Young heroes

We held the "Baby Shower" for my son's wife at our house yesterday. It went really well. It is great to see the generation we raised coming through to parenthood. It turns out one of the guys at the party (in his 20's) is a film and TV star. One of the young ladies who was also there is a star of a London West End musical. They both friends of my son. True to my fuddy duddy lifestyle I didn't recognise their names or careers until my son told me afterwards. It is great to see these young people building their careers.

UK NHS cuts.

Another sign of the deterioration of the UK's NHS care under the Andrew Lansley plan. A GP practice chops patients because they are too expensive. These people are close supporters of Lansley.

http://www.guardian.co.uk/society/2012/may/31/gp-health-reform-cost-cut

Lack of hospital beds in UK

It is sad that I feel duty bound to use my blog as an author to raise the problems I see with the UK's National Health Service, but where else can one get one's views in the public view? The bloated administration of the NHS is sucking the lifeblood out of the service where administrators with no clinical experience are on six figure salaries. At the same time skilled clinical staff are losing their jobs.

Take for example the reported shortage of hospital beds (BBC article - Nick Triggle). The Government deny there is a shortage, but if you talk to any A& E Matron and you will hear a very different story. Patients are regularly kept waiting because of bed shortages. The hospitals employ "Bed Managers" whose sole job is to chase the clinicians in the hospital wards to discharge patients early.

The problem with hospital beds is that a "bed" has become a unit of accounting in hospitals. The bean counters find it very convenient to work out the "cost of a bed" by taking the total running costs of a hospital ward/unit and dividing it by the number of beds. Don't forget they also impose the "management overhead + PFI costs" into those running costs. It is not just the medicines, doctors, nurses and ward staff. The bean counters then have an easy to use spreadsheet figure called "bed cost". The cost figure gets absorbed into the management mythology and the people using it forget the original components of the cost.

When senior hospital management realise there have/are going to run out of money they'll introduce cost cutting measures. Some bright bean counting spark will say "if we cut 20 beds from the service we'll save a lot of money over five years". As a consequence patients lose access to those beds, but the overhead hospital costs never go away.  Let's be plain about this: A hospital bed only costs about £5,000 When a hospital "closes" a bed, they don't sell the bed to reclaim the money. The hospital still has to pay infrastructure costs, floor rent, the administrators costs are still there, the PFI costs remain.  The action doesn't reduce the number of patients, people still get sick.

The hospital planners/administrators need to get away from the concept of a "bed cost" and use more realistic accounting methods. 

Here's another view of the problems by a Doctor.

Absolute stupidity of NHS Reorganisation

Before the last general election in the UK the leader of the Conservative Party declared that he wouldn't impose yet another re-organisation on the NHS if he was elected as the new Prime Minister. Promptly on arrival as the new PM he handed control to a dubious politician called Andrew Lansley. This silly man promptly set about reorganising the National Health Service. He has this "bee in his bonnet" that is he removes layers of management from the NHS and hands control to General Practitioners (Doctors) they will magically reduce the public costs of the NHS. This man Lansley has the stubbornness of a dead donkey and the listening ability of a beach pebble when it comes to listening to the views of the massive majority of the health care professionals. Just about everyone says scrap the new new re-organisation.

Here's some of the problems:

• The GPs are independent contractors (I have a letter from the Dept of Health confirming that); their own profit comes first. Giving them control of the purse strings give them the opportunity to avoid any measure that would reduce their profit.
• The GPs won't have spare time to run the national organisation or even local ones. They'll just re-employ the bureaucrats who used to run the defunct Primary Care Trusts. It won't save money.

Here's a real life example of the changes in progress right now. A friend of mine is a Nurse Practitioner. She's a highly skilled medical practitioner who has a cluster of medical degrees, over 30 years experience who works without the need for clinical supervision at the level of GP/Registrar. Her costs are about half that of a highly paid GP. As a direct consequence of the re-organisation she is being made redundant. Well not exactly redundant, the patients she used to see are being redirected to the local A&E department. The cost the public purse per patient has increased by a factor of three and queues will lengthen in the A&E. 

This senior nurse's redundancy settlement has yet to be agreed, but by the Departmental rules the additional cost to the public purse will be close to £500,000 if an unfair dismissal claim is to be avoided. Meanwhile the same group of GPs who pushed for the closure of the Nurse Practitioner's department are looking to employ her on a freelance basis at a Doctor's rate of pay. The nurse didn't ask for the re-organisation and she doesn't want to be made redundant. She is a strong proponent of the NHS. How many times is this type of situation going to be repeated throughout the NHS?

Who's snooping on your site?

We occasionally check who has been accessing the websites set up for each of my published books. This is fairly easy to do because every time someone visits a web site there's an electronic trail left in the log files on the web server computer. From those details we can check who owns the IP Address of the person/organisation making the enquiry.

On the Company Mole web site we found one interesting entry(IP: 30.100.21.18) leading back to a company called Cyveillance Inc which is owned by QinetiQ. QinetiQ is the research company which was spun off from the British Ministry of Defence. It is often involved in classified work and the Intelligence services.

The log entry showed Cyveillance had scanned all of the Company Mole web site. A look at the Cyveillance public web site shows as part of their public activities they are involved in "Brand Protection" for major corporate organisations. Interestingly our CM web site is set up so it can only be accessed by name "www.companymole.com", so this was no random search. Maybe Cyveillance has discovered the truth about the Foundation of Honour? Is Adam Cranford now recorded on a secret massive intelligence database?.

GPs in charge of chaos in the NHS

I've posted before on the matter of NHS Walk-In Centres being closed in the UK, now I've experienced it for myself. Unusually I've come down with a cold which has migrated into a chest infection. For the first time in 15 years I've phoned my local GP Practice to ask for an appointment to see my GP so I can get a dose of antibiotics to knock this infection on the head. No appointments for 3 days, even then that would be with a locum doctor. GPs should not be allowed to hold the NHS purse strings.

What do they expect - should I let the infection progress until I end up in A&E?  There used to be a Walk-In Centre in the locality managed by experienced nurses where I could be seen fairly promptly, but that has been closed, the next nearest WIC closed a couple of months ago.

I'm going back to bed and hope that my body can deal with the infection. I've contributed money to the NHS all my life, and now when I need their assistance I've been let down. Nice one Andrew Lansley! He is so keen to listen to the well paid GPs and let the Walk-In Centres slide into oblivion.

Black Hole devours nurses

I've earlier written about the death of an NHS Walk-In Centre, I'm now watch the terminal stages of this process in one location. It's nothing new I've seen it before and I'm sure the remaining Walk-In Centres will suffer a similar fate.

This is a direct consequence of Andrew Lansley's misguided leadership of the NHS. Abolition of the Primary Care Trusts have left Primary Care Walk-In Centres without any real sponsors. The General Practitioners (GPs), who now hold the purse strings in advance of actual parliamentary approval, will not save the Walk-In Centres because it disturbs their Edwardian business model of private practice partnerships.

No, the WIC I'm watching has been handed over to the black hole of a local A&E department of an Acute Trust Hospital. The once highly efficient team of Primary Care Nurses is being torn apart. This is a team which has worked for 10 years, rarely breaching patient time waiting targets and almost zero serious patient complaints. Nurses who were trained to work as autonomous practitioners who are qualified and able to assess medical conditions and to prescribe treatment. Their clinical leader has been elbowed away and replaced by an A&E nurse manager who has no experience of Primary Care medicine. The remaining Primary Care nurses are looking for new jobs having been told they are "not competent" by someone who has no experience in their skills. The GPs who once worked as part of the team are refusing to work with the new management. Within a few months little trace will be left of what was once a strong team.  

One remaining question  is what happens to the funds assigned to the WIC Nursing team? Does it get buried in the A&E hoard? What happens to the (average) 200 people who used to go to the Walk-In Centre? Their needs don't go away.

Update May 2012:
The Matron of the A & E Dept which absorbed the WIC has resigned. She's tired of the bullying from senior managers and clinicians, meanwhile the Matron of the now closed WIC is in the final stages of redundancy. It all seems a silly waste of resource to me.