Running on empty
Labour’s conference did not please everybody in the NHS. A member of Doctors for Unite, a pressure group wedded to conspiracy theories, said: “Streeting….is an arch-privatiser, funded by toxic health care transnational corporate interests. The privatisers rely on public apathy (the result of recurrent political defeat), and on sowing confusion as to what it really means to support the NHS”. So now you know.
Source: doctors-in-unite-email-group@googlegroups.com
Policy wonkishness
A member of the Socialist Health Association who attended Labour’s annual conference asked plaintively how can ordinary members have a say in developing policy? Easy, say NfN moles, just work out some solutions to problems that the NHS actually has, make sure the solutions are plausible rather than magical, propose them at annual conference, blend them into similar proposals to make a composite resolution and promote it to the National Policy Forum. Labour’s leaders will look at the compromise and use it selectively. Or not, as circumstances require/allow.
Paperwork
A fifth (20%) of care home managers spend between 7-8 hours a day on administrative tasks alone. Nearly half (48%) say paperwork 'prevents me from doing the job I actually should be doing' and 45 per cent say it has been a drain on team morale. One in six (17%) say they need at least 50 per cent more staff to operate properly. Four in ten (45%) say the time spent on admin is impacting negatively on home residents’ health or care.
Source: Survey of 222 NHS and social care and managers across the UK, conducted September 2023. https://www.florence.co.uk/posts/pointless-paperwork-survey
Food glorious food
NHS England is throwing away the equivalent of 100,000 meals every day according to its zero food lead, Timothy Radcliffe. The NHS is estimated to produce around 185 million meals a year.
Source: Zoe Tidman Health Services Journal 4 October 2023
Outsourcing hip replacements
There has been a steady increase in the number of total hip replacements (THRs) that were NHS-funded and performed in NHS hospitals from the beginning of the registry in 2003 until 2014. After this time, this number plateaued until 2019 and then reduced substantially due to the impact of COVID.
The growth in the total number of THRs performed from 2014 to 2019 was largely driven by growth in the number of NHS-funded procedures being performed in independent hospitals Although the total number of THRs performed in 2022 has nearly recovered to 2019 levels, the recovery of NHS-funded THR procedures being performed in NHS hospitals is only partial.
There has been an increase in the number of both NHS-funded procedures performed in independent hospitals and independently funded procedures performed in independent hospitals. These changes account for the overall recovery.
Source: National Joint Registry 2023 p52 https://www.hqip.org.uk/wp-content/uploads/2023/10/NJR-20th-Annual-Report-2023.pdf
Not being heard.
The Lucy Letby case has sent ripples of concern through the NHS. NfN contacts are hearing about NHS staff trying to open complaints that management thought had been formally closed. The justification given is “I was not heard”, a claim made in the Letby case by alarmed clinicians against allegedly dismissive senior managers. Some of the grievances now being re-examined are single-issue problems, and others are more complex. A dispute between a CEO and a Chair at a northern Trust managed to include concerns about the handling of deaths of new-born babies in a portfolio of blistering complaints about each other.
Sources: NHS managers and clinicians, talking with NfN moles.
The new (snake) oil
When The Economist promoted AI for the NHS on the grounds that data serves doctors well, HSJ analyst Steve Black get very annoyed “The idea that data serves doctors well is not credible for anyone who has looked at how hospital systems work…. In many cases, assembling all the relevant data to make a decision about a single patient needs someone to manually assemble parts from six to eight unlinked systems all with separate logins and data formats”. Automating this task of glueing badly designed systems together is one reason why Palantir has had some successful case studies in hospitals.
The hype about the potential of AI is built on top of a previous wave of exaggerated Big Data marketing claims for data as the new oil. More like the new snake oil says Steve Black . Only people with former health secretary Matt Hancock’s level of credulity could take such claims seriously.
Sources: The Economist How to make Britain’s health service AI-ready: The NHS should clean up and open up its data. Patients will benefit October 19th 2033 & Steve Black The mythbuster: Analysts not AI are the answer to the NHS’s data woes Health Services Journal 30/10/33
Advice & Guidance-who needs it?
Advice & Guidance services allow GPs to contact hospital consultants before making a referral in order to ensure only clinically appropriate patients are referred to secondary care. The A&G model is described by NHS England as a key part of the National Elective Care Recovery and Transformation Programme’s work.
A and G is, when used well, a way of getting simple questions answered ('when does this person need referring?', 'is there a second line treatment for this that they should try before seeing you', 'should I be worried about this symptom in the context of their other conditions' etc).
That’s why a decline in use has rung alarm bells at NHSE. The number of A&G requests processed between June and August 2023 dropped from 196,000 to 142,000 (28 per cent), while the number of processed cases resulting in a patient being diverted fell from 98,721 to 66,969 (32 per cent).
The declines in activity might be due to strike action by consultants, a summer-time dip in demand, familiar delays in entering data in August or rising pressures in general practice that divert clinical attention. Whatever is driving the decline, it has the NHS rattled.
Source: Mimi Launder Exclusive: Performance of vital demand management service collapses Health Service Journal 26 October 2023
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/