Sounds familiar?

Waiting list sizes are a problem, so cut them down using ingenious methods. Ten years ago News from Nowhere’s moles gathered five suggestions then circulating in the NHS. 

1) Simply decline to take any more referrals, as had been known to happen in clinical psychology, orthodontics and plastic surgery. 

2) Raise the bar for referrals, creating threshold criteria based on symptoms (pain for more than 6 months, for example). 

3) Establish a holding list, before the waiting list, so that referrals are not formally added to the waiting list itself. 

4) Prune the list regularly of those who have died, moved, changed their mind or simply failed to return the enquiry letter – the latter group is small and although distressed by their displacement can at least go back into holding. 

5) Do the quick and easy work first, if the numbers are large and the medical or surgical task easy enough, and let the complicated ones wait.

What has changed?    Source: News from Nowhere  2003

The ‘insurance gap’ narrows

Analysis of PHIN data on private medical treatment from leading independent consultancy Broadstone reveals a narrowing “insurance gap.”  It reflects accelerating insured admissions amid growing demand from businesses to invest in the health of their employees amid the crisis in the NHS. In Q4 2022 the number of insured admissions rose to 140,000 – the highest volume since before the pandemic – and are now accelerating at a far quicker rate than self-pay admissions which plateaued at 66,000 admissions in Q4 2022 (still substantially higher than pre-pandemic - 50,000 admissions in Q1 2019).

Source: www.templebaradvisory.com

Now play nicely!

An acute trust chair has said its emergency department is effectively operating as a primary care service. The Trust is Princess Alexandra Trust, the Trust Chair is Hattie Llewelyn-Davies, who blames a combination of factors for high A&E attendances but low admissions. The publisher is the Health Service Journal. As usual the readers’ comments are the best bits. Here’s one NfN moles really loved.

“The aggressively defensive approach to the management of financially 'independent' and 'responsible' 'trust' organisations as developed over the decades of the internal market has trained a cohort of managers and clinicians who are really not at all sure how to play nicely.

This is the fundamental skill in a cooperative and coordinated, even 'integrated', system.
Those with insight have been reaching retirement at a startling rate. To the extent NHSE has formed a support group for new CEOs”.

Source: Zoe Tidman  Trust’s A&E ‘effectively running primary care service’, says chair  Health Service Journal 15 May 2023
 

Conversations about Hewitt in the Era 3 group

What happens if experts from different parts of the NHS  decide to summarise their thoughts? Here’s an example, prompted by the Hewitt report.

• The Tories fear the Hewitt Report and have shelved it. It goes to the root of the problem – their mismanagement of the NHS since 2010.

• The NHS does not just need more doctors and nurses, it needs greater productivity to reduce the waiting list backlog. It needs to modernise

• The Hewitt Report asks the right question about the NHS. Where does the real power lie?

• To change the NHS’ direction of travel it needs top class clinical leaders, good general managers and first-rate data managers. They come at a price.

• Modernising the NHS means mobilising its staff and its users to act as change agents.

• The NHS will take time to recover from its mistreatment. Long timescales are needed, and long vision. 

• Multi-year funding is needed to promote local, regional and national planning by the NHS. The NHS can make the case for Local Authorities to be offered multi-year funding, and to better align themselves with the NHS. Know-How will be needed to put the NHS right. This is where skilled management comes in.

• The NHS manages budgets badly as resources are so tight. Money is taken from Capital (equipment, procurement, repair) to plug gaps in Revenue spending for services. This is no way to run a business as big as the NHS.

• Inside the NHS there is a continuous struggle between the services (run by skilled experts with a long-term commitment often to specific areas or services), the funders (The Treasury) that want to control spending and seek efficiencies, and the Department of Health and Social Care (DHSC) that sets treatment targets and seeks health gains.

• We are all too often kept in the dark. How many of us can say, on using the NHS, “I know who is in charge here”? What would such ‘I statements’ look like for a better NHS?

• General practice is in a mess and needs fixing. Its contracts with the NHS are complicated and prevent change. Funding streams can be uncertain but mortgage payments cannot.

• GPs are collecting data to show their compliance with targets, not outcomes for their patients. General Practice needs fewer targets.

• GPs were once gatekeepers to specialist care, but that model of provision no longer works. GPs should become gate-openers.

• Primary care leadership will be needed to make integrated care work, but it has all but disappeared following the abolition of the Clinical Commissioning Groups last year.