How to Save Money on the NHS -Managers versus Staff

The esteemed consultants McKinsey recently held a stakeholder summit for management and staff from the NHS.Much fat,carbs and black forest gateau was consumed. The idea was to have a brainstorming session with blue sky thinking in order to effect a step change within the culture of the NHS. Or to put it another way, they wanted to know how to save money. The managers got together and made up one list. The staff got together and made up another. Yours truly was sneaked a copy of the result which I print below.

Managers list of Money Saving Ideas for the NHS

1. Sack 1.5 million staff by 2014, leading to a saving of approx £75 billion
2. Remove any patient from GP lists whose case notes are more than 1/4 inch thick.
3. Put all patients in hospitals, out into B&Bs in the community and let social work pay for them.
4. Let that nice man Richard Branson in to run GP practices with lots of nice potted plants and flip charts.
5. Pay out the £50 billion to managers for being so clever at doing all these things.

Staffs' List of Money Saving Ideas for the NHS

1. Sack anyone with the word 'facilitator' in their job title.
2. Sack anyone with the word 'Donaldson' in their name.
3. Firebomb all Darzi clinics.
4. Put a Doomsday virus into the 'Connecting for Health' supercomputer. On the other hand don't bother; it'll not be noticed amongst all the others.
5. Put in the Tower anyone who uses a beard, jumper or hot air balloon in an attempt to appear friendly and engaging.

There was also one other paper found, but nobody knows who wrote it, except that they signed it 'Cassandra'. Their list said,

1. Use the government's newly acquired control of the banks to give back the profits made on re-financing PFI deals;
2. Employ more frontline staff to improve productivity and ensure patients are not hanging about in hospitals when they don't need to;
3. Get the government to reduce the capital charge or abolish it altogether. This means that city hospitals especially are paying out an inordinate amount on the value of their property. At the very least, charge hospitals on the actual value of their equipment for the capital charge, not what it costs to buy new.
4. Provide some proper step-down beds and continuing care beds in whats left of the old day and continuing care hospitals and don't take up room in acute care.
5. Instead of trying to build a massive supercomputer that spotty faced teenagers can hack into when they're bored, build a number of smaller localised computer services in each county, like wot the Jocks are doing. And the next time Accenture breach their contract sue them for £1 billion, not £63 million.
6. Abolish the internal market in the NHS and bring back the health boards. That will get rid of the endless paper trail following every purchase, every patient, every tender and it will get rid of the accountants, lawyers, middle managers and alternative health care providers that know diddly squat about health that hang on to that system. All things being equal, you should be able to halve your admin costs from 12% to 6% by doing this.

Cassandra indeed..

Vote for Margaret Haywood -Support Our Whistleblowers

Margaret Haywood, the nurse who blew the whistle on poor standards of care for the elderly on Panorama, has been shortlisted for the Patients' Choice for the Nursing Standards Nurse
Awards. You can vote for her here. If you do nothing else this week do this; Margaret Haywood lost her job whistleblowing and it's important that we show our support. And do pass the message on..

Playing at Doctors -Big Pharma is Coming to Town

I'm a suspicious sort of soul. When choosing between cock up or conspiracy, I always go for the latter. It does mean that sometimes you are pleasantly surprised when things do not go as badly as you think; but more often it means that you're right and everyone hates you for it. So it came about that when the 'minor ailments' service was brought in in pharmacies, I began to be suspicious. On the face of it, it sounded like a good idea. GPs really don't like being phoned up every five minutes to write out prescriptions for Calpol and the like, and there's no doubt that it did take a burden off them. But it's what went with that. Consulting rooms. Prescribing powers. Hmm. Was this about convenience or was it the government's idea for further dilution of the GP service?

The answer came this week. Lloyd's the big pharmacy chain, has applied to be an 'alternative medical services provider.' It is going to set up consultation rooms where a patient can speak to a virtual doctor online. So instead of going to the doctor you can go to the pharmacist and at the same time you can buy all your lovely drugs from Lloyds instead of those boring generic ones you can get at the local dispensary. Great.

It's going to be particularly interesting how this is going to pan out in Scotland. The SNP has a policy against privatisation in the NHS and in 2007 the attempt to bring in SERCO for Harthill GP practice was closed down very quickly. This is opening up another front and is a direct challenge to the SNP's current attempts to amend the GP contract that allows this. There was always a danger that this would happen, because although the Scottish Government can change our legislation, European legislation states that any business worth more than a certain amount had to be open to tender. GP practices could get round this by being small and it was thought that the relentless march of the health centre and the resulting merging of practices would be the way big business would worm its way in. It looks like they've found a back door. Instead of having to deal with GPs and persuading them to shift to new premises they're doing the process the other way round. And we are going to lose GPs and dilute the service we have.

It was a conspiracy. I was right. And I hate that I'm right..

A Toast to the Scottish Government

There aren't a lot of bright spots in healthcare at the moment, what with Daniel Hannan slagging off the NHS on American tv and the political parties rushing to its defence while simultaneously privatising what's left of it. But today there was a good news story. The Scottish government has brought in measures to restrict the sale of alchohol to one place in supermarkets, to ban irresponsible drinks promotions and loss leaders, and is following up with proposals to price drinks according to units instead of classification. This means that sights like this are going to become a thing of the past. I'm sure there are folks out there who are disappointed not to find their regular Lambrusco beside a pair of rolling skates in Tescos, but otherwise I think it's a good day for Scotland and a gold star for Nicola Sturgeon. It looks like we have someone fit for taking on the big drinks companies at last.

Hedgehogs, Pigs and the Edinburgh Festival

The Edinburgh Festival is in full swing just now and so are the comedians. The top ten jokes of the Festival were voted on the other day. The winner was 'Hedgehogs? Why can't they share the hedge?'

But the best worst joke was;

'I phoned up the swine flu line and all I got was crackling..'

Sorry. I'll just go and get my coat..

IMGs and Hysteria

Twitter has been tweeting its head off this week as Republican rednecks queue up to have a go at the NHS. The NHS is to blame for absolutely everything according to them and I suppose it was only a matter of time before they got round to two of their favourite subjects - immigrants and terrorism.

American commentators have been pointing out that the terrorists that carried out the jeep attack on Glasgow Airport were IMGs (Interntional Medical Graduates). Therefore the NHS represents a terrorist security threat. What this view hooks on, is that some years ago, the government decided to take in more IMGs to deal with a shortage of staff. Those on the lower grades were allowed to work for a number of years without a work permit, but once they wanted to apply for a higher grade, they needed to get a work permit. This was one of the untold stories of the MMC debacle, where IMGs found that they could only apply for job situations if their visa extended beyond August 1st. As many of them didn't have a visa in the first place, it was the boat home for them. I've told the story here.

It's difficult to know where to start with such a ridiculous assertion. How about the Tube bombers who were born and brought up in Leeds? What happened to them? How about one of the bombers of the American Embassy in Nairobi, who went to Nairobi, stayed there for some years and even married a girl there, while preparing for blowing up two hundred people? How about the Madrid bomber Jamal Zougam, who ran a mobile phone shop in Madrid? How about the 9/11 bombers who entered America and trained in their pilot schools before attacking the Two Towers? If I was being really uncharitable, how would the American health medical organisations run without immigrants? From the country that lifts the lamp beside the golden door, it's really rich to lecture us about immigration policy and security.

The truth is, terrorists can find any way in they want. They don't need the NHS for entry and identity cards in Spain did not stop the Madrid bombings. There is actually only one way to stop terrorists and that is to have the moderate majority on your side. Terrorists don't work on their own. They need money, weapons, safe houses and people to look the other way. And when you demonise and ostracise the moderates, that's when terrorism thrives.

The NHS from its inception has relied on immigrants from the Indian medical colleges and others, to be able to function. It is the second biggest employer in the world, after the Chinese army. And for all its faults (and they are many)it is a great British institution. I will be saying more on this, but for now, it's time to tell those Texan peskies to take a hike..

Revenge of the Jobsworth - Domiciliary Care and Arifa Farooq

For twelve years now, I've been a carer for my mum who has dementia, and for ten of that twelve years I have had carers coming to the house. I've had several different organisations come, and so I know that home support is a bit of a curate's egg. Good in parts and absolutely rank in others. Amongst those experiences was a very brief brush with Domiciliary Care. I won't go into details, but I suffice to say that I was not in the least surprised to see them appear in a half hour investigative programme filmed by the BBC.

To be fair to Domiciliary Care, the faults that were revealed could be found in any care organisation. Saying you'd been half an hour when you'd only been ten minutes; giving people sandwiches instead of a proper meal (and Quavers); not knowing how to move and handle or how to use a hoist, turning up late; these things happen to a greater or lesser degree in all care organisations. It was the sheer unremitting extent of Domiciliary Care's failings that made it the bogeyman of poor service. At the root of this malaise was South Lanarkshire's auction system for the care contract in their area. All those tendering had to log on to a webpage and the company that bid the lowest got the contract. Corners were cut and the service suffered as a result.

Step forward Arifa Farooq, investigative journalist for the Beeb. She went undercover as an employee of Domiciliary Care and unsurprisingly, did not state on her CV that she was a journalist. Last week she was arrested for providing false personal details. The NUJ are backing her and so are the BBC, but she is part of a growing trend of the persecution of whistleblowers in the area of elderly care. Remember Margaret Haywood? She was the nurse that filmed undercover for Panorama in an elderly ward to expose the abuse going on. She was struck off the nursing register for filming patients without their permission. The fact that she asked their permission to show the footage before it was broadcast cut no ice with the nursing board; she was sacked and without registration she will not be able to work in nursing again. Then there was Dr Rita Pal, who exposed abuse going on in an elderly hospital ward in North Staffordshire NHS trust. Her reward for that was ten years of persecution through the courts of the GMC. It's still not over and she is now working as a GP.

One could laugh at the sheer pettiness of the rage of these jobsworths. I laughed out loud when Arifa Farooq revealed that 'Lady' Mary Beattie who is the head of Domiciliary Care is in fact nothing of the sort; Burke's Peerage had no record of her honorific title. (I also thought Farooq would pay for putting in that detail and I wasn't wrong.) At the same time the sheer violence of the reaction to anyone exposing the faults in elderly care is disturbing. It is par for the course for jobsworths to try and trip up whistleblowers; it is not usual for them to succeed, as they did with Margaret Haywood and Rita Pal. I am keeping my fingers crossed for Arifa Farooq and I am hoping the fact that she is a journalist rather than a medic will protect her. In the meantime, it's a rough old world out there for whistleblowers,but we need them. It's time we gave them proper protection.