NHS reforms

The NHS would appear to be suffering an in-flight emergency. It is locked on auto-pilot. The cabin crew are unsure what to do. A few are close to panic. The nature of the problem is unclear. The causes indeterminate. No one was trained for this.

Cabin crew announcements become more insistent and louder by the minute. The passengers are told to stay in their seats with their seat-belts on. Window shutters remain closed. The drinks trolley stays firmly in its bay.

Disaster looks certain and everyone braces themselves for impact. Every Act of Parliament thar has ever had anything to do with the NHS flashes in front of their very eyes.

Until, that is, the youngest stewardess seizes the microphone from her boss. She pulls no punches as she candidly tells her fellow cabin-dwellers what is happening. ‘Any ideas?’ she asks. ‘Could any patients on board please make themselves known to the crew?’

Speaking to reporters afterwards here is what was recounted. First, some bright spark lifted their window shutter and it appeared the plane was still in one piece. Then they all did and it was clear they had never left the ground. So another who knew a thing or two went forward and helped the captain get the airplane off the ground. They didn’t understand the dials but, my, how they could pull back on that yoke.

A hysterical patient was given water by his neighbour and then sedated. They all agreed to even get rid of the baggage just to make sure the aircraft would lift off before the end of the runway. For they knew everyone’s life depended on it and they all wanted to get to their destination – which they had all chosen. One even had a friend at the other end who talked them down to the airport there.

Having listened to yet another radio discussion of the great and good about the NHS this morning with not a patient in sight….

And having observed last week’s spat between the overly defensive (we all work hard!) Royal College of General Practitioners (RCGP) and the ever so slightly hysterical Patients Association ( are there any solutions to the problems you would like to actually own yourselves?)….

One can’t help but think that we are partly at risk of talking this plane into the ground ourselves. There’s a lot of shouting going on and not a lot of listening. Cockpit communication has broken down. This can only spell doom or the hardest of landings at the very least.

And yet I wait to really hear ‘the system’ ask patients and the public for their help. Not just their views. Or feedback on the non-threatening. But their support in dealing with issues for which they have run out of solutions. And an acceptance that actually for many patients the present can feel no better than boarding a low budget airline.

I am reminded of a recent story about a GP’s Patient Participation Group. It has excelled at improving the decor. It has even had new automatic doors installed. Great! Brilliant! Just imagine how they might help improve doctor-patient dialogue. If only they were involved. But they are not.

Crash positions!

We are a nation that no longer knows when to put its rubbish bins out.

So I reflected, as I dragged our two overflowing wheelie bins back to their usual place. To be fair to Bromley Council, it’s not that they fail to pick-up our rubbish; just that no one can quite predict what sort of rubbish they are going to collect in any given week.

I won’t bore you with the details. Suffice to say that some months ago they changed the system of waste collection here – successfully ‘piloted’ with local residents I should add – so that various items would be picked-up on alternate weeks. Well, for the life of me, I and my neighbours have got it wrong at least 40% of the time. I wouldn’t mind that much but after hours toiling over separating tetra packs from the New Scientist it does get a bit irritating to see the bin men and women dump it all together in the back of a dustcart. As my mother would say – and she is usually right about most things: ‘it all goes down one way.’ But I do wonder if I am part of some sort of rather wicked observational study.

Such episodes in life do however serve as useful metaphors for larger trends at work. In this case, perhaps, it is the passing of what was once certain, fixed, reliable. Now I just sound like John Major don’t I?

Anyhow, enter stage centre-right, the NHS. September is upon us after another crummy August and our politicos have quickly rejoined battle over the health service reforms. The Sunday Times front page from yesterday suggesting that overseas companies are being primed to run hospitals (or should that be the other way round) left me unsettled to say the least.  Notwithstanding the so-called ‘Listening Exercise’ prior to the summer, it really does feel as if the tectonic plates are shifting beneath the NHS and fast.

The BBC Online has a good overview of where the battle lines have been draw if you wish to look deeper and I wish that I had been able to attend this evening’s Stempra briefing and discussion on the Bill – perhaps someone will post a comment giving us a sense of what happened. 

But I was struck by the passage in the BBC piece about the anticipated forensic scrutiny of the legislation when it gets to the House of Lords.  Heavens knows it needs it.  When I was a little closer to these things than I am now it was well-known that Peers were getting together regularly to examine and prise apart the Bill in preparation for its stages there.

This is the thing.  If you are into your pure politics then I suspect you will be attracted by the likely rough and tumble during the party conference season and in the House of Commons come October.  If, however, you are looking to throw your weight behind the forces that might ensure the reforms are changed for the better then I encourage you to assist our Peers in every way you can with good evidence and good briefing.

Otherwise, it will not be that the NHS fails to treat people in the future, rather that none of us will be able to predict which patients it will treat in any given week in any given part of the country.


PS: Apologies that the links are to ‘home pages’ but I can’t seem to use anything other than the WordPress recommended links on this computer.

I suspect you have seen today’s news bulletins covering Macmillan Cancer Support’s report predicting a significant rise in the number of people who will get cancer. To quote the opening lines of their statement today:

Cancer rates are increasing at such a rate that research shows 42% of people who die in this country will have had a cancer diagnosis. And for most of them (64%), it is cancer which causes their death.

Macmillan calls for better services and support for those with cancer. Fergus Walsh on his BBC blog emphasises the need for people to take more personal responsibility for their health. Cancer Research UK has been quoted as also emphasising the prevention message saying that half of all cancers could be prevented by better diet, stopping smoking etc. They are all right of course. As is also the message that we need to continue to fund cancer research if we are to ultimately secure new and ever-better treatments.

Similar comments were made yesterday at the excellent All-Party Parliamentary Group on Cancer hearing about the impact on cancer of the NHS reforms. I am sure that some rule to do with Chatham Docks prevents me from directly reporting the comments by the panel – Peter Johnson from Cancer Research UK, Jennifer Dixon from Nuffield, Heather Nathan (patient) and Dr Steve Field (GP and Chair of the NHS Future Forum) – or audience. But hopefully their insights will be appropriately incorporated in the final report of the Group on Commissioning expected later this year.

For the moment then, just two thoughts of my own:

It is pretty evident that for many patients – and not just those with cancer – the opportunity to benefit from new treatments and trials is often dependent on their own strength, determination and gall. It should not be like this. There is still a gaping need for better information to be provided and for patients to be better supported by health professionals and others on their patient journey to remove the element of ‘chance’ in their care.

We need to overcome this notion that somehow research is outside the remit of service commissioning or commissioners. It has to be integrated with the decision-making that sits behind such activity. While the changes to the Health and Social Care Bill which will mean new duties on GPs etc with regard to promoting and using research are good news, how we ensure this happens in practice is the unanswered question as yet.

In the closing stages of the meeting the panel were asked to identify the one significant challenge and opportunity arising out of the reforms. The challenges ranged from ‘money’ to safeguarding continuous patterns of care for people. The opportunities include the development of IT systems that enable better care, to developing a more responsive system.

And if there is one positive from Macmillan’s report today it is perhaps that the increasing numbers of cancer patients will mean a greater pull on the system to meet their needs better.

…and in other news:

I was delighted to see the following statement on NIHR’s website about the fact that NIHR funding will be considered alongside Research Council funding in the Research Excellence Framework (REF) in 2014. The new guidance also states that applied and practice-based research must be assessed on an equal basis with other types of research. This will ensure full recognition for the clinical and applied research which NIHR funds. In other words it is a strategically very important news.

We can all have a field day (pun intended) now that the conclusions of the NHS Future Forum have been published. For 24 hours at least anyway.

The next step is the Government’s response which is due tomorrow. Hopefully they will have taken on board the NHS Future Forum’s overall message that it was a case of the NHS reforms not being ‘able to work’ rather being ‘unwilling to work’ when the Government referred them to its ‘House.’

National Voices have posted a quick pros and cons sheet on the report.

The strong patient component to the recommendations is excellent – both the Citizen’s Panel and the underpinning ‘Right to Challenge’ services and standards of a poor quality. There does not appear to be a specific recommendation on research but then it has never been considered ‘high politics’ in the NHS debate thus far. That may well be to its benefit as long as the message is getting through to the people and organs responsible for implementating Plan B.

Indeed, when I looked at the recommendations my sense is that the revised legislation is going to be more ‘enabling’ than anything else – establishing and getting various quangos up and running as soon as possible to design the future. Not designing the future itself so much anymore.

A reminder that David Cameron will be making five pledges on the NHS in a ‘keynote’ expected this week (possibly tomorrow (Tuesday)). Things like..there will be no privatisation, and an end to waiting lists etc.

The Economist’s ‘Leviathan’ blog – which is always worth a look – takes a rather derogatory view of the Prime Minister’s five-a-day prescription, calling it mood music.

I read it as a sortof high-five to the NHS to rebuild confidence. But it will be the stuff between the lines that we’ll need to look out for, since this will hint at the conclusions drawn after the recent ‘listening exercise.’