Ouch!
In issue 133 we asked “How long will it take Labour to stabilise the NHS? A) 12-18 months B) as long as Wes’ tenure at DHSC C) A decade D) Two decades. A robust mole replied immediately; Not A, Not B, Not C, Not D! “The healthcare system will stabilise when health becomes the guiding principle of society."Health" = the status individuals have when their vital, social and agency needs are optimally satisfied. If you define "health" as the absence of disease, then you are giving up on meeting human needs. You are simply lining them up for a hospital bed. You are preventing the stabilisation of the NHS”.
Discretionary effort- one more heave!
Senior managers at NHS England have suggested reduced discretionary efforts from staff could have contributed to hospitals being a tenth less productive than they were before the pandemic. Here’s what HSJ readers said…
“…..one of the things that still hinders us is the growth in critical backlog maintenance, and the fact that every day we will be losing a theatre, a ward block, a pathology department".
“…nurses, junior doctors and senior doctors have all been on strike at some point over the last year! Successive (mainly Tory) governments have relied, abused and depleted the goodwill that so much of the NHS workforce had to offer. It is now gone and will be very difficult to get back”.
“The problem on the ground is tiredness. We're all so tired. Tired of strikes, tired of working longer and longer hours. Tired of picking up more and more for no reward. At least if you're clinical you're incentivised to do additional clinics. As a manager you're given the equivalent of a "thoughts and prayers" message and told hurry up”.
“..in Covid, clinicians were given enormous autonomy just to get on and sort problems out at the coal face without a myriad of regulations and control”.
“But if we have got record levels of spend and now having to make swathes of redundancies because we have too many staff, then explain to me, a normal member of the public, why this is happening”?
“Discretionary effort went after Covid. People value time far more than they ever have. Working conditions are intolerable, from board to ward. Reward and recognition don’t exist. It’s good that somebody has actually attempted to quantify it”.
Source: Henry Anderson NHSE reveals 10% productivity drop Health Service Journal 17 May 2024
And another thing
“Despite more spending on the service and large increase in numbers of nurses and doctors, overall hospital activity has not returned to the level that hospitals achieved directly before the pandemic... This is caused by underinvestment in capital and lack of management capacity, poor retention of experienced staff, high vacancies at critical points of patient flow and poorly aligned incentives across the service”.
Source: The annual performance tracker for 2023 published by the Institute for Government (IfG) and the Chartered Institute of Public Finance and Accounting (CIPFA).
No more logjams
“If the juniors do not get what they are looking for I hear they will be going all for an all-out continuous strike starting two weeks before the election so that the NHS will have properly fallen over by the day of the election. Can’t say I blame them…. They have a once-in-a-generation chance to sort this out, they’re not going to muff it now”.
Source: Anonymous comment on Nick Kituno’s Government and junior doctors explore mediation to break ‘logjam’ HSJ 16 May 2024.
Cold comfort
Inspections by the Human Tissue Authority have found deteriorating or decomposing bodies in 12 hospitals’ mortuaries since 2022. One trust resorted to “rotating” bodies between refrigerated and unrefrigerated storage. Bodies are being left to deteriorate and in some cases decompose in hospital mortuaries, often because of a lack of freezer space.
Source: Alison Moore ‘Decomposing bodies’ discovered at multiple hospitals Health Service Journal 16 May 2024
Rolling back the private sector?
Greater Manchester has the second largest elective backlog in England on a per capita basis, while also having one of the largest numbers of cases already waiting. The GM system has relied heavily on private capacity to reduce the backlog, from providers such as Spamedica, Ramsay’s Oaklands Hospital in Salford, and the Circle Health facilities in Bolton and Rochdale. It won’t be enough. A recent board paper noted the need for a “systematic reduction in our dependency on the independent sector”.
Source: Lawrence Dunhill ‘Systematic’ cuts to private activity planned by stricken ICS Health Service Journal 16 May 2024
Promoting the private sector?
Private providers dislike integrated care systems, believing that they (the private providers) are better suited to a more demanding commercial environment. They argue that patient choice is being eroded by collaboration whilst commissioners want to keep funding within the NHS.
The Independent Patient Choice and Procurement Panel (IPCPP) was recently established to help private providers gain accreditation to provide NHS services.
A recent IPCPP report shows significant variation in choice between systems driven by commissioners who discourage GPs choice and encourage referrals to local NHS trusts.
There are alleged instances of financial incentives being given for referrals to particular providers, and conflicts of interest when referral assessment services are operated by NHS trusts providing local services. In response to the IPCPP, NHS England will begin monitoring the NHS on the extent to which patients are given private provider options for investigation and treatment.
Lawrence Dunhill New crackdown on ICSs that ‘discourage’ referrals to private hospitals
Health Service Journal 15 May 2024
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/