'll spend less on materials and staff.
However it gets worse, even the most die-hard don't touch our NHS, leave it as it is'er will surely question the idea that NHS management and accountability structures don't need an overhaul when they read the findings of the independent Co-operation and Competition panel report. As described by the Telegraph:
"Executives believe the delays mean some people will remove themselves from lists “either by dying or by paying for their own treatment” claims the report"
Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts
Friday, July 29, 2011
Thursday, February 3, 2011
Good MPs have nothing to fear from NHS Reforms
Benedict Brogan has posted a piece to his blog reminding us of one parliament Labour MP David Lock. Mr Lock, Brogan reminds us, was elected in the Labour landslide of 1997 and after supporting changes to Accident and Emergency services at his local hospital in Kidderminster found that he lost the next election to a local GP stood who won 60% of the vote.
Brogan suggests that many Tory MPs who have been around since the heady days of ‘97 are eyeing the Health reforms with concern and worrying that they’ll be in his words “Kidderminstered”.
Personally I think that’s rubbish. The only MPs who have anything to fear from any controversial proposal are those that are lazy and no good at the job of being a modern MP. Oh and those that are more interested in protecting their jobs by opportunism than doing what is right.
For a start the situation isn’t the same. Mr Lock was defeated by a GP, seeing as we’re putting GPs in charge of the health budgets and it will be their decision whether to use a hospital or not, I’d like to see one stand on a platform of this hospital closed because you put the likes of me in charge. If anything Lock’s experience proves why we are right to put GPs in charge of commissioning, the public believes that they know what they are doing (despite the attempted lobbying of the press of NHS managers and unions to the contrary) and trusts GPs more than it trusts either politicians or faceless NHS managers.
Also this argument that Brogan puts forward that price competition will definitely squeeze out smaller hospitals simply isn’t true. If they’re well run and concentrate on specific areas then local hospitals won’t be squeezed out. As an example locally we have a super hospital in Coventry (UHCW) which is under an enormous PFI contract, and a smaller hospital at Warwick, then there are tiny local hospitals like the Ellen Badger in Shipston. UHCW has been squeezing the PCT for every penny it’s got to cover its costs, whilst Warwick offers A&E and general surgery as well as concentrating on some specific areas and is seen as one of the best in certain areas such as ophthalmology and cancer treatment. If anything I’d put my money on Warwick offering better prices than UCHW as it doesn’t have the same ridiculous overheads. In fact as most mega hospitals were built under PFI, if anything, price competition will risk the under utilisation of larger hospitals not smaller ones. Whilst at the smallest local level GP consortium are desperate to take over the running of smaller local hospitals like the Ellen Badger as they feel they can manage them more effectively and understand their place in the community.
Then there’s the issue with lazy MPs and their attitude to issues in their constituencies. If there’s a perception that something is going wrong in your constituency then it’s your job as the MP to find out about, react to it, and try to influence people to resolve it. This could be either way, if the public are misinformed or confused about government policy and the reasons behind it, then it’s your job to help inform them and change their mind, if the organisation in question (in this case the GPs) seem to be making the wrong decision then within the realms of letting them get on with their jobs, it’s your job to make sure they know. If you wait until an election time to go and try to convince them your party’s views are right then you’re toast.
Unfortunately I think too few MPs see this as their job. MPs of the old school, who have been around for a long time seem significantly less likely to have a constituency office to keep them in touch with what’s going on back where they were elected, and less likely to deal with local issues. I’m also constantly shocked by how few staff older MPs have. I constantly meet MPs who have been around for ages who have one member of staff. By comparison we have 3 and take in work experience students as well, but despite this barely keep on top of our member’s workload and particularly their correspondence from constituents. To only need one member of staff, your constituents have clearly given up trying to communicate with you and know it’s just not worth it. Now if there’s something controversial in your constituency, how likely do you think they’ll be to re-elect you on the basis of all the other good work you’ve done for them?
Then there are those MPs who are more worried about getting re-elected, or thanks to the boundary changes re-selected, than working for the good of their constituents or their country and so target their efforts at easy win opportunism rather than helping to explain government policy to the electorate. HS2 is a good example of that, it’s not going anywhere near my constituency, but I’ll oppose it because I’m getting letters on it and it might help my re-election or selection chances. The forestry consultation is an even worse examples with MPs playing both sides. Yesterday I watched Conservative MPs carefully craft lines in their speeches to fire “warning shots” at the government about a consultation that hasn’t even completed yet, that will play well in the local papers, whilst their overall speech and their final vote supported the government’s position.
So back to my point on NHS reforms, personally I think good MPs should have nothing to worry about, if they explain the reforms properly, the reasoning behind them and if they monitor what’s going on in their constituency and react to it then it shouldn’t be a problem. However if they’re lazy and more interested in looking out for themselves than their constituent and the country then they’re in trouble.
Bootnote:
As an aside Brogan’s piece highlights the exact problem with the Comms of the NHS reforms, it’s become way too much of a process story. Every time it’s mentioned you get the process background i.e Lansley had a free reign for being quiet in the campaign, the PM wasn’t sure about his reforms, Oliver Letwin had to look at it, medical practioners aren’t sure, now MPs aren’t sure, instead of it being stories about the substance of the proposals.
It’s said that Coulson had become obsessed with the communication strategy of these reforms just before his departure, hence getting the communications maestro of the PM involved, and it’s no doubt at the top of the list for his replacement Craig Oliver. For what it’s worth my opinion is that we need to start talking about the largesse of PCTs again and the layers of management and staff within them to win the public over to the need for reform.
Brogan suggests that many Tory MPs who have been around since the heady days of ‘97 are eyeing the Health reforms with concern and worrying that they’ll be in his words “Kidderminstered”.
Personally I think that’s rubbish. The only MPs who have anything to fear from any controversial proposal are those that are lazy and no good at the job of being a modern MP. Oh and those that are more interested in protecting their jobs by opportunism than doing what is right.
For a start the situation isn’t the same. Mr Lock was defeated by a GP, seeing as we’re putting GPs in charge of the health budgets and it will be their decision whether to use a hospital or not, I’d like to see one stand on a platform of this hospital closed because you put the likes of me in charge. If anything Lock’s experience proves why we are right to put GPs in charge of commissioning, the public believes that they know what they are doing (despite the attempted lobbying of the press of NHS managers and unions to the contrary) and trusts GPs more than it trusts either politicians or faceless NHS managers.
Also this argument that Brogan puts forward that price competition will definitely squeeze out smaller hospitals simply isn’t true. If they’re well run and concentrate on specific areas then local hospitals won’t be squeezed out. As an example locally we have a super hospital in Coventry (UHCW) which is under an enormous PFI contract, and a smaller hospital at Warwick, then there are tiny local hospitals like the Ellen Badger in Shipston. UHCW has been squeezing the PCT for every penny it’s got to cover its costs, whilst Warwick offers A&E and general surgery as well as concentrating on some specific areas and is seen as one of the best in certain areas such as ophthalmology and cancer treatment. If anything I’d put my money on Warwick offering better prices than UCHW as it doesn’t have the same ridiculous overheads. In fact as most mega hospitals were built under PFI, if anything, price competition will risk the under utilisation of larger hospitals not smaller ones. Whilst at the smallest local level GP consortium are desperate to take over the running of smaller local hospitals like the Ellen Badger as they feel they can manage them more effectively and understand their place in the community.
Then there’s the issue with lazy MPs and their attitude to issues in their constituencies. If there’s a perception that something is going wrong in your constituency then it’s your job as the MP to find out about, react to it, and try to influence people to resolve it. This could be either way, if the public are misinformed or confused about government policy and the reasons behind it, then it’s your job to help inform them and change their mind, if the organisation in question (in this case the GPs) seem to be making the wrong decision then within the realms of letting them get on with their jobs, it’s your job to make sure they know. If you wait until an election time to go and try to convince them your party’s views are right then you’re toast.
Unfortunately I think too few MPs see this as their job. MPs of the old school, who have been around for a long time seem significantly less likely to have a constituency office to keep them in touch with what’s going on back where they were elected, and less likely to deal with local issues. I’m also constantly shocked by how few staff older MPs have. I constantly meet MPs who have been around for ages who have one member of staff. By comparison we have 3 and take in work experience students as well, but despite this barely keep on top of our member’s workload and particularly their correspondence from constituents. To only need one member of staff, your constituents have clearly given up trying to communicate with you and know it’s just not worth it. Now if there’s something controversial in your constituency, how likely do you think they’ll be to re-elect you on the basis of all the other good work you’ve done for them?
Then there are those MPs who are more worried about getting re-elected, or thanks to the boundary changes re-selected, than working for the good of their constituents or their country and so target their efforts at easy win opportunism rather than helping to explain government policy to the electorate. HS2 is a good example of that, it’s not going anywhere near my constituency, but I’ll oppose it because I’m getting letters on it and it might help my re-election or selection chances. The forestry consultation is an even worse examples with MPs playing both sides. Yesterday I watched Conservative MPs carefully craft lines in their speeches to fire “warning shots” at the government about a consultation that hasn’t even completed yet, that will play well in the local papers, whilst their overall speech and their final vote supported the government’s position.
So back to my point on NHS reforms, personally I think good MPs should have nothing to worry about, if they explain the reforms properly, the reasoning behind them and if they monitor what’s going on in their constituency and react to it then it shouldn’t be a problem. However if they’re lazy and more interested in looking out for themselves than their constituent and the country then they’re in trouble.
Bootnote:
As an aside Brogan’s piece highlights the exact problem with the Comms of the NHS reforms, it’s become way too much of a process story. Every time it’s mentioned you get the process background i.e Lansley had a free reign for being quiet in the campaign, the PM wasn’t sure about his reforms, Oliver Letwin had to look at it, medical practioners aren’t sure, now MPs aren’t sure, instead of it being stories about the substance of the proposals.
It’s said that Coulson had become obsessed with the communication strategy of these reforms just before his departure, hence getting the communications maestro of the PM involved, and it’s no doubt at the top of the list for his replacement Craig Oliver. For what it’s worth my opinion is that we need to start talking about the largesse of PCTs again and the layers of management and staff within them to win the public over to the need for reform.
Friday, January 29, 2010
NHS waiting times up 57%
In a press release titled "STATISTICAL PRESS NOTICE - NHS INPATIENT AND OUTPATIENT WAITING TIMES FIGURES" the Department of Health quietly announced that the number of English patients waiting more than 13 weeks for an outpatient appointment has risen by 18,000 from December 2008 to December 2009 a rise of 45.3%
The release also said that those waiting over 8 weeks had increased by 26,900 from December 2008 to December 2009 an enormouse rise of 57%.
The government have put cutting waiting times at the heart of their NHS reforms and have even promised that there will be a legal protection of your right to see a specialist within a certain timescale. Revisiting my previous post that laws are not for aspirations, I wonder that if we had a law that told you you had a right as an outpatient to be seen within 13 weeks who would be in court, or imprisoned for not achieving that today?
Tuesday, January 12, 2010
Government IT Projects
One only has to look at the devastating failures of IT projects over the past decade to see that radical reform of goverenment's approach to IT is desperately needed. Since 1997 approximately £100 billion has been spent on IT projects, far more than any other European country, however despite this expenditure a study found that 70% of recent IT projects have failed.
The list is endless but a few personal favourites include:
- Broadband procurement, a £200m project to save the costs of procuring broadband by pooling resources, saved just £3.5m
- National Programme for IT, delayed to date and forecast to be £10.3 billion over budget
- Department for Work and Pensions Customer Information system, £48 million over budget
- NOMIS and LIBRA systems for the Ministry of justice, still not complete, and £620 million over budget
- NHS IT modernisation programme, has cost £12bn so far, with the pilot beign delivered 4 years late and is in the process of being abandoned
These are just a smattering of examples that show that IT procurement is becoming the defence industry of the modern age. Just as defence procurement (see the A400m for example) never delivers on time or on cost, neither does the IT industry, and for some reason despite contracts being signed and companies being contracted to deliver at a certain cost, the government continues to pay more and more money, in effect billions of pounds more than they contracted to do so. And just like the defence industry there are just a few giants, companies like EDS (now owned by HP) and Siemens who are sacred cows given projects again and again despite their track record and their failure to deliver in the past.
The solution is clear, radical reform of IT procurement and contracting and most importantly project management within the civil service and ministers that understand the projects that are being embarked upon, rather than believing the radical claims of suppliers.
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