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PATIENT OUTCOMES ARE INFLUENCED BY EXPECTATIONS.
UNJUSTIFIED NEGATIVE PRESS NOT ONLY DAMAGES THE NHS, IT CAUSES REAL HARM TO REAL PEOPLE.

 

» Big Up the NHS

The Future of our NHS – if we do nothing

Steve Smith

nhs_cartoon_graham_syringe_help_patricia_hewitt In part one of this series I described some of the threats to our NHS in its present form. While nobody can predict the future with accuracy it is worth taking a moment to consider where we are heading if nothing is done to protect the service.

You will find this hard reading. No doubt some will accuse me of scaremongering. I concede that the picture I will paint is grim but I truly believe it to be a real possibility. I will not suggest a precise timescale these events – that would really be stretching it too far – but suffice to say we are talking months to  a couple of years rather than decades.

To follow the logic of my argument you need to have read part 1 of the series.

Where are we now?

Let’s start from the current situation. Emergency departments in hospital trusts are under extreme pressure. Ambulances cannot offload at hospitals so there are not enough vehicles on the road for new emergencies. Hospital bed occupancy is near 100%. Mental health bed occupancy is over 100% with patients sitting for days in emergency departments waiting for places.  Primary care is struggling to cope with increasing demand. GP workloads have rocketed and we cannot recruit enough GPs to replace those taking early retirement.  Social care is near breaking point with limited community places and no cash for care packages.

We have already started to see a deterioration of performance against government operational and financial targets affecting all sectors of the health economy. Emergency department 4 hour waits, ambulance pick up times and cancer treatment targets have all deteriorated. Two thirds of acute  trusts are in financial difficulties and some may go bankrupt.

So what will happen next?

Senior managers will be put under enormous pressure by Monitor, NHS England and the CQC to improve both financial and operational performance AT THE SAME TIME. There will be some extra cash from a government slush fund which will be trumpeted but will be manifestly inadequate.

CEOs will find their jobs are on the line so they will respond in the only way they know. By putting more pressure on their front line staff, cutting non-essential services to the bone, cancelling elective work (while being careful to shuffle the patients around so elective targets are not compromised), freezing vacancies and putting a ban on procuring paper clips.

This will not work. Performance will deteriorate. Staff morale will fall and recruitment will suffer. General practice and front line emergency services will be the first to really struggle with recruitment. The private sector will look appealing to exhausted staff and some will jump ship.

The regulators will up the ante piling on the pressure from the centre. Ministers will screech that something must be done. A couple of high profile CEOs will be sacked, and several more will walk while they have the chance. Unsurprisingly their vacated posts will not attract any suitable candidates and other non-executive board members will “act up” on a temporary basis (which eventually will become permanent).

The twice daily local health economy teleconferences between commissioners, acute and ambulance trusts, primary care and social services will become increasingly acrimonious and ineffective as the combatants try to shift the blame away from their service. Participation will be delegated down to more junior managers until they fizzle out completely.

Eventually Monitor and the CQC will realise that trusts cannot reasonably expect to meet the targets and will back off. Watch out for this happening because THIS IS WHEN IT ALL FALLS APART. Services which have only been kept going by fear and Draconian management will take their collective feet off the gas. Burnt out staff will accept patients waiting on trolley for 12 hours as the norm. Quality and patient experience will plummet. Waiting lists will increase, routine surgery will be reduced and “non-essential” services such as infertility will be discontinued altogether.

While all this is happening private healthcare providers will tender for the profitable parts of the NHS. They will usually win these bids, partly because they have more resource to put into the preparation and partly because they can afford to offer loss leading prices. Current NHS providers of these services will disinvest in staff and equipment. Some may even be slightly grateful as it gives them an opportunity to meet cost improvement targets – but they will be deceiving themselves.

B6xowL9CYAAYsJOThe private providers will attempt to make any money out of their new services. These will still be branded as NHS so the public will be largely unaware of what is happening. They will cut costs, downgrade staffing, avoid complex cases and stoke up demand for the profitable parts of the service. They will try to maximise profit by offering “enhanced” services for cash top ups.

If it turns out to be too hard to make money they will walk away, leaving a hole for the NHS provider to fill. But remember – the NHS provider has given up the staff and equipment for CIP and they have no cash to reinvest. Some private providers will take advantage of this and renegotiate a better contract price.

As the core NHS business shrinks, quality nose dives and waiting times rise there will be a big increase in the number of people with the spare cash taking out private health insurance. This will lead to a steady growth in the non NHS private sector (as opposed the private sector still branded as NHS). Many of the most powerful and influential of the population will become less reliant on the NHS. Pressure to keep it going will diminish – by that stage it will be pretty rubbish anyway - and it will become an organisation providing second rate health care for those without insurance. It will be staffed by a combination of skilled altruists and no-hopers who cannot make it in the private sector.

Patients who genuinely need to access healthcare will stay at home because they don’t want to impose on a pressured system – and nobody will have the energy to try to persuade them otherwise.

At the end of the day we will have a fragmented healthcare system. It will be much more expensive but we will pay for the increased costs through insurance schemes rather than tax. It will be inefficient, inequitable and socially decisive. Illness will be a financial as well as a physical catastrophy – even for the very rich.

So what do we have to do?

I warned you it would be grim. I scenario I have described may be towards the "worst case" end of the spectrum but there are other potential issues that I have not included which could make it even grimmer – a flu pandemic for instance.

Whether or not you believe all of this analysis to be correct there has to be a great deal of cause for concern. Much, if not all, is avoidable but it will take early and decisive action from a strong government to fix things.

In the final blog of this series I will describe what I think could be done to save the NHS, and you will have an opportunity to have your say too.

Isn’t about time we shared some good news?

Steve Smith

First published by the Nursing Times but you need to be a subscriber to read it.


#MyNHSChristmas

Wouldn’t it be great if at 12 noon on Christmas Day thousands of people across the UK simultaneously shared their good news stories about the NHS on Twitter and Facebook?

These could be personal experiences, pictures of Christmas celebrations or just a word of thanks for those who are working in the NHS during the festive season.

They could come from patients, NHS staff, carers or the general public. They could come from you.

Videos, photos, text or sound bites will all add to this movement. But the common theme is they all include the hashtag #MyNHSChristmas so everyone’s good news stories are easy to find and can be shared with as many people as possible.

This surge of activity would be picked up instantly by search engines and #MyNHSChristmas would appear as a “trend” - visible to everyone using social media and fighting back against negativity aimed at the health service.

More people would look in and contribute their own messages and stories. The best would be shared or retweeted, the whole movement fuelled by seasonal good will and a tsunami of support and affection for the NHS involving hundreds of thousands of people.

When it all dies down, there would be a subtle but real shift in the national mood. Morale of NHS workers may be a little better, patients may have a bit more confidence is the system and politicians would learn why they should value the NHS.

What’s not to like?

imagesEJCSRXM1

But could it really happen?

It could and it will!

Big up the NHS is a national campaign aimed at promoting good news about the NHS using social media. The #MyNHSChristmas campaign is in full swing and is picking up support rapidly.

Politicians and celebrities have been recruited to promote and take part. Newspapers and TV have picked it up and it will be getting national coverage on Christmas Eve.

downloadThe event will be opened with a tweet from Sir Bruce Keogh – Medical Director of the NHS – at 11.59.

It will definitely be big – the only question is how big?

If you have never been part of a live Twitter event of this type then I would strongly recommend that you give it a go. To see the positive messages flooding in is emotional and uplifting.

And if you have never used social media now may be a good time to start. It is easy and free to open account - and it will open up a whole new dimension to your life.

A sad NHS is a bad NHS so it is in all our interests to make this work. Please spread the message. Look for #MyNHSChristmas adverts and share them with your friends.

ChristmasPost some of your early thoughts or pictures using the tag, but make sure you keep some back for the day.

Please join #MyNHSCHristmas at 12.00 midday on the Christmas Day.

Have a very Happy NHS Christmas

Steve Smith, Consultant Physician and Nephrologist, Heartlands Hospital

 

Find out more:

@butNHS

www.bigupthnhs.com

It could have been worse........

Steve Smith

End of a busy day, about to drive home then out of the blue – my car broke down. Just refused to start. Nothing too dramatic but a bit inconvenient.images (1)

I was not concerned. I have a Gold Membership with the AA. They cover the cost of repairs and a hire car if they cannot get you going. It would be fine.

The AA man arrived quickly but after 30 minutes with no joy my confidence started to diminish. “Had I used the right petrol?” I was starting to feel it might be my fault even though I was (fairly) sure I had done nothing wrong. The AA man looked worried – no compression – it would have to be towed.

I know enough about cars to understand the implication of “no compression”. It could be serious, possibly fatal. The first question – which garage do you want it towed to? Main dealers are expensive but it was a reasonably new car and I wanted someone who would do it properly. I chose the main dealer. download (3)The next day I got the call from the garage. Probably a slipped timing chain which may have wrecked the engine. The next question – did I want to authorise the work to find out what was wrong? Best part of £1000 for just the diagnostic work. Much, much more if their fears were realised. The sums they were talking about seemed mind boggling. Ludicrous labour charges. Could I trust them? Were they ripping me off? Getting the car anywhere else for the work to be done would mean towing and more expense and I didn’t know any other garages anyway. Without the work the car was worthless so I said yes – but felt vulnerable and unsettled.

Then I learned about the limitations of my AA Gold Membership. Only 3 days car hire and a maximum cover for repairs of £500 with an excess of £35 – and I needed proof of regular servicing and had a whole load of other criteria to satisfy. I was pretty much on my own.

To cut a long story short I needed new engine – over £5000 and 2 weeks work. All outside warranty and so my responsibility to pay. I spent a fortune in taxis and I worried a lot about whether I was being fleeced. For me it was not exactly a life changing amount of money but it was an unexpected loss, and I felt alone and vulnerable. Nobody seemed to be on my side. It was a genuinely distressing week. All sorted now thankfully though but I am still in correspondence with the AA who are asking more questions which are clearly designed to find ways to wriggle out of paying their rather small contribution. The experience set me thinking though. It could have been worse. It was only a car. What if it had been a heart attack on the way to work? And then I realised why we have to be so thankful for the NHS. article-2058424-0EB2A17C00000578-464_468x311

If you suffer a major unexpected health “breakdown” you get immediate emergency attention from the best available - on the NHS. You know that the clinicians’ primary objective is YOUR wellbeing and not THEIR profit. You don’t have to worry about money or making insurance claims. Just about everything you need is available where and when you need it and if not you will be “towed” by ambulance to the most appropriate centre. People take on your problem as their own. They advise and support and try to make it right – for you - with the minimum of fuss. You can trust their motives.

Our NHS is under threat right now and we may lose the “free at the point of demand” principle unless there is a significant change of heart from all political parties. We may also find ourselves being treated by people who are in it for the money.

Please, please don’t underestimate the value of the NHS just because you have not used it recently. We will be all the poorer if it is gone.

Somebody else’s story could start like this - End of a busy day, about to drive home,  then out of the blue - I got this crushing pain in the chest...... 

POST SCRIPT

It turns out it was a bit worse than I thought. The AA have refused my claim on the basis that a slipped timing chain is wear and tear and thus excluded from the policy. If anything that might be worn is excluded what is the point? I am fighting.  Would like to hear if others have had similar experience with the AA. I feel a non NHS campaign coming on.

POST POST SCRIPT

I have now had the letter from the AA confirming they will not to pay up because they presume the timing chain must have been worn. They could not inspect the part because the garage quite rightly refused to strip down the engine. This would have cost more than the value of the claim.

As a result I am in a difficult position. The car had done only 23,000 miles and was fully serviced by a main dealer. To me it was a sudden mechanical failure but they disagree. I will appeal but it feels unfair and one sided and I don't want to throw more money into this mess by involving solicitors.

This story illustrates why we must NEVER give up the NHS for an insurance based system.

It is also a reason to never use the AA. I may not succeed in getting what they owe but if I can stop just a handful of people joining their dodgy scheme they will be the ultimate losers. Spread the word..........

 

 

Schwartz Rounds – a key to unlock culture change in the NHS?

Steve Smith

I was a medical director in a large acute NHS trust until recently and one of my jobs was to read through all letters of complaint. It was heart-breaking. Some described simple mistakes or misunderstandings but many told stories of cruelty, neglect and callous indifference. So I began to wonder – how could this happen? The staff seemed to me to be reasonable, caring human beings. Indeed most clinical staff members are rigorously selected for their caring natures.

cruel-doctor-225x300Then it happened to me. I was having a bad day, too much work and not enough time to do it, worries about a health issue at home and a major presentation later that day that was not properly rehearsed. I was in clinic and an elderly lady was banging on about something (apparently) trivial. I cut the consultation short and bundled her out as quickly as I could but just caught the briefest glimpse of disappointment in her eyes as she left. It wasn’t awful, not worthy of a complaint letter, but it was definitely not good.

I can still remember pang of guilt as I recognised what had just happened. I had appeared (been?) uncaring and unsympathetic, I had not given my patient what she needed and the encounter had been unsatisfactory for both of us. I did not set out to do that. On most days I am pretty good and my patients are usually happy. I had just let my internal turmoil get in the way of delivering compassionate care. It could happen to anyone.

In fact it could and it does happen to almost everyone. Working in health care can be stressful to a degree rarely seen in other professions. We make decisions that have life and death implications and have to learn to live with ourselves on the rare occasions we get things wrong. We each have to develop our own strategies to deal with this – blocking, denial, distraction, overcompensation - and sadly these may affect the way we interact with patients.

1729007NHS workers are not good at talking to each other about how they are feeling. The culture is “don’t moan” and “don’t hesitate to cope”. People who externalise their feelings are often considered to be a bit flaky. You certainly would not want one of those on your team. Believe it or not there is no forum in the NHS where team members can say what they feel about their work, share their stress and anxieties and help to support each other. Or at least there wasn’t until Schwartz Rounds were introduced.

Schwartz Rounds were developed in the United States about 20 years ago by the Schwartz Centre for Compassionate Healthcare. The founder, Ken Schwartz, was a healthcare attorney who at the age of 40 developed terminal lung cancer. During the 10 months up to his death he wrote movingly about his experience in an article for the Boston Globe Magazine entitled A Patient’s Story. In it, he reminds caregivers to stay in the moment with patients and how “the smallest acts of kindness” make “the unbearable bearable.” He founded the Schwartz Centre in 1995 – just days before his death – to ensure that all patients receive compassionate and humane care.

Schwartz Rounds are structured meetings for all members of the clinical and non-clinical staff, but not for patients. The one hour meetings consist of brief presentations form three or four staff members about a particular case or experience followed by a facilitated discussion. Two trained moderators make sure that the discussion is kept to the emotional aspects of caring and does not drift into problem solving or personal confrontation.

Everything that is said during the meeting is regarded as confidential. Participants can talk about the process in general outside the meeting but must not attribute anything that is said to individuals.

The Schwartz Centre web site sums up the principle nicely with this quote from a participant - "Schwartz Center Rounds are a place where people who don’t usually talk about the heart of the work are willing to share their vulnerability, to question themselves. The program provides an opportunity for dialogue that doesn't happen anywhere else in the hospital."

schwartzbhhI have just completed training as a facilitator and we have conducted a couple of rounds in my organisation and I can tell you first hand that they are wonderful. The participants all came out of the meeting feeling reenergised and supported. I am sure it will help them care more compassionately for their patients – at least for a while.

My main concern is that there were only 50 people in the audience from a staff base of over 10,000. I can’t yet see how the benefit will roll out to the rest of the organisation.

Nevertheless these meetings have started to address a serious and intractable problem. We will not make real progress in delivering more compassionate care for our patients until we understand and tackle the root cause of poor care directly and assertively.

Schwartz rounds are being rolled out in the UK by The Point of Care Foundation. They are a charitable foundation dedicated to improving patient experience. If you would like to know more about Schwartz rounds their web site is a good place to start.

Steve Smith

Is this deliberate NHS bashing from the chairman of the CQC or just political ineptness.

Steve Smith

By Roy Lilley The Original title was "What does he do for and encore" and you can read it here. I have reblogged as it illustrates the problems of press and government coverage of the NHS perfectly.


 

 

If you read this in the morning the NHS will have killed about thirteen people. If you read this in the afternoon the NHS will have killed another 13 people. If you read this, this evening just over 26 people will have, deliberately, inadvertently, neglectfully or somehow been slaughtered by the NHS.

It is unlikely the police will have been involved, no record made. The identity of the dead will be known only to the families who will be unaware of how their loved one might have met their end. Death certificates will offer little clarification.

By the end of the week 190-ish people will, by accident or design, be slayed by the NHS. In the course of the year... ten thousand.

How do I know? The Daily Telegraph tells me. They offer no evidence, only the word of the Chairman of the CQC, chief flat-earther and high Tory, David Prior. The Guardian makes the same claims based on the same vapour.

In  response the CNO at the Carbuncle, Jane Cummings said; "The NHS treats millions of people every year and the overwhelming majority of our patients receive great care from staff who are pulling out all the stops. We do need to do more, but the quality of care is better now than at any point in the history of the NHS."

In other words *&%%$£-off.

The NHS deals with over 1 million patients every day and a half. In that time, Prior tells us, 39 of that million will have been killed. One death is too many, let's get that straight, right from the off, but do his sensationalist allegations hang together? What exactly does he mean? Does he know?

It appears Prior is basing his comments on this old Telegraph story which is a complete over-reporting of a not very good academic study. 

Mortality amenable to healthcare is an international measurement. Research requirements in diverse countries, different ways of recording death, often poor data and so-on means the information is not last week's. This is from the OECD; out of 31 countries the NHS is rated in the middle, 19.

Preventable mortality is a different matter and probably what Prior is talking about. The most recent and authoritative study (2012) the source of the Telegraph story, was funded by the National Institute of Health Research conducted by researchers from the London School of Hygiene&Tropical Medicine, the National Patient Safety Agency, Imperial College and the Uni of Newcastle.

 It's a review of the patient records of just 1,000 adults who died in 10 hospitals across England, five years ago, in 2009.  It concluded that one death in 20 had a 'greater than 50% chance of being preventable'... poor diagnosis or inappropriate treatment; mostly occurring in the frail elderly with multiple other medical problems. This raises debate over whether these deaths were actually "preventable".

The researchers extrapolated their results, multiplied them up and made an educated prediction on the national picture.  Guestimate, conjecture, supposition.  When academics guess we are supposed to genuflect... I used to... not any more.

The study reviewed medical records, which may not be accurate. Previous, similar studies have produce estimates ranging from 840 to 40,000 deaths a year. They highlight adverse events but cannot say if they contributed to death and are, in any event a subjective view. They excluded paediatric, obstetric and psychiatric hospital admissions.

Here's the cracker that Prior ignored; the researchers concluded '... the incidence of preventable hospital deaths in England is lower than previous estimates'. In truth - we still have no idea.  There is more interesting stuff here that concludes death is probably not the best measure of quality care.

If you are with me so far you will be far better informed than the Chairman of the Flat-Earthers and better able to talk intelligently on the matter.

Prior has form for saying unevidenced things. Here and here. It looks to me, from the CNO's comments that the Carbuncle is fed up with him. I know for a fact a lot of his staff and some of his Board think he's an embarrassment. Monitor just ignore him.  As the election comes nearer I expect the Tories will be sick of him, too.

On Prior's watch the CQC struggles: to recruit; to justify sending 79 people to inspect a hospital; cannot defend inspection as a technique to improve quality; has trophy-senior-inspectors with no management qualifications; has a Board that lacks grip and has had to row back on its strategic objectives; recruited inappropriate staff it can't sack; has an eye-watering budget; mired in legal cases; has no evidence that it is improving Trust performance; publishes no meaningful peer reviewed data and has a hot-head for a chairman who can't control his organisation any more than he can control himself when faced with a journalist.

 What does he do for an encore?

Socialised or commercialised healthcare for the UK – which would you prefer?

Steve Smith

This blog is a little longer than my usual offerings but I hope you will take a few minutes to read it and then to share it widely. I think the message is important and helps to clarify the current arguments about privatisation of the NHS. Those with short attention spans may wish to cut to the take home message by going to the last paragraph (but you will miss a couple of brilliant video clips). BulCCYiIUAA5d1eThe privatisation debate

There has been much debate in the media recently about “privatisation” of the NHS. Should we allow parts of the service to be subcontracted to private companies or do we believe that our future health care needs will be better provided by not for profit, publically owned organisations?

Clearly this is a crucial issue but in some senses the “p” word is unhelpful and can be misleading.

Much of the current service is already in private hands. All GPs are independent (private) practitioners and are not employed directly by the NHS and many existing services are already provided by the private healthcare industry under the NHS banner.

The law has been changed so that further privatisation is pretty much inevitable and effectively irreversible, so the argument about privatisation is not about “if” but about “how much” and “how fast”.

The main weakness of the term “privatisation” is that it allows the argument that that as long as the NHS remains free at the point of need the financial basis of its providers is irrelevant. I don’t believe this argument to be true but will park it for the moment and come back to it at the end of this piece.

To complicate matters further the term privatisation has acquired political connotations and has a tendency to divide people on party political grounds – not a great help when trying to engage the general public in this critical debate.

A much more important debate

A much more important question is what are the underlying principles that govern healthcare strategy in the UK? To my mind there are two broad approaches - socialised or commercialised medicine.

  • Socialised medicine is characterised by central control with the PRIMARY intent of achieving the maximum amount of health gain from the available cash.
  • Commercialised medicine is characterised by relinquishing control to market forces with the PRIMARY intent of extracting the maximum amount of profit from any available cash.

Socialised Medicine

Ironically the term socialised medicine was first used in the USA in the early 1900s. It describes a healthcare system that provides medical and hospital care for all at a nominal cost by means of government regulation and subsidies derived from taxation. The NHS is often held up as the archetypal example of socialised medicine.

While initially a positive term in the USA, by the 1940s it had become a brickbat used to discredit Truman’s proposed national healthcare system. The implication was anyone advocating universal healthcare access must be a communist.

Socialised medicine is strong in terms of cost, equity of access, efficiency in procurement, preventative medicine and economies of scale. On the other hand it tends to be bureaucratic and unwieldy, slow to innovate and struggles to control demand.

Commercialised medicine

Commercialised medicine runs according to the rules of the market place. The primary purpose is to generate profit from delivering health care. There is no central control or planning so it tends to be agile and innovative. Access to care is determined by access to cash so it is intrinsically inequitable. Companies are keen to increase demand and they can do this most effectively by promoting health anxiety. The United States health service is often held up as the archetypal example of commercialised medicine.

A key principle of commercialised medicine is that profit comes from delivering the maximum amount of healthcare for the smallest cost while charging the highest price. Health improvement for individuals is not so important and in some instances becomes irrelevant.

0One good way to increase profit is to drive up demand by stoking up public health scares. Genital herpes was turned from a minor, inconvenient, untreatable disease into a hugely scary and stigmatising untreatable disease by a drug industry intent on selling treatments which are largely ineffective. A whole generation grew up fearing that they had halitosis which could stop them finding a partner, which they could not detect themselves and which their friends would not tell them about. It was all so the manufacturers of Listerine could make millions from the gullible spitting gallons of their product down the sink.

Why can’t we have both?

Well of course we can and do. Every health economy consists of a mixture of socialised and commercialised services. Proportions vary between countries with the UK being at one extreme and the USA at the other. Most European countries sit towards the socialised end of the spectrum. Where we sit on the spectrum is not set in stone and there is a real danger that we in the UK will move towards the US model.

So which is best?

While both socialised and commercialised medical systems have their faults you only need to look at the comparison between US and UK health systems to see which is best. International studies have demonstrated time after time that the UK system is cheaper, more effective and fairer.

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It is sad that the US paranoia about “reds under the bed” in the McCarthy era and throughout the cold war led them to develop a health care system that is second rate, inequitable and overpriced. Thousands of their citizens die for want of healthcare or are financially ruined by chronic illness. In this respect you could argue that the US lost the cold war, and is still taking casualties to this day.

In that case who on earth would support a commercialised health service?

There can be no doubt that a socialised medical system is better for the nation as a whole but there are some groups of society who benefit from a commercialised system – and among these you will find individuals who are happy to put their own self-interest above the greater good. These individuals are likely to come from the following groups:-

  • Investors in healthcare companies.
  • Employees of healthcare companies. This may include clinical staff – especially doctors.
  • Politicians. Commercialised healthcare reduces the central tax burden on health, generates tax revenue and increased economic output.
  • The wealthy. Progressive taxation means that the very wealthy pay more towards healthcare in a socialised system than they take out in healthcare.
  • The healthy. If you don’t need healthcare why pay for it?
  • Some political hardliners who have philosophical objections to socialised systems on principle.

Combined these various groups are powerful but remain a minority. The problem is that the majority who stand to gain most from socialised healthcare come from the least empowered sections of our society.

What is the difference between commercialised and privatised healthcare?

I am very aware that this treatise may generate some confusion. The terms commercialised and privatised are not synonymous though there is an overlap.

I agree that it is possible for private healthcare companies to take part in a fully socialised healthcare system as long as their activities are strictly regulated. This means that the care they provide should be controlled; the cost and quality of treatment is determined and paid for by government rather than market forces and they should not be able to manipulate demand (for instance by advertising).

Much healthcare in the UK is currently provided by private companies on that basis. Further privatisation does not necessarily mean that we will move to a commercialised US style healthcare system, but it does of course increase the danger that we could move in that direction.

While “privatisation” is a relatively new and trendy term, worries about commercialisation have been around since the birth of the NHS 66 years ago. Nye Bevan himself said “The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health”.

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So what are the chances that the UK will move towards a more commercialised model?

Privatisation is already with us and is likely to increase. The way we prevent privatisation turning into commercialisation is to have strong central commissioning, tight controls on quality and clear rules about the interface between commercial and NHS services.

Unfortunately these controls have already been eroded by changes in legislation such as the Health and Social Care Act which removed the responsibility for the health of citizens from the Secretary of State for Health. This, and the proposed Transatlantic Trade and Investment Partnership (TTIP) has opened up the NHS to future privatisation.

Existing controls on private healthcare providers such as NICE and the NHS commissioning board have been undermined in the press and the continuous barrage of anti NHS media has (to a degree) weakened the will of the British people to fight for it.

All it will need is a relaxation on the rules about advertising and commercialised medicine will be unstoppable. There is real danger here.

So what do we need to do next?

Doing nothing and we lose the NHS in its present form and risk drifting into a commercialised US style of health care.

While privatisation alone does not necessarily lead to commercialisation it makes it much more likely. If you choose to swim with sharks you are much more likely to be bitten. We must continue the campaign against privatisation and try to reverse the changes in the Health and Social Care act and stop the introduction of TTIP.

This alone is not enough though. We have to ensure that the NHS is strong enough to manage effectively the big International healthcare providers and stop them being able to exploit our sick and vulnerable. We must support the NHS regulators and make sure they know what we expect of them.

We must remain solid on the rules about advertising and stop companies creating unnecessary fear to drive up demand.

This will take a strong government driven by a strong public voice.  I don’t know which party will succeed in the next election so it is imperative that politicians of all parties know that we value our NHS and want to preserve it from exploitation. This has to be the top priority as we approach the next election.

So, to preserve the NHS we ALL have to do SOMETHING. Lobby your politicians. Join in the #March4NHS. Share your views on social media. Write to the press. And most important please, please, please Big Up the NHS!

Back to the top (for those who cut to the chase and now want to read more)

Steve Smith

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Who will save the NHS?

Steve Smith


image

I know the approach I have taken in this blog is a bit contrived but as a device to get the main message across it might work. Please bear with me and read to the end to find my answer. Share widely if you agree with the logic.

It takes the form of a conversation between me (@butNHS) and the average man (or woman) in the street (TMITS).


TMITS  - “What - save the NHS? Surely the NHS is one of the UK's best loved institutions and is recognised to be the most efficient, effective and equitable health care system in the world. We all depend on it from cradle to grave. It is at the core of our society, truly a national treasure. How can it possibly need saving?”

@butNHS - “Yes, all these things are true, but the NHS as we know it – funded through central taxation and free at the point of need -  is under real threat at the moment.  Unless things change quickly we will see it systematically dismantled over the next decade.”

TMITS  - “How come? I have grown up with it.  I have always been certain that we will have it for ever.”

@butNHS - “There have been two significant changes in the law recently which are certain to force large chunks of the NHS into private ownership.

download (2)The Health and Social Care Act of 2012 obliges commissioners to buy in services through competitive tendering. Private companies will be able to use their extensive business development know-how to out-manoeuvre NHS trusts and pick off the best and most profitable parts of the NHS.

The Transatlantic Trade and Investment Partnership is a piece of European legislation that when passed at the end of this year will oblige the NHS to offer its services for sale to the big American healthcare corporations.

The combined effect of these two bills will be a steady transfer of NHS services to the private sector – and as the new services are all badged as “NHS” the public will not see it happening.”

TMITS  - “But if it is still free at the point of need and funded from central taxation why should we worry?”

@butNHS - “ Mark my words - there is a lot to worry about!

Big business is mainly interested in the profitable, safe and predictable bits - routine surgery for instance. They have their shareholders to pay. Messy things like emergency services will be less attractive.

When the NHS acts as a unified whole the profitable and non-profitable, easy and difficult bits balance each other out, but take away the easy stuff and the rest is put under greater pressure.

And what’s more the move to private ownership is a one way street. When private companies take over a service the existing NHS provider loses the income and has to disinvest in staff and equipment. In a cash strapped health economy it is virtually impossible to upscale to take on the service again – even if the private company eventually decides to release it.

NHS staff will be torn. Should they work in the safe and sanitised private sector where they will most likely receive a variety of tempting inducements, or should they work in an increasingly underfunded and pressured NHS. Recruitment and retention is already an issue in many areas and this will make it much, much worse.

The final straw will come when private providers start to offer an “enhanced” service for those who can afford to pay a bit extra. It will fall outside the NHS umbrella at first bit we will see an inevitable drift towards those who can afford it taking out private health insurance.”

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TMITS  - “I have heard a lot or press reports recently that the NHS is failing. Perhaps it is best to dismantle it anyway.”

@butNHS - “Many believe that the bad press is deliberately orchestrated by the government to undermine the credibility of the NHS as part of a plan to sell it off to the private sector for profit. This view has been widely circulated through social media. I am not a natural conspiracy theorist but I can see the logic of the argument.

There is little doubt that current press coverage of the NHS is skewed heavily towards the negative. The NHS bears comparison to any other health economy in the world and often comes out top in international league tables.  There is a lot of good work that never gets reported. The NHS is definitely NOT failing.

I don’t discount conspiracy but I think it is more likely that journalists simply do not realise the harm they can do. Sections of the public enjoy the feeling of righteous indignation that comes when they read of failings in others. We pick away at the scabs for the pleasure of the picking even though we know this is likely to be damaging and may cause permanent scars.”

TMITS  - “OK – I get it. So what can we do about it? Surely there will be a public outcry.”

@butNHS - “Well no. Privatisation is already happening big time but there does not seem to be much noise about it at present. A bit of activity in social media and the odd article in the papers, but if you ask the average person what they know about this you will probably find it is very little.

I am really worried that there is no one with both the will and the means to save the NHS!”

GovplansTMITS  - “So how about the big political parties? They know the popularity of the NHS. Protecting it should be a big vote winner for them. But you said that they may be orchestrating its demise.”

@butNHS - “Yes I am afraid that may be true. All the mainstream parties were complicit in (if not directly responsible for) the legislative changes that have put it under such threat. The NHS poses a big problem as far as all the mainstream parties are concerned – regardless of what they say in their manifestos.  They know that it will require more funding in future but they do not have the courage to increase taxes to pay for it. Selling it gets them off the hook. They would rather you pay a lot more through private insurance policies than risk losing your votes by asking for a little more tax. It is political cowardice of the highest order.

Sadly though, it is only the party in power that can really make the legislative changes that will safeguard the NHS. If we are to save the NHS we have to convince current and future governments that it is in their best interest to preserve it. We need to exert sustained, forceful and unambiguous pressure. All parties need to understand that saving the NHS is the Great British public’s top priority when we come to vote in the next election.”

TMITS  -  “Yes that makes sense. So we need a big campaign. Let’s get the press behind this.”

@butNHS - “Oh dear – I don’t think you have been listening. The press seem intent on undermining the NHS. So far they have not taken this on. They may even be part of the problem.”

TMITS  - “Then we must make them change their minds. Who else can exert an influence on press and politicians? What about the big bosses at NHS England? They must know what is going on.”

@butNHS - “They are far too embroiled in politics and worried about their own jobs. They dare not speak out.”

TIMTS - " Or the Care Quality Commission?”

@butNHS - “Not likely – it is a political quango which looks to be operating at present as though it wants to undermine the service  too.”

TMITS  - “Well there are the professional bodies, the General Medical Council, The British Medical Association, the Royal College of nursing etc.”

@butNHS - “Maybe one day but they seem more concerned with protecting their individual members and keeping out of the spotlight than looking at the full picture. To be fair it would be a bit intimidating to take on a hostile press. They would be massacred. You must have seen what Channel 4 News can do to a society president.”

TMITS  - “The Trade Unions? Surely they must understand the importance of socialised health care.”

@butNHS - “Possibly but they have not made a lot of noise so far. I hope they may get more involved in future but we need to get them engaged somehow.”

TMITS  - “There are 1.3 million people working in the NHS. Surely they can exert some influence.”

@butNHS - “Eventually maybe but many NHS staff are not in good place at present. Overworked, underappreciated – at least by the media - and too beaten down to lead this. Some are worried about their jobs. We know that whistle blowers can be very badly treated. There is huge potential for NHS staff to get involved though given, the right guidance and support.”

TMITS  - “Why don’t we just vote in the NHS Action Party? They seem to care about this stuff.”

@butNHS - “Undeniably true but single issue parties will rarely win seats in an election. Even if they do they don't get to make law. They can only lobby the government like the rest of us. They can help in spreading the message but they will never hold real power.”

TMITS  - “A-ha, I have got it. You are a big fan of social media. That must be the answer.”

@butNHS – “Well no, not really. Social media has quite a lot of reach and works quickly but it is ephemeral. The vast majority of the UK population do not use any form of social media. This campaign needs to be firmly in the real world. There are lots of little social media groups working separately but nothing seems to join up. Committed people can tweet at each other as much as they like but it will not change the world.”

TMITS  - “OK – I give up. Who do you think will save the NHS?”

@butNHS - “Think about this logically. The only people who have the power to make the legislative and organisational changes needed to save the NHS are members of the government who you, the man in the street,  put in charge of the country next year. The problem is neither of the mainstream parties seem to have the political balls to take it on.

They will only do it if they think their political lives (as opposed to their real lives, ironically) depend upon it.

We have the make saving the NHS the top priority for every party in the coming election.”

protect the nhsTMITS  - “But how can we do that? You have just spent 10 minutes telling me that everyone is impotent or disengaged and nobody can make a difference!”

@butNHS - “Well yes , and also no. The truth is that no single organisation can do it but if everyone joins in we can make a difference. Social media can be a big driving force to spread the message. We need to coordinate the various pressure groups and get them all working together. We each individually need to encourage our unions and professional organisations to get involved and give them the confidence to speak out. We need to big up the NHS and empower its staff to speak out.

Any person can canvass an MP or a healthcare correspondent and these are the people who will make all the difference. They all need to be bombarded with thousands of messages from concerned men and women in the street.

We need petitions, demonstrations, marches, celebrations, and lobbying. We must celebrate the NHS and counter the negative press stories.

We need the nation to be proud of it greatest institution.”

TMITS  - “So you are saying that the only thing that will save the NHS is the combined will of the British people, and that it is everyone’s responsibility to do something about it.”

@butNHS - “You have got it in one. If we all sit back and wait for someone else to fix it we will have no NHS in 10 years’ time and we will all be much the poorer, and many will be dead.

So, man in the street, what are you going to do now?”

 

Footnote

I am thinking about converting the dialogue into an animated video using one of the free on-line services. What do you think? Would any of my dear readers have experience and be able to help with this? 

Big Up the NHS needs YOUR help!

Steve Smith

briton needs youOn the 31st July Big Up the NHS will be 1 year old. It is hard to believe how quickly it has grown. It all started with a simple concept and a new twitter account. It now has 25,000 followers on twitter and over 2000 members in the Facebook group. There are also LinkedIn, Google+ and Flickr groups, an active blog and (although I say it myself) a pretty zippy web site. I am just about to start publishing a regular newsletter for the growing mailing list. People often assume Big Up the NHS is an organisation with a membership but they are wrong. It is just me, working alone, burning the midnight oil and missing lots of sleep.

Despite this I think the campaign has made a difference. #NHS66 and #thankyounhs campaigns have been hugely successful. Politicians and media people are following the campaign and taking note. We still have a long way to go but I believe this approach has ENORMOUS potential for good.

The problem is the rate limiting step is now my time and energy. I cannot fit in any more without getting sacked, divorced or both. I need YOUR help!

How can you help?

There are four ways you can help – listed here in order from least (almost none) to most time commitment. You can of course do more than one.

1)      Become a Big Up the NHS Supporter

Basically you just register your support by completing this form. No commitment to do anything. You will receive an occasional newsletter and get a slight warm glow for being involved.

2)      Become a Big Up the NHS Tweeter/Re-tweeter

Make a commitment to scan for good news NHS stories and tweet them to me. I will then re-tweet to 25,000 people. You should also follow my tweets and re-tweet them. The commitment is as little or as much as you want. Email me at butnhs@btinternet.com if you want to do this. I will add your details to a page on the web site. It will show you care and will help you pick up more followers.

3)        Become an Big Up the NHS Group Administrator/Moderator

This is a bit more of a commitment and carries a responsibility to behave well and keep to the positive, non-party political message. It is possible for me to delegate administration rights to members of the Facebook, Linkedin, Flockr and Google+ groups. You will have the power to approve and delete posts, add and delete members and promote the groups. I am looking for people who will be prepared to commit time and energy to promoting and growing these groups.

If you are interested let me know by email which platform you would like to take on. We will need to discuss things with you on the telephone before getting going with this.

4)      Start a Big Up the NHS local Group

Set up a new Big Up the NHS account to serve your local health economy. Make connections with your local NHS organisations. I will help support your efforts and list your details on the web site. This is potentially a lot of work but there will be a huge sense of achievement for those who take this on. Once again I would need to talk to prospective local group owners on the telephone before getting started.

 

If you care about the NHS and want to take an active part in making a difference one or more of these options may be of interest to you. Please give it some thought and get in touch if you want to help.

Steve Smith

Big Up the NHS.

The Big Up the NHS in a verse e-book now published

Steve Smith

It was all Sandie's idea.book She approached me as I started to develop the concept of #NHS66 - a celebration of 66 years of the NHS - with the concept that we should Big Up the NHS through verse.

We asked people through Twitter and a Wordpress blog to submit poems of 100 words or less about the best of the NHS. All the entries were excellent so we were able to include everything that was submitted in this e-book.

You can access the book by clicking on the image of the front cover to the right or by following this link. Please share the book with anyone who you feel will appreciate it.

Steve Smith

Waiting room

Steve Smith

I love this piece written by Steve Biddle. He originally submitted it as a comment on the blog. This is what he said when I asked if I could publish as a full article. "I'm elated you like what I have written and wish to publish Waiting Room. It is as written on my mobile phone as I waited so the gaps are as they were. I'm happy if to fit on a page with in margins it needs altering.  If once published you would be kind enough to send the link so I can share that would be much appreciated.   I have read Waiting Room at poetry readings and people always come and chat to me about their experience. I'm very grateful to give something back to the great work the NHS does."

It is published below exactly as it was typed on his phone.

 

Waiting Room © 2013 Steve Biddle.

Waiting room, we’ve all been there.

Are all these people ill?

Thank god for Doctors and the people in care.

Facing forwards looking back, glasses, papers, magazines, some old folk looking red faced, veins running blue, map of England heart attack.

The amount of people just like me occupied with phones, one is making the occasional bubble noise.

38 people to go before me.

 

Just heard, 65 minute wait for a needle to puncture my skin.

Steady hand, watch my blood, biology, I’m human, tick box, my name date of birth, pleasantry grateful that’s just me.

The little round plaster must have been brave.

Shuffling down the line ultimate illness dig a hole, yes I’d like a grave.

Not there yet, nothing's  wrong, is what one said by mistake.

I like mistakes surprisingly, we make them all, or there would never be a mistake.

Define a mistake, negative outcome.

No! Some mistakes are positive, so there you have it.

Back to the process, 65 minutes what shall I do?

28 to go just like sheep.

 

Ok the people, the noise, the young are few.

Middle, that’s me, waiting room 65 minutes of getting old.

I’m safe here, this is the safest place, no accidents, even if I do have some kind of freak illness, where better to be?

I look up “Wow” to the Art on the walls; I’ve been here 20 minutes consumed with the slowdown of the power of this waiting room.

No Artists name to be seen, the gravity of Art the vision of the mighty wall filler.

I wonder where these pictures are from? Skies, mist, the sea, and this incredible planet we’re on.

Right got to turn round now and check out the rest of the Art.

 

I’m surrounded by accents from around the world, I can’t even work out what nationality some are.

Ok look.... I’ll be back in a moment. Right that was a quick.

Scarf count, winter is cracking on, umbrellas, tissues, coats on chairs.

20 people to go.

The number counter is electronic and to my listening pleasure is Welsh, the people next to me discussing life are Welsh.

The old couple who probably go everywhere together, remind me of how we should all be, looking out for each other.

During life’s bad bits, the ones to forget, we always remember the people who helped us through.

The bad bits become like a ball of mushy peas, but the people they demonstrate love and compassion just like the old couple, we never forget.

16 to go.

There is a window facing a wall, neat brick work.

Builders use string to get their lines straight then along come the other trades, putting their vents, pipes, clips, grey boxes where ever they like.

Hospitals have the largest selection of cacti’s I’ve ever seen, they grow so well in this humid carbon monoxide, well watered, public blood, rich street.

13 to go.

 

Why with so many people in one room is hardly any one talking?

Everyone I think has deep thoughts here about life, outside this room and in the world we are free.

Here we are controlled by complicated words, we could be told anything and we would just believe.

“Mr. Biddle you have an itinoplumupietred condition and will live to 110”… yep I’ll go with that.

“Mr. Biddle I’m sorry but we have run out of number tags and can’t see you for a year!" Ok.

The TV screen now has a who’s who of hospital staff, now it’s a drink campaign.

The fluffy adverts for the hospital use models, the bad stuff it’s us, real people.

I really love the NHS.. again, read this really slowly ……I LOVE the NHS, I have been here with chopped off fingers, broken bones, kids being born, metal removed from my eye, acute appendicitis . Now, this kidney problem I can't even spell. My folks are horsey people and the NHS has saved all of my families lives.

2 to go.

If I win I’ll be back.

 

© Nvember 2013 Steve Biddle Bournemouth Pathology

The vultures are circling - be very careful who you talk to

Steve Smith

This email trail is cut and pasted as it occurred so should be read from the bottom up. Some names and email addresses have been removed to maintain confidentiality.  Approaches which at first sight may appear to be a genuine scientific inquiry may be aimed at working out how to carve up the best bits of the NHS for the private sector. We should all be very careful who we talk to. Well done to the ethical consultant physician who received this approach.

Hi Tom

 I feel very uncomfortable about sharing 'intellectual property' on that basis as it may lead to a greater likelihood of NHS services being outsourced.

 I am sorry I am not able to assist you.

 Best wishes

XXXXX

---------------------------------------------------------------

From: TGibson@uk.ey.com [TGibson@uk.ey.com] Sent: 02 June 2014 15:16 To:XXXXX Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease

Hi XXXXX,

Of course, happy to answer any question you have.

Our work is focussed around understanding and developing new ways in which private providers could work with public healthcare that would reduce pressure and spend for NHS whilst focussing on optimising outcomes for patients.

We work with a lot of clients in this area, and are currently working with a client to develop new ways in which they could offer services to the NHS specifically around CKD and dialysis.

We are exploring both alternative payment/reimbursement structures as well as partnerships or outsourcing models.

We would like to discuss these with you to gain your insight, and understand your views on the key challenges being faced by the system.

The purpose of this would be to validate and test ideas that we could then propose to be implemented.

All of our notes and reports would be fully anonymised and we would not reference your involvement.

Kind regards, Tom Gibson --

 
Tom Gibson | Life Sciences
Ernst & Young LLP
1 More London Place, London SE1 2AF, United Kingdom
Office: +44 (0)20 795 14013 | Mobile: +44 (0)7785 444 079 | tgibson@uk.ey.com
Website: http://www.ey.com

------------------------------------------------------------------

From: xxxxxxxxxx
To: "'TGibson@uk.ey.com'" <TGibson@uk.ey.com>,
Date: 02/06/2014 11:46
Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease

OK Tom. I understand. 

Perhaps you could just give me a little context of what you will be doing with the information you gather. XXXXX 

-----------------------------------------------------------------------------------------------  From: TGibson@uk.ey.com [mailto:TGibson@uk.ey.com] Sent: 02 June 2014 10:38 To:XXXXX Cc: 

Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease   Hi XXXXX,

Hope you had a good weekend.

We unfortunately cannot offer any commercial arrangements for this piece of work.

I know that this is not the most ideal situation but we would be happy to schedule outside normal working hours, or even a quick 10 minutes to just understand your views on a couple of areas if that would make it easier?

We would of course share with you some of our insight from this work, as well as a summary of the wider conversations we have.

We would obviously be hugely grateful for any time that you could spare.

Kind regards, Tom Gibson --

   
Tom Gibson | Life Sciences
Ernst & Young LLP
1 More London Place, London SE1 2AF, United Kingdom
Office: +44 (0)20 795 14013 | Mobile: +44 (0)7785 444 079 | tgibson@uk.ey.com
Website: http://www.ey.com
From: XXXXX
To: "'TGibson@uk.ey.com'" <TGibson@uk.ey.com>,
Cc:
Date: 30/05/2014 09:58
Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease

  Dear Tom

I am sure I can contribute significantly to your project. I have attached a paper recently published describing our work. We are in the process of preparing a project to spread the surveillance system described in it across the UK.   I do not wish to be mercenary but I am still not clear of the commercial aspects of your involvement in this. I have nothing against EY  but time is money. I do not wish to gain personally but I am paid by the NHS to work for the public.   Perhaps you could clarify the arrangements, please.   Best wishes XXXXX

--------------------------------------------------------- From: TGibson@uk.ey.com [mailto:TGibson@uk.ey.com] Sent: 29 May 2014 20:35 To: XXXXX Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease   Hi XXXXX,

Thank you for getting back to me so quickly.

One of the things that we have seen in CKD management is that there is an opportunity to focus on prevention, early diagnostic and patient follow-up programs, avoiding high costs associated to those patients in the later stage of the pathway.

We would like to get your perspective around this, approaches to commissioning of services including a prevention component, as well as key challenges and pressures being faced.

We propose a short call of about 20 minutes for us to discuss this, as well as getting your insight into any wider issues, opportunities and trends that are being, or you think can be, explored in the UK.

We propose to then circle back round with you to share our findings and insights from the wider interviews we conduct; within a week to 10 days of our call.

Please let us know when you might be available to talk. Kind regards, Tom Gibson --

   
Tom Gibson | Life Sciences Advisory
Ernst & Young LLP
1 More London Placdon SE1 2AF, United Kingdom
Office: +44 (0)20 795 14013 | Mobile: +44 (0)7785 444 079 | tgibson@uk.ey.com
Website: http://www.ey.com

 

From: XXXXXXXXX 
To:  "TGibson@uk.ey.com" <TGibson@uk.ey.com>,
Date: 29/05/2014 12:56
Subject: RE: EY research - healthcare system trends in the management of Chronic Kidney Disease

 

Dear Tom

I may be willing to assist with your research. What are the terms of this commitment? Best wishes XXXXX

-------------------------------------------------------------- From: TGibson@uk.ey.com [mailto:TGibson@uk.ey.com] Sent: 29 May 2014 11:55 To: Dr XXXX secretary Subject: EY research - healthcare system trends in the management of Chronic Kidney Disease

Hi Dr XXXXX secretary,

We spoke on the phone briefly just now as I am trying to get in contact with Dr XXXXX.

I am part of the Global Life Sciences Team at Ernst & Young (EY).

We are conducting research at a European Level exploring the main healthcare system trends in the management of Chronic Kidney Disease, with a focus on Dialysis and on the collaboration between public providers, private providers and other stakeholders.

Dr XXXX's insight as a senior professional in this field would be enormously valuable to us and we would be very grateful if he could spare 20 minutes for us to schedule a brief phone call between now and 5th June (next Thursday) to discuss his point of view in a few areas.

Happy to call back to give some more information if that would be helpful, and find a time that suits.

Thanks for your help.

Kind regards, Tom Gibson --

Tom Gibson | Life Sciences Advisory

Ernst & Young LLP

1 More London Place, London SE1 2AF, United Kingdom

Office: +44 (0)20 795 14013 | Mobile: +44 (0)7785 444 079 | tgibson@uk.ey.com<mailto:tgibson@uk.ey.com>

Website: http://www.ey.com<http://www.ey.com/>

 

The Ombudsman and the Daily Mail – a toxic cocktail?

Steve Smith

This story appeared in the Daily Mail today under the headline “Too polite to make a fuss: Elderly NHS patients suffer in silence say health watchdog”. It was based on a short article from Dame Julie Mellor, the Health Service Ombudsman. The article itself, which was quoted in full within the body of the story was pretty sensible and constructive. Titled “Please don't suffer in silence” it is a plea for people with issues about their treatment to complain rather than put up with things. It is carefully written in reasonable language. Dame Julie speculates, without much hard evidence I must say, that older people may be more reticent about complaining than the young. She suggests we need to simplify complaints processes and make sure that complainants are treated fairly and with compassion. This comes from the only person in the UK who sees all the instances when complaints are not resolved to the patients’ satisfaction but does not see any satisfied customers to provide balance to her view.

All this is fair enough – a few reasoned, sensible and constructive paragraphs which highlight a potential issue for elderly patients.

The trouble starts with the text Daily Mail hack Daniel Martin has chosen to hang around it. A series of misrepresentations, exaggerations and misquotes. These precede the actual article so are read first and they do not reflect accurately what she said. Examples include:

  • “Tens of thousands of elderly patients are enduring appalling NHS care because they are too frightened to complain”
  • “She said she had investigated cases of pensioners being effectively starved on wards and treated without a shred of dignity”
  • “The damning comments from such a high-profile figure are significant because they indicate that, despite all the reforms announced after the Mid Staffordshire scandal, little has changed.”

Then there are a series of anecdotes of bad care which we assume are cases Dame Julie has investigated but which are not included in her article. They are snippets of information without detail or reference. They are unbalanced and probably break rules of confidentiality.

All of this is spiced up with archive pictures of ill looking elderly people just in case we have forgotten how unpleasant it is to be old and infirm.

To make things worse the story has been picked up in the Guardian, the Telegraph and MSN. The venomous quotes from the Daily Mail have been reproduced with even bothering to include Dame Julie’s original piece. All of these articles have been tweeted hundreds of time. The damage to the reputation of the NHS is real and significant.

One can only speculate why Dame Julie chose to write this piece for the Mail. She must have known what damage they could do with it and how they would twist and exaggerate her views. A clue may be towards the end of her piece where she calls for a new unified approach and a single Public Ombudsman Service for the England and the United Kingdom. Aha! – She has a political agenda.

High profile figures will often have a political axe to grind and may be drawn to the press to further their own political ambitions. They should be careful though. Large sections of the press are sensationalist, partisan and unprincipled. By writing this article for the Daily Mail, Dame Julie may have progressed her objective of changing the way the Ombudsman service is set up but she has inadvertently damaged the bigger service she purports to want to  improve and will have caused real harm to some real patients.

The NHS is not “unsustainable”

Steve Smith

You may have noticed a flurry of articles in the press this week as well as comments by politicians that current NHS spending is “unsustainable”. It has appeared everywhere from an Audit Commission statement to right wing hack Isabel Oakeshott pontificating on BBC Question Time. The sudden popularity of this word in connection with the NHS is interesting and not a little worrying. Why should it happen this week? There have been no big changes in funding plans or expenditure and all the news about the economic growth and financial recovery is good. It is also strange that Jeremy Hunt has chosen to ignore the spending review body and deny health workers a less than inflation pay rise. No sensible senior manager would do this if they cared for their business. The true cost far outweighs the benefit in real terms. He will infuriate more than a million employees for the sake of less than 0.2% of the NHS budget. He could even provoke industrial action - but I suspect this too may be part of the plan.

What if these two events are connected? What if the extravagant use of the “U” word and the deliberate goading of NHS staff is part of a centrally orchestrated plan to make it appear that there is a crisis imminent if not already upon us?  Are we being deliberately softened up for the sell off?

The bottom line is that the NHS is NOT unsustainable. Yes it needs reform but it also needs investment – and we can afford to invest. We currently  get some of the best value health care in terms % of GDP in the western world. It is cheap, efficient, effective and most importantly equitable.

And we can afford to spend more. Just 1 penny in the pound on income tax will fix the problem and allow us to reform, improve and stabilise the NHS. Politicians will find that hard to swallow as we come up to an election but it is the ONLY solution that makes any sense to the man in the street.

If we do not get out politicians to accept that more investment is needed then the alternative is a semi privatised system which will get the government off the hook but which will be less efficient, inequitable and will COST MORE!

Would you rather pay 1 penny in the pound more in income tax or three times that much in private health insurance. I know which I would prefer.

We need to tell out politicians to do what is best for us – not their prejudices about the chance of getting re-elected. And we need to tell them now.

Lobby your MP.

Spread the word on social media.

BIG UP THE NHS!!

Steve Smith

Another example of misleading healthcare reporting from The Independent

Steve Smith

First read this headline from today’s Independent “Fewer nurses educated to degree level putting patients' lives at risk, study finds”

nursing

Most people get no further than the headline. What does it tell you? It is a British newspaper so presumably it is talking about the NHS. “Putting” is an active verb in the present tense so something different is happening right now which is leading to the effect. “Putting patients’ lives at risk” sounds pretty serious so people must be coming to real harm and it is a “study” so it must be true.

Most normal people reading just the headline would take home the message that our struggling NHS is once again failing, probably due to bad management and budget cuts, and – no surprise here - people are getting hurt.

Now read the article itself (link here)

It is a multinational study but it is not made clear how much if anything was conducted in the UK. It seems to be a very large study published in the Lancet, a top notch journal. It found that “every extra patient added to a nurse’s workload increases a patient’s chance of dying within 30 days of being admitted for surgery by seven per cent.” A really scary finding you will agree. Just a few extra patients will lead to loads of unnecessary deaths.

Furthermore “patients are more likely to die after routine surgical procedures at hospitals with fewer nurses educated to degree level”. And guess what - the UK has amongst the highest patient/nurse ratios and lowest level proportion of degree level trained nurses in Europe. Not quite the message that nursing cuts are killing patient as implied by the headline but still pretty grim reading.

Now read the original research paper (abstract here)

Apologies that I cannot link to the full text which requires a subscription.

It turns out that this is an observational uncontrolled study so it cannot tell us anything about cause and effect. Only 10% of the hospitals included were British. The death rates in British hospitals were no different from the other European countries.

The authors concede that “(their) measure of education relied on each country’s definition of bachelor’s education for nurses, which differs by country” which makes it impossible to draw definite comparisons. They also concede a range of other methodological issues and conclude that “further research is required”.

This study is valuable as it points to an association of higher level training and high nurse numbers with better patient outcomes – hardly a surprise – but it does not tell us why. Hospitals with more highly trained nurses may be more likely to be found in affluent neighbourhoods with a cooperative, healthier local population for instance.

Now read the headline again

“Fewer nurses educated to degree level putting patients' lives at risk, study finds”

It is hard to believe that any intelligent person who has read the paper could believe that this conveys the essence of the story. It sensationalises a pretty ordinary finding. It misleads and misinforms. Worse it undermines confidence in our health services, demoralises staff and frightens patients.

This must be DELIBERATE SENSATIONALISM and it is SHAMEFUL. We must not let it go unchallenged. It is not the first time we have seen this sort of shoddy journalism form the Independent.

I have referred this article to the press complaints commission and will share my concerns on Twitter. I would encourage others to do the same.

Steve Smith

Ten common misconceptions about “Big Up the NHS”

Steve Smith

I receive a handful of tweets every day from people who have either misunderstood my purpose or think I have ulterior motives for running the Big Up the NHS campaign. Most are polite but some can be surprisingly unpleasant. I don’t usually respond because entering a public debate in bursts of 140 characters is unlikely to lead to a resolution and I don’t want to spread a bad vibe. This blog is primarily for people who have questioned my raison d’etre. I hope it provides a reasonable rebuttal of the common misconceptions and gives some insight into my motives for starting Big Up the NHS.

If I have referred you here after a tweet please take a couple of minutes to read the points below, and then get back to me by all means if you still want to.  If you have arrived here under you own steam I hope you will find it interesting.

Ten misconceptions

1)      I am in denial about the problems in the NHS

Trust me I understand the problems. As part of my job I see all the complaints that come into my trust. I know that things go wrong, that people can suffer horrendous harm and that some staff can be cruel. I believe in openness, listening and learning. I want to encourage and support whistle-blowers.

To improve an organisation needs to embrace its mistakes and learn from them. This will happen more easily in organisations that are confident, valued and unpressured. Bigging up the NHS will ultimately help it to improve.

2)      I have exaggerated the risks to the NHS

I don’t think so. The fall of the NHS will be a quiet affair that will go unnoticed unless we shout about it. Large chunks are already being run under the NHS logo by private companies. The public can’t tell who owns what at present.

So why does this matter if the service is still free at the point of demand? The problem is it won’t stay that way. Companies will soon start to offer an ‘enhanced’ service for a small cash top up and the rot will then have truly set in.

Ultimately you will have to make your own mid up on this but look at the stuff that is now out there on the net about the way things are going. Much of this is pretty compelling.

3)      I am a front for NHS England…

…or a whole range of other organisations. Honestly – this has been suggested but it is not true. Big Up the NHS is all my own work.

4)      I am politically motivated

I am not aligned with or affiliated to any political party. My primary purpose is to improve the NHS and save its fundamental principles for future generations. This may mean that I take the odd swipe at the current government but it seems to me that all parties are actively or passively complicit in the current crisis.

5)      Big Up the NHS is an organisation with a membership

No – at the time of writing it is just me. That is not to say I would not like to enlist some help, perhaps by setting up local groups. Things may change in future. Watch this space.

6)      I don’t really understand the complexity of the NHS

Consultant Physician for 20+ years, Clinical Director for Renal Services for 15 years,  medical director of a large trust for 5 years, past president of the British Renal Society……

7)      I am in it for personal gain

I can’t deny feeling a slight sense of satisfaction as I watch this enterprise grow but there is no ulterior motive. I make no money from it. It is, as it always was, about the NHS and not about me. You can read how it all started here.

8)      I have no mandate to represent NHS staff

I don’t pretend to represent anyone. The views expressed are all my own.

9)      It is too late to do anything, the NHS is already a lost cause

While sadly there may be some truth in this I do not believe that all is lost. Unfortunately the legal framework for privatising the NHS is now in place and it will take an enormous public outcry to reverse this. Unless it is reversed privatisation will progress relentlessly.

It is for others to mobilise the public. My mission is to help convince the public that the NHS is worth saving by countering the relentless barrage of negative press which sometimes seems deliberately designed to undermine it.

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10)   Big Up the NHS is only on Twitter

Twitter is effective, immediate but also transient. Apart from this blog there is also a Big Up the NHS group on Facebook and two groups on Linked in – ‘Big Up the NHS’ and ‘NHS  - Putting Patients First’. Here you can enjoy a more in depth debate. Please have a look and join in.

And one truth

I am often accused of being partisan, filtering out the good news and ignoring the bad. I hold my hands up to this. The whole premise of Big Up the NHS is that positive feedback loops will help staff and patients and improve outcomes. It is based on positive discrimination - indeed this is how it works - and I am not ashamed of taking this approach.

Steve Smith

@butNHS

Why we need to 'Big Up the NHS'

Steve Smith

First published in Open Democracy 17th February 2014 It started with an article in the Telegraph about 12 months ago. It caught my eye because it was about my hospital. A patient had been told he had lung cancer based on an Xray but in the end it turned out that the problem was caused by a garden pea that had “gone down the wrong way” and had lodged in his lung.

The article was critical of the doctors concerned and made no effort to convey their side of the story. It felt unfair and misleading. The fact that the appearances on the X ray would be due to lung cancer 99.9% of the time was not mentioned. The thing that really irritated was the description of the treatment by doctors as “frantic”. I knew the people concerned and I was sure they would be professional and caring - even in a crisis. They would never appear frantic. This journalist had not been there but had spiced up his story with an unjustified swipe at the medical staff.

I know the NHS isn't perfect. But from then on I started to notice a pattern in the press. Almost every article seemed based on the premise that the NHS was failing, that staff were uncaring, that managers were incompetent and that patients were the ultimate victims rather than beneficiaries of the system. It seemed unfair and it slowly dawned on me that it was actually damaging the NHS and would cause real harm to patients.

Patients’ experience of treatment is coloured by their expectations. If you think you will receive poor treatment you will focus on the negative, see the problems, be more frightened and have a more distressing experience. Imagine you are about to board a flight and you read in the newspaper that the airline has faulty equipment, pilots are poorly trained and that you have a high chance of crashing. At the very least your enjoyment of the flight will be curtailed. Most people would decide not to fly or to switch airlines. But choosing to avoid necessary treatment is harmful in its own right.

And there is good evidence that patients’ outcomes are influenced by their expectation of success. Complication rates will be increased and some may even die.

The casual unjustified swipe at the NHS in the media will cause real harm toreal people.

And it devastates staff morale. The vast majority of NHS staff are caring, dedicated and sensitive. Indeed most clinicians are selected for these qualities at the start of their careers. Unjustified bad press is hurtful, it damages morale and desensitises the sensitive. Sickness rates increase, staffing levels fall andpatients have a bad time. The press gets even worse. We hit a relentless downward spiral.

Why is the press so bad?

A charitable explanation would be that the journalists are driven by a desire to improve the NHS. But if that was the case then we would see some hint of encouragement and suggestions for improvement in future. This is hardly ever seen. I don’t buy this explanation.

Three years ago NHS satisfaction was at a record high. Our outcomes wereworld class though we spend less per head than most equivalent countries. We had higher patient confidence, fewer errors, and far higher satisfaction with the overall system than countries including France and Germany. Almost every measure of efficiency and patient satisfaction has been steadily improving in recent years.

Can things really have changed so quickly? Perhaps the service has really got worse? From the inside it doesn’t feel like that. And most of the news reporting tells us that this isn’t a ‘new’ problem.

Some have said that the bad press is a political plot to undermine the NHS and make it ripe for selling off. I can see the logic of the argument, but I’m not a natural conspiracy theorist. I find the idea that a whole party would deliberately destroy the NHS for its members own individual personal enrichment, unlikely.

The sad truth is that knocking the NHS has become the fashionable thing to do. As a nation we enjoy a sense of righteous indignation. Journalists have come to believe that feeding this appetite will sell papers. It is all about circulation, profit and short-sightedness.

We are destroying our only reliable source of comprehensive health provision. We are all dependent upon it for cradle to grave yet we collaborate in demonising it. We are engaging in societal self-mutilation.

The start of “Big Up the NHS”

Each time I saw a negative press report my feeling of discomfort increased. Last year I decided I had to do something about it.

The idea of using Twitter to promote the NHS came to me while I was out running. The name ‘Big Up the NHS’ just popped into my head and I had the whole thing worked out by the time I got home.

At the start I didn’t add my name to the campaign. I was a medical director in a big trust and was worried about taking an approach that seemed subversive or anti-establishment. In any case it was about the NHS, not about me.

There was never any intention to take a political stance or support a particular party. This was purely an attempt to reverse the negative spiral and improve the NHS for staff and patients.

…great oak trees grow (or at least a sturdy sapling)

Then it was just a case of designing a logo, setting up a twitter account with a new email and posting good news. I followed lots of random health professionals pretty shamelessly in order to build a following but it soon took of. After a month it had 500 followers. It now has over 9,000.

In January 2014 I decided to add my name to the site. Some tweeters had implied that I was a front for NHS England and it felt a bit dishonest to be tweeting anonymously. My “coming out” was well received.

There is now a Big Up the NHS network on Facebook, a Big Up the NHS groupon Linkedin as well as the blog.

Where next?

Positive news cycles can be as strong as or even stronger than negative cycles.The main aim is to increase and disseminate positive stories about the NHS, through the blog, the various online groups, and through live tweet sessions. Big Up the NHS is gaining new followers fast.

To help save the NHS, we need to promote it. It really is the greatest institution ever created.

Steve Smith (@butNHS)

It’s time for the worm to turn!

Steve Smith

OK enough is enough. Today’s banner headline in the Independent announcing NHS Hospitals Flatlining is a step too far. Yes - there are some issues highlighted in the article but flatlining - in full arrest, needing CPR, about to die – really? We have become so used to press hyperbole that I bet most of us did not even notice the crassness of this statement. flatling

In fact over a million people will set out to work in the NHS today and the vast majority will go to fully functional departments and deliver great care to grateful patients. Today will be like most days  last week or last year, a mixture of good and bad, up and down, but definitely not peri-arrest.

If you have not had chance to read my analysis of the harm unjustified negative press does to patients then it may be worth you taking a minute to do that now. This is much more serious than you may at first think. We cannot sit back and let press vandalism progress unchallenged. It is time for the (admittedly oversized) NHS worm to turn.

So what can we do?

The press and media need to understand the harm they are doing when they undermine the NHS. I still believe that most of it is passive bandwagoning rather than a deliberate plot and that we should be able to turn it around. We need to get the message through though. Here are four ways we could go about doing this.

1)      Use Twitter. If you see an unjustified, unfair or unrepresentative story send a tweet with something along the lines of the following format “Shame on [twitter account of offender] for this article [link to article]. It is misleading/untrue/unrepresentative. #fairpressforNHS RT.”

2)      Spread the word about the harm negative press can do by any means at your disposal. Social media is quickest but not the only way.

3)      Report unfair coverage to the Press Complaints Commission or Offcom.

4)      Write directly to the editor of the paper or producer of the television programme.

If we sit back and do nothing they will slowly erode our pride and confidence in the NHS. We will forget its value. Hands up – who read that ludicrous headline in the Independent and didn’t even notice the incongruity of it.

Unless we fight back with resolve and determination, we will eventually get to the point of genuinely  flatlining -   and then will we realise that the government has already quietly signed our do not resuscitate form.

Big Up the NHS

 

So why do we need to Big Up the NHS?

Steve Smith

Let me start by being very clear – I don’t believe the NHS is perfect. As part of my job I see all the complaints for my hospital and they are heart-breaking. There is no doubt that some patients receive poor treatment, that staff can sometimes be uncaring and that on occasions things can go very wrong. I know that the NHS complaints process is clunky and ineffective and that it often leaves patients and relatives more distressed than when they started. I accept that we find it difficult to learn from our mistakes and that whistle-blowers can get a rough deal. Yet the NHS has a lot to commend it. It is the only health service in the world that is completely free at the point of need without any reference to financial means. Our outcomes are world class though we spend much less per head than most equivalent countries. National surveys show that more than 95% of users would be likely or very likely to recommend the department which performed their treatment to Friends and Family. It is one of the things that makes the United Kingdom a civilised country.

Nobody can deny that the NHS has had a bad press over recent years. A firestorm ignited by the horrors of Mid Staffordshire and fuelled by a series of subsequent scandals. Knocking the NHS seems to be a national pastime. It sells newspapers and builds viewing figures.

Sometimes even good news is reported as bad. Don Berwick in his report on safety in the NHS said “At its core, the NHS remains a world-leading example of commitment to health and health care as a human right” and that we should “abandon blame as a management tool”. The  headline in the Telegraph was “NHS staff will be prosecuted for ‘reckless neglect’ of patients.”

Currently the vast majority of national media coverage is bad while the service is recognised internationally to be largely good – and this is a problem.

Why is unfair and unbalanced reporting of the NHS a problem?

The main issue is that our patients’ experience of treatment is coloured by their expectations. If you think you will receive poor treatment you will focus on the negative, see the problems, be more frightened and probably have a worse outcome. Imagine you are about to board a flight and you read in the newspaper that the airline has faulty equipment, pilots are poorly trained and that you have a high chance of crashing. At the very least your enjoyment of the flight will be curtailed. Most people would decide not to fly or to switch airlines.

NHS patients do not have this luxury. Avoiding necessary treatment is harmful in its own right and few have the means to go elsewhere. They will have a more distressing experience as a direct result of the negative reports. Worse than that, there is good evidence that patients’ outcomes are influenced by their expectation of success. Complication rates will be increased and some may even die. The casual unjustified swipe at the NHS in the media will cause REAL HARM to REAL PEOPLE.

And there is also the effect of staff morale. The vast majority of NHS staff is caring, dedicated and sensitive. Indeed most clinicians are selected for these qualities at the start of their careers. Unjustified bad press is hurtful, it damages morale and desensitises the sensitive. Sickness rates increase, staffing levels fall and patients have a bad time. The press gets even worse. We hit a relentless downward spiral.

Is there a political agenda?

Many believe that the bad press is deliberately orchestrated by the government to undermine the credibility of the NHS as part of a plan to sell it off to the private sector for profit. This graphic has been widely circulated through social media. I am not a natural conspiracy theorist but I can see the logic of the argument.

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I think is more likely that journalists simply do not realise the harm they can do. Sections of the public enjoy the feeling of righteous indignation that comes when they read of failings in others. We pick away at the scabs for the pleasure of the picking even though we know this is likely to be damaging and may cause permanent scars.

NHS bashing is a form of societal self-mutilation. The service is one of our greatest assets, we all depend on it from birth to death, yet we seem to want to cause it harm.

In the final analysis it is irrelevant whether there is a conspiracy to damage the NHS. The legal framework for privatisation is now in place and this will progress at a pace whatever we do. Bad press will make it happen more quickly with less predictable results. We may even have to endure a complete collapse of services. Positive press will give us more control of the process. It can help us sit up and take notice of what is happening.

What do I hope to achieve with Big Up the NHS?

I started Big Up the NHS as a twitter account in August 2013. The idea was to counter the negative press, raise the profile of the NHS, help improve morale, lobby for more funding and ultimately improve the experience of our patients. To reverse the downward spiral. This rather grandiose idea proved popular the account attracted more than 8000 followers in the first 6 months. This blog was started in January 1014 as was a Facebook group which attracted 350 members in the first week. There is a Linked in group which is just starting to get going.

The plan is to use these sites to disseminate good news. I hope to collaborate with others to promote the best of the NHS. The political debate is not off limits but it is not a primary purpose of the enterprise. Big Up the NHS has no political affiliations – just a commitment to supporting and promoting the best in the NHS.

What next?

I will be guided by others here. I have no current plans but it may be that we could look to developing a membership or at least recruit some like-minded collaborators. While I am really enjoying doing this stuff it is quite time consuming and I could do with some help (before I get sacked and/or divorced). Let me know if you are interested.

In the meantime please follow the various sites, spread the good news, feed me positive stories and BIG UP the NHS.

Steve Smith

We must stop searching for heroes and villains in the NHS

Steve Smith

I have been thinking since setting up this blog that I should write about why I felt it was necessary to start Big Up the NHS. I hesitated, and then this article came along. It is a really eloquent analysis from Karen Castille in Guardian professional. For every negative news story we hear about the NHS we must tell two.

You can read it HERE.

Please feel free to leave comments.

 

Steve Smith

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