Lansley's NHS

Andrew Lansley has published his plan for privatisation of the NHS, ooops I mean health reforms. They cement my view that the concept of the NHS Walk-In Centre is thoroughly dead. There is no mention of Walk-In Centres in the Primary Care bit of the plan (item 44), the GP lobby in the Lansley advice coterie is getting its way. They are determined that the public will attend their [private partnerships] surgeries at a time convenient to the well paid  GPs rather than the needs of the public. People go to Walk-In Centres because they either can't get the service they need from their GP or the quality of service is so bad that they seek an alternative.

Meanwhile I've been contacted by a Nurse Practitioner (30+ year's experience, Masters degree in medicine) who tells me his future employment is so uncertain that he's stopped buying a season ticket for travel to work. He now only buys a weekly rail ticket.

Hospital A&E Walk-In Centres

You'll have seen my earlier comments about NHS PC Walk-In Centres. In the main these are being closed, though sometimes a Walk-In Centre will be attached and managed by Acute Trust personnel rather than senior primary care medical staff. With the PCT WICs the emphasis is on successfully treating the person who walks through the door with subsequent follow-up by that person's GP. Where the need is serious andurgent the PCT WIC nurses will refer the case to the nearest A&E dept, usually following phone discussion between the WIC and A&E medics. The objective is to divert less urgent and less serious cases to the WIC.

When the WIC is managed by an acute trust and located close to an A&E department the nature of the service changes. The focus is much more dealing with unwarranted non-urgent patients to direct them away  from A&E. The focus is reducing the queues at A&E rather than treating the patients.

There's a case reported in the Daily Mail web site where a person who should have been treated by an A&E doctors was turned away by an A&E receptionist and told to go the WIC next door. The details in the Daily Mail report are not extensive but it appears the poor chap left the WIC with just eardrops and subsequently died from blood poisoning and brain damage. Here's the BBC report. It is very sad and my heart goes out to his family.

I do wonder however what the outcome would have been had the patient initially attended a PCT WIC where the nurses are trained to work autonomously (on their own) and give a through examination. Any urgent/serious cases are then passed immediatly to A&E, if necessary using a blue light emergency ambulance. There are clearly defined medical protocols the nurses are trained to follow which provide "red flag" markers of serious conditions.

In any event, patients presenting with a medical condition should not be turned away on the word of a clerical receptionist.

Rats or Birds?

One of the signs that something is wrong in an organisation is when several senior managers leave of thier own choice in a periods of a few months. A recent article in the Guardian Newspaper highlights a case in the Barts Hospital in London UK. The guy in question has worked at the place as a skilled surgeon for many years. Suddenly he finds it an unacceptable place to work! There have been several instances of senior administrative and clinical staff (5 out of 14 orthopedic surgeons) finding employment at an alternative location more attractive. Is it rats leaving a sinking ship or is it birds flying away before an earthquake? Has someone broken the spiritual backbone of the place? It is very difficult and expensive to repair a damaged corporate psyche. Maybe there is a programme of cuts using an experienced aggressive "Turn Around" Director?

The same kind of thing has happened in the North Staff's hospital. Now the administrators had to draft in Army Medics to keep their A&E  department running. Professional medical staff such as surgeons and specialist nurses will be caution about joining to work at a hospital with a damaged reputation.

It is a pity, because BARTS does some good clinical work caring for the patient. For example they're the only hospital actually checking the safety standards of surgical instruments. See the worrying Panorama programme in July 2011. They also do good work in research in Prion infection on surgical instruments. Perhaps the problem is the way the administrators engage with the clinical staff? Is there a climate of bullying? Are we getting value for money from these highly paid administrators?

Rescue the economy - no income tax

The United Kingdom is in financial trouble. As a country we are spending more than we earn. Our government has to borrow money to be able to provide basic services. If your monthly income is £1,500 yet you spend on average £2,000 a month you will very soon get into serious financial trouble.

The old financial tools deployed by the UK Government to deal with this situation just do not work in the current global environment. They may try to stimulate the economy by reducing the bank interest rate. The idea being that lower interest rates encourage people to borrow more money and spend that on manufactured goods, thus promoting growth. The problem is that interest rates are already at a record low level and the real interest rates charged to the public remain stubbornly high. As the banks try to recover from the losses of their previous toxic debt (casino banking) scandal and also raise their reserves they have no incentive to reduce interest rates charged to customers. The other problem with stimulating growth through low interest rates is that people use the borrowed money to buy imported goods thus worsening the country's debt position.

The lower interest rates also discourages frugal people with spare money from long term savings. The is little point in saving if the actual deposit interest rate is lower than the rate of inflation. People see their savings better protected by investing in property. This gives no net gain in the national wealth and sees money sucked away from investment in UK industry. The Catch 22 with "investment" in property is that it only works by forcing up property prices. People borrow more money to pay these increased property prices, when there is an increase in the interest rate it will suck a massive amount of spending money from the economy to pay banks. In 1989 the base bank interest rate rose to 15%.

Another Government tactic is to print extra money. This is not money that has been earned or borrowed, it is merely a devaluation of the national currency. In effect it is debasement of the coinage or clipping silver from the coins. It is a technique usage for centuries when the rulers do not have enough income to meet expenditure. The current fashionable name for this is Quantitative Easing. The problem is that this reduces the value of the money held, in our Sterling currency, by overseas banks and investors. It is in effect a back door devaluation against other currencies. The problem is that devaluation increases the price of goods imported into this country. As we spend more on imports than we earn by exporting the effect is that we further increase the indebtedness of the UK by printing money. If anyone doubts the impact of a currency collapse look at the example of Argentina. Currency devaluation tends to increase interest rates as oversea depositors look to maintain the return on their loans to this country.

Over the past couple of decades businesses based in the UK have tried to reduce their operating costs by moving their production processes overseas. While this may reduce the monetary cost of the product it increases the amount of goods that we import. Moving production overseas also removes paid employment from UK employees. It means those ex-employees (and the companies on their behalf) no longer contribute to UK employment and national insurance taxation. Unless that employee can find another job he/she becomes a burden on the UK Government in terms of social benefit payments and reduced tax contribution. It also means that the individual surviving on social benefits is less likely to contribute to the UK economy by purchasing UK manufactured goods. The last Labour Government expanded the size of national and local government to create jobs, but this increases the national borrowing requirement to pay for the additional Government direct employees and outsourced employees.

At the end of the twentieth century the UK economy was bolstered by additional income from North Sea oil and gas, but that additional income source is rapidly diminishing. The United Kingdom needs to take some serious steps to rebalance its economy. We need to start earning a lot more than we spend. We have some massive debts to pay off. We cannot use the old tactic of inflation and devaluation, that would just increase the repayments on our existing massive debt.

We need to make imported goods less attractive to the UK population while at the same time make UK manufactured goods much more attractive. This would help to rebuild the UK manufacturing base as businesses are encouraged to produce locally. This can be achieved by applying a minimum 30% tax on any imported goods, food stuff, fuel, service, raw materials to this country. An import tax on food would also encourage farmers in this country to produce more food from their land, thus improving our food security. At present our food supply chain breaks down very quickly if imports are disrupted for any reason. With the prospects of global food prices increasing we need to encourage our farmers to produce more homegrown food.

To compensate for the increased price of goods in the shops we should at the same time alter the income tax bands so that the ordinary 95% of the population pay no income tax. There could still be taxation of the wealthy. Suitable balancing of the tax rates would mean there is effectively the same same life quality for the UK population, but just that there is a greater incentive to buy locally produced goods and less incentive to use imported goods. That would boost the incentive for businesses to manufacture in the UK thus improving the employment of people within the UK. As the employment situation improves the reducing demand on social benefits will follow, reducing the demands on the public purse.

No doubt many of the current politicians and economists will argue that using import taxes is a bad thing. However, those people have had their chance and failed. Their theories, maxims and economic models no longer work. It is time for a new direction. We should shrug off the colonial guilt of trying to stimulate the economies of overseas countries. They've had their start-up, we now need to look after ourselves and prevent an economic hangover for our children.

NatWest Bank Branch problem

I've just had 25 minutes of my life stolen from me by the NatWest Bank.

I used to have my main accounts and savings with them, but those were removed to another bank long ago following poor service and dubious interest rate practices. My wife and I have a joint account with the NatWest ever since we married over 30 years ago, but I cannot access it because the bank lost its record of my date of birth. However that's another story.

My company currently banks with the NatWest, but needless to say that customer relationship is hanging by a thread. It is only the work required to notify our clients and suppliers which protects the NatWest. We no longer leave any substantial sums of money in that bank. It goes elsewhere to where we know our custom is valued.

I've taken a day out from my business and was tidying some paperwork in my home office when I came across a bunch of shares dividend and royalty cheques I'd overlooked. Mostly I use direct payment of dividend/royalties into my other bank, but there are a few I still handle manually via the NatWest. I duly totted up the total value of the cheques and filled in the paying-in book prior to visiting the local NatWest Bank branch. As I'm in London at the moment it just happened to be the Lewisham branch. When I arrived at 2:25pm I found a long queue snaking around inside the branch. I checked my watch suspecting a long wait would follow. Only two counter positions were open.

I was not disappointed. It took 25 minutes for me to reach the front of the queue. During the wait I'd seen fourteen people turn away from the branch when they saw the length of the queue. By that time an additional counter position had opened. The manager tried to make the claim that refurbishment works would be completed within a couple of weeks and the queuing would not happen. What total nonsense! The queue was there because there were not enough counter positions open. In fact their refurbishment work is reducing the physical number of counter positions.

Perhaps the NatWest bank regards 25 minutes as an acceptable waiting time for their customers? I most certainly don't. The rot started when the retail banks decided it was a clever idea to remove Branch Managers. You know the type, they'd recognise you in the street and would have an idea of how much money you owe/deposit in the bank. When things went wrong with their service you'd know who to complain to. Instead now the NatWest wastes its money on television advertising spouting propaganda that the NatWest is a caring bank or something similar.

Another senior nurse goes from UK NHS

Yesterday a highly skilled senior Cardiac nursing sister left the UK NHS. She'd worked at a central London hospital for many years. During the period she self-funded BSc and MA degree qualifications in medicine. She was managing a ward of critically ill cardiac patients. Tired of the clinical nurse staffing cuts under Lansley, the excessive unpaid overtime (12 hour days) and professional bullying abuse from some doctors/managers she decided to leave. She could no longer tolerate the disrespect from her Acute Hospital Trust employers.

She's looked around and has found a senior post in a middle east hospital. She's instantly doubled her salary, has paid for accommodation and it is all tax free.

It is fascinating yet unsurprising that the Acute Trust Board discuss a survey on staff concerns and conclude that people are happy. In reality the medical staff are angry and frustrated. It is time for the board members to get away from the board room and go actually meet the workers. Such bullying can have severe financial consequences.

Death by attrition - Walk-In Centre

I'm watching the death by attrition of an NHS Walk-In Centre:-

• Buildings closing (scheduled to be demolished quickly after);
• Alternatively buildings given to a GP practice; even though they are a private concern;
• Primary patients directed away without treatment ("Go to your GP or another clinic such as sexual health");
• Any vacant position arbitrarily removed, regardless of the reason for the vacancy.
• Senior nurses bullied and excluded from management meetings to encourage them to leave;
• Senior nurses made redundant;
• Junior nurses told their jobs are being regraded (downwards) with no real consultation;
• Overnight working in A&E (not primary care) imposed regardless of contract;
• Nurses diverted to streaming duties in A&E;
• Nurses joining a union for the first time ever;
• Specialist computer systems for patient consultation records abandoned and no further maintenance paid.
• Services like Emergency Contraception cancelled - "go to another clinic" even though it is closed and the patient would need an appointment. 
• Senior administrators making arbitrary clinical decisions
• Budgets diverted away to other purposes.

All of this happens without consultation with the public and little warning to patients. All that is left is a deskilled shell nominally called a Walk-In Centre where a couple of nurses share a room somewhere in a larger department.  The PCT or Acute Trust claim the Walk-In centre hasn't "closed".

I've now seen this happen in four different locations over the past couple of years. It is a sickening waste of the public money invested in the creating WIC infrastructure and in the cost of building and training a skilled team of nurses. The public are left with no improvement of services as a result and the workload (queues) in the local A&E increase as a consequence.

One point never successfully handled under if retaining the patient records. They are supposed to be maintained safely and accessible for at least 25 years. This is an enormous cost risk, with the nurses dispersed there is no one able to dispute a legal medical claim. It is another consequence of the Lansley blind bull in a china shop leadership.

This happening in many places in the UK..

Edit: 17th April 2012

I recently had a chest infection which needed treatment with antibiotics to help it clear up. I've not troubled my GP for the past 15 years but I was not surprised to find I could not get an appointment until the following Monday (I was phoning on a Wednesday).  The receptionist's advice was to go to A&E dept or to the local Walk-In Centre. The local walk-in centre is one of those which has closed to be replaced by a ghost service located in another GP Surgery. I wasn't working so I drove to the WIC and was seen by a Nurse Practitioner within half an hour during the normal working day.  However I note that the opening hours have been cut down considerably and there is a map on the wall showing the "Catchment Area" street by street, within a radius of one mile. Proper Walk-In Centres do not have catchment areas! They deal with whoever comes through the door

The next closest Walk-in Centre by time of travel was open in December 2012, but it is now closed and the site is a car park.