Notes from Warks Fabians - Mike O'Brien on NHS

Mike O’Brien Warwickshire Fabiens Thursday 28^th November 2013

The National Health Service.

1948 Formation of NHS – Local Government taking the patient interest. Since then there have been many re-organisations – too many re-organisations. Every re-organisation results in dislocation, when managers focus on the re-organisation and not the patient and the NHS. The latest 2010 re-organisation was promised not to happen.  The 2010 re-organisation has resulted in too many organisations – some helping to improve, others not – General Practitioners are in charge of 60 – 70% of the NHS budget – the General Practitioner managers are facing complicated procedures, that which they did not train for.  At the same time the NHS is facing extended life, greater demands, dementia. Mike believes that the only answer is to focus on integrated clinical pathways – keeping more people at home.

1997 The NHS had just had a new target considered by the outgoing Conservative government. This proposed target was an 18 MONTH wait (not an eighteen week wait).  Labour invested and until 2010 patients did much better.  For example The 18 month wait became an 18 week weight. Nunaeton Private Hospital closed. 

 2000 Tony Blair promised that health spending should be the same as Europe.  Promise happened off the cuff.  Gordon Brown commented ‘thanks Tony – that is five years spending gone!’.  No 1 focus on delivery, targets with a delivery unit at number 10 to measure.

 

2004 Waiting list highs were down but improvement had plateaued.  Too slow.  Labour investigated Spain and Keiser Permeate in California.  Health maintenance organisation.  Highlighted that the health service was undermanaged, patients could go home earlier and not to spend so much time in hospitals -  there were issues with consultant power ‘consultant do as you want’. Competition starts to become a big issue. In Spain people run their own hospitals.

GPs re negotiate their contract to try and increase early intervention but there was a lack of early intervention. 

2004 + money follows the patient. Payment by Results.  There are public sector values.  Several elements described above and below risk losing the valuable ‘public sector ethos’ (NHS values). Foundation Trusts were insular and Stafford was one result.

 

Independent sector treatment centres ran from 2004 to 2009.  Labour deliberatively paid over the odds to get results.  Independent sector treatment centres ran mainly until late 2009 results in 100s getting earlier treatment.  Targets, foundation hospital status have their critics but hundreds received better hospital care. 

Since 2010 Hospitals with new management – e.g. Hitchingbrook. Consider hospitals – who they are managed for?  Private sector has to pay money back.  So private sector priorities are 1 Banks,  2. Shareholders  3.  Patients where as NHS priorities are 1. Patients.

The holding company for Hitchingbrook is registered in the Caribbean and has a majority of private shareholders not consultants as published. Is there a scam here?  Hitchingbrooke contract won Feb 2012.  In October 2012 Circle demanded 400M more.

2010 reorganisation.  No organisation. Biggest top down organisation ever. Most competition laws. Including E U competition laws that are bizzar and expensive.  All services have to be put out for (private) tender.  Removal of private patient cap. New organisation prioritises acute hospitals. Issue of consequences of GPs with a vested interest.  Leading to not the NHS as we know it.  Competition between acutes and communities confuses the critical care pathway which is the best practice pathway. Priority needs to be given to Patients Health, Cancer Dementia and Cardiovascular. Clinical Senates seem to be marginalised.

Mike would like to see district hospitals being the centre virtual wards. Care teams, remove competition and replace with collaboration.  If services are protected with a lack of competition then clinicians can work in the comfort zone.  Mike advocates paying for long term care management e.g. (oddly) Keiser Permamante paid for people to be cared for at home. Mike advocates the new concept of a virtual ward.  A  list of, say, 30 people living at home who community nurses car for as if they were a ward but  they are not - Team goes out virtual ward.  More integration in Primary care, in Community, With or without beds

Enhanced role for community staff.

Innovation is very important in the NHS – needs to be paid more attention. Mike’s final caution is the competition law that he feels is secretly very aggressive and doing the NHS great harm. Needs repealing although some of it is down to Labour and Mike himself. See Q1.

 

Questions:

1.    Consider change demands on managers …. Repeal the competition 2012 law

2.    Scandinavian health is under pinned by 60% tax and changes

3.    Clinical Commissioning Groups are responsibilities without power ‘decide when to make the cuts!’

4.    Trade Unions, loss of caring – staff under pressure, loss of NHS ethos … this unfortunately follows – build up NHS ethos again. 

5.    NHS England … a centralisation of power in the NHS

6.     Community v  Acute – always going to be an issue.

7.    Recap Labour’s big investment - Necessity not nicety, Mike defends, Such a back log of surgery in 1997. Public Finance Initiatives needed to cope with Public Sector Borrowing Requirement. Definitely Benefits. Labour needed to make it work. Labour needed to make it work.  It was a High price - Worth it - Saved lives.