We have a proper summer and

Taunting our friends in Arizona is a rare delight but yady yady yaya - every day is a tolerable sunny day at the moment - you remember days when you can stay outside for a reasonable time!!
Today is predicted to be 25 degrees and another day on the bike yippee.
I was speaking to about 40 GP`s last night over at Judges on changes in the NHS in Yarm and afterwards had a gorgeous cross country blast through sleepy villages. Sleepy no more!! Wake wakey it`s the "Bells Angels".
Anway I wanted to bring you all up to date re the NHS and how this government has been absolutely appalling at managing the money and I have pasted the speech given by my ex-flatmate Paul Miller from Newcastle Uni days who now is a "Leading Doctor" according to the Times!!!

Leading doctor's damning diagnosis of NHS

Dr Paul Miller's damning diagnosis of the NHS's woes and suggestions for a possible cure, made in a speech to the annual conference of the BMA's consultants committee today:

"The deficits are clustered in a few areas and are caused by local service management and strategic planning failure, often caused by political interference with proper local service planning.

"But most particularly they are caused by bad policies and shocking incompetence inflicted on the whole service from the top, from Whitehall. And a large part of that is an excessive keenness and liking for expensive management consultants.

"So where has the NHS money gone? Let me give you a few answers, starting with tens of thousands of pounds.

"One trust with big debts, Surrey & Sussex, paid over £52,000 for less than two months’ work from an interim chief executive from a management consultancy in February and March 2005.

"The finances remained dire, so the Strategic Health Authority brought in more management consultants, McKinsey, for half a million pounds.

"How about hundreds of thousands of pounds? The chief executive of an NHS trust in the Northwest left after a critical external report - yet got a £475,000 pay off.

"How about millions of pounds? At the start of the year the Secretary of State sent 'Turnaround teams' from management consultancies into eighteen trusts in financial difficulties. I have written to the Secretary of State asking for the costs of these teams, but have received no reply.

"However, the figures have leaked out anyway. £100,000 per month at Leeds, £800,000 in total. £700,000 in 3 months at Surrey & Sussex Trust, which STILL finished 05-06 with an operating deficit of £28 million and accumulated deficit of over £57 million, before bale-out money.

"But these trusts already pay handsomely for their managers. The annual report for 2004-05 shows one trust paid its executive directors £1.2 million in 2004-05.

"What extra can these trusts be getting from duplication of management costs by employing outside management consultants without significant NHS backgrounds, apart from huge bills?

"How about tens of millions? Let’s look at the huge waste of NHS money in Public Finance Initiative schemes, PFI. The Paddington basin PFI ran up £14.9 million in costs before being abandoned. The National Audit Office condemned the project as having a fatal flaw because the Department of Health had no single body to oversee it.

"A two month ministerial delay to the PFI at Bart’s is said to have cost £35 million.

"The chairman of the Commons Public Accounts Committee who investigated the Norfolk & Norwich PFI said: 'It is hard to escape the conclusion that the staff managing the project were not up to the rough and tumble of negotiating refinancing proposals with the private sector…this was a poor deal.' The NHS missed out on an £82 million of refinancing windfall. That’s over £130 million wasted on these three projects alone.

"We understand that PFI was used to get large amounts of capital investment quickly. But we also understand you cannot bring NHS spending up to the EU average for just a couple of years and expect to have corrected decades of underspending amounting to hundreds of billions of pounds. The good levels of NHS funding must continue permanently, to bear fruit.

"But let’s talk real money, let’s talk billions.

"I want to turn to the costs of the Independent Sector Treatment Centres, which are multi-billion contracts. The NHS is wasting many millions on setting up these facilities when there is spare NHS capacity going unfunded and unused. Remember the instructions to hospitals to stop operating and let waiting times increase, to save money at the start of this year? So much for efficiency.

"First, I want to dismiss an untruth that has been continued on occasions by some this last year. It is simply not true that ISTCs are 8 times as efficient as the NHS. The ISTCs themselves do not claim that their surgeons are better or faster than the NHS.

"They do organise their facilities better around the surgeon than the NHS, and the NHS would do well to learn from this simple fact. Are ISTCs more innovative than the NHS? No, they are not. The Chief Executive of one of the ISTC companies very honestly told the Health Select committee, when asked about innovation: 'None of this is unique to us. All those things are happening no doubt in parts of the NHS.'

"Next, let’s remember the Oxford eyes debacle, and bring the story up to date. The PCTs did not want it and knew they did not need the extra capacity. Nevertheless, the treatment centre was imposed by bullying from the top, and this has been confirmed in the public domain by senior managers who have now left.

"The Chief Executive of Netcare has since stated in public: 'The Oxfordshire commissioning was incorrect, they already had the capacity, they didn’t need Netcare.' Yet the PCT was forced to pay £500,000 per year for four years for 400 operations per year, outside the NHS, they neither wanted nor needed. Last year only 160 were done.

"The clinic no longer makes regular visits to Wantage, as it is not needed. The Strategic Health Authority says: 'The PCT is aware that it's our expectation they will bear the cost.' Meanwhile, there are overspends in the county estimated at £82 million and 600 posts are to go at the Oxford Radcliffe.

"And the examples of ISTC capacity paid for but not used goes right across the country. Unbelievably, spare capacity is being hawked around the country at cut prices like soft fruit at 5pm on a market stall. Expect to see it on eBay soon.

"If you had made this up, you would be laughed at. If you were the one who did make this up, you should be ashamed. If you continue to make it happen, you will destroy the NHS. This is not the way to run our NHS.

"Care is suffering, jobs are disappearing, patients and staff are paying the price. If a patient gets worse instead of better with treatment, then it’s time to figure out whether the diagnosis or the treatment is wrong. Something is going very badly wrong with these health policies. It is time to call a halt. Examine what is not working and why.

"But it is not just me saying so. The chairs and chief executives of 4 children’s hospitals - Great Ormond Street, Alder Hey, Birmingham and Sheffield - wrote to ministers in April to protest about the effects of what they termed 'an inaccurate and highly insensitive tariff' under payment by results.

"Ironically, the DoH had the management consultants reporting on them. It is said that they described the Department as dysfunctional and having lost control of its relationship with the NHS, the finances, and the system reform agenda. Incidentally, I and several others have written to ask for a copy of that report, but we have all been refused.

"The NHS director of clinical governance criticised the reforms. He later resigned. That made 9 senior positions either vacant or with new appointees for resigned staff.

"Of course, the NHS chief executive and the director of workforce have both resigned recently.

"Even a health minister, Jane Kennedy, has reportedly expressed concerns about payment by results, but was allegedly sacked or resigned for her honesty.

"Is not the effect of Government policy on the health service now to pit nurse against nurse, hospital against hospital, doctor against doctor? The result will be to divide and rule and the commercialisation, demoralisation and break-up of the health service, when people want to see the national health service run as a proper national service for the people." These words are not mine, they are verbatim from Hansard and were spoken by Mr Tony Blair on April 27 1995 to John Major:

'Prime minister, you believed in our NHS then, don’t give up on us now.'

"Colleagues, it is hard to avoid the conclusion that we are working in a service which is being broken by policies which do not work; devised by officials who have resigned; implemented by managers who don’t believe; on staff in disbelief; and patients without a say. Enough is enough. The emperor of English health policy is wearing no clothes.



"And to top it all, the massive total spend on management consultants is starting to become apparent. The Management Consultancies Association represents 65 per cent of the industry, does not include McKinsey, but still billed the public sector £1.9 billion in 2004 and £2.2 billion in 2005. It seems the whole industry is therefore charging the public sector £3 billion, with perhaps £1 billion pounds being charged to the NHS. That would dwarf the deficits.

"This has been the NHS’s best year ever …for management consultants…for losing staff…for wasting money.

"But what to do about it now? We must give the leadership where the Department of Health has failed. To lead, we must remember where we have come from. But leadership is not only about knowing your history, leadership is about making history. We must now begin to make the history of the future of the NHS.

· The NHS I believe in would always remain funded from taxation, free at the point of patient need.

· It would treat patients according to their clinical need not political targets.

· It would put patients first by aiming to bring all NHS facilities up to scratch, not by offering a false choice of taking your custom elsewhere.

· It would focus on improving standards of care by clinical networks, not on using "creative destruction" to force the "remanagement" of "failing trusts".

· It would concentrate on good quantitative and qualitative data from IT systems to improve patient care, not just for producing bills.

· It would not be constantly torn apart and turned around by "initiativitis".

· It would realise that by respecting its staff it will get the best for patients.

· It would employ good managers for the long term, not for short term projects or dirty work.

· It would be run at arms length from politicians, who do not have the ability to run it, or allow it to be run for the best.

· It would put clinical collaboration above commercial competition.

· It would put patients before profit.

"Where ever one goes these days, one hears cries of "clinical engagement". From politicians, from the most senior civil servants, from managers. "Clinical engagement" repeated like a prayer in the dark to protect from bad things happening. I hear it often enough, but see little sign of those who talk the talk being prepared to walk the walk.

"Clinical engagement is not about hospital consultants doing what politicians or managers want. Clinical engagement is about consultants-the NHS’s most senior doctors- using their medical expertise to interpret the needs of patients to senior managers and working in partnership with those managers to meet patient needs, within the budget.

"It requires managers and politicians to give up some of their power and control and to understand that no health system will ever be as good as it should be until NHS consultants are running the organisations in partnership with managers for the good of patients. It requires a realisation that 20 years of increasing managerialism, and now management consultants, have failed.

"It’s time now to put hospital consultants back at the forefront of planning, running and delivering patient services. We are not the problem, we are the ONLY solution.

"So, here’s how to begin to fix the NHS. My prescription to the Secretary of State:

"Integrate properly with NHS patient services those ISTCs which already exist. Don’t sign off any more contracts for further ISTCs. Relax the additionality rules.

"No more of the perpetual central redisorganisation of the NHS. It accomplishes nothing and costs hundreds of millions of pounds each time. Where you pulled out of doing the recent PCT mergers properly, because of the views of local MPs, let the PCTs reorganise themselves, just as was happening anyway before your recent big bang.

"Stop interfering for political reasons in the sensible, local planning of services.

"No more external management consultants to be brought in to tell NHS clinicians and managers how to run their services. They have no special knowledge, they don’t know better.

"Stop thinking that there is lots of money to save by getting care moved out of hospitals. There are benefits to giving more care in the community, but it is not a cheap option.

"Let all of us get on with the job for which we were actually trained. Stop expecting everyone to be doing a job beyond that for which they are trained. Skill mix is fine up to a point, but beyond that it can be dangerous and even more expensive.

"Have the NHS run by an independent body, depoliticise it.

"If you are serious about clinical engagement, then require trusts to ensure that real, meaningful, funded management training is there to enable clinical and medical directors to do the job well. And they will, brilliantly.

"Finally, if you are serious about clinical engagement with consultants, then have consultants make up half the trust board. Just think, clinical directors putting patients’ clinical needs at the heart of corporate consideration! What a possibility that offers!

"If you do this, and you can, you will eliminate the overall deficits, win back the trust of 1.3 million NHS staff and most importantly, put the clinical needs of patients at the heart of trusts’ thinking.

"If you do this, truly THEN it would be the best year ever for the NHS."