The A&E Unit of the Future

Ms Hewitt said that casualty services in future would divide into three kinds, with “super- A&Es” for people with the most serious conditions, local A&Es for most treatment and the A&E that “will come to you” for less serious injuries.

(From The Times, Wed 6th December weblink here)

I’m sorry, I’m not going to beat around the bush about this one. What the fuck is she talking about?

So, if I get this right

Major injuries will go to trauma centres. No problems there.

Local A&Es for most treatments – er, like we’ve got already. But just a few more of them, but not to save money of course.

It’s the third category that’s the clincher however. Lets say it again for its full effect

“The A&E that “will come to you” for less serious injuries”.

No matter how much I look at it, it still sounds ridiculous.

We are closing local A&E to save money to redistibute the funding to massive trauma centres of excellence but, meanwhile we will have staff going to the most minor of injuries?The malingerers, who can’t get off their arses to come into casualty until the footy has finished, will now get a door to door service, a bit like pizza delivery, so they can be seen at their convenience, and not miss too much of the game.

And how will we run this service? Who will ‘come to us’ Patricia?

Will it be paramedics? Oh no, they will be on the road to the new super A&E as “Long ambulance journeys do not lead to more deaths.” ( Sir George Alberti) [1]

Will it be GPs? Will you try to bully them into it? I see Lord Warner may have started the campaign already. They want out of hours cover back.

Will it be some of the staff you are in the process of sacking because of your monumental fuck ups?

Will it become another pressure placed on current staff?

Are we going to see A&E on-the-road caravans?

So please Patricia. Don’t leave me in suspense. Tell me what you mean. Show me your vision of the A&E of the future. Tell me how I’ll take their x-rays when I go to them.

 +++++     +++++     +++++     +++++

[1] So why bother with air ambulances then?

I’ve spent a little while perusing the latest “Public Expenditure on Health and Personal Social Services 2006 Memorandum received from the Department of Health containing Replies to a Written Questionnaire from the Committee“.
Some of it makes very interesting reading.

Some little nuggests contained within its 294 pages include the fact that   NHS infrastructure support has increased staff from 170,623 to 220,387 between 1997 & 2005. However of this total there has been an increase in managers and senior managers from 22,173 to 39,391 – a 77.65% increase. Compares this to the mid 20’s percentage increase for nursing staff and radiographers (All figures are for headcount not FTEs)

There are now more managers than GPs (39,391 vs 35,302,2005 figures)

The Government admitted to underestimating the cost of Agenda for Change. In the first 12 months this amounted to £220 million made up of £120 million in case terms with another £100 million for the indirect costs of replacing additional hours and annual leave arising from AfC.

From 05-06 to 08-09 the yearly costs of implementing Agenda for Change are £950M, £1,390M, £1,780M & £2,200 M respectively.

It confirms they blew another £90 million undersetimating the cost of the new GP contracts.

PFI expenditure, both the cost of running existing PFIs and the cost of abandonning plans is even too depressing to comtemplate.

They spent £133 million on Patsy’s friends the management consultants in 05-06 alone. To put this into context the projected  net deficite which has us all shitting our pants is only £94 million

Turn-around teams in underperforming Trusts have, so far, cost £21.1 million. However we don’t need to worry about that (yet)

Before we can say whether this has been money well spent, we need to know what has been released in terms of savings. If it has delivered more than £22.1m it will have been money well spent; if it has only delivered £5m it may have been a waste.

(Dr Gill Morgan, NHS Confederation chief executive).

Lets face it. They’ve fucked up. Big time.
We know it. They know it.

Health secretary Patricia Hewitt has hinted that she may resign if the NHS does not break even by the end of this financial year.

(HSJ, 22/11/06)

Maybe we could all help her on the way.

Anyone know how I can charge a new Aircraft Carrier to the department budget?

 The following is nothing new but it sheds some light on comments I make elsewhere on this site. It’s a story about Alan Milburn (remember him?) and Alliance Medical.
Back in 2004 Mr Milburn resigned as  Secretary of State for Health “to spend more time with his family”. During this time he took on a £30,000 a year consultancy with the venture capital firm Bridgepoint Capital Ltd, part owners of Alliance Medical Ltd.

When he took up the job with Bridgepoint in March 2004 he was told by the advisory committee on business appointments  he could begin the job “forthwith but for one year after leaving office he could not be personally involved in lobbying any government ministers or officials”. As he left the DoH in June 2003 he was free to lobby from June 2004. On 29 June, Health Minister John Hutton announced that Alliance Medical had been awarded a £95 million five-year contract to provide and operate 12 mobile MRI scanners for the NHS carrying out 120,000 scans.
At the time the Allliance Medical contract was announced, Professor Adrian Dixon from the Royal College of Radiologists cautioned: “There are a lot of MRI systems in hospitals which have just been put in by the government which are not running to full capacity. We hope [the deal] will not interfere with proper funding of these machines.”

This deal broke a promise made by Labour in 1997.

“After the 1997 election Labour said its privatisation programme would only embrace ‘non-clinical’ parts of the NHS. The DTC scheme ends this promise…. I recall sitting in a fringe meeting at the 2000 Labour Conference, at which an angry radiographer asked Alan Milburn why scanning services, although clearly ‘clinical’, were being privatised. The former health secretary did not answer.”

(Solomon Hughes, Red Pepper magazine)

The contract itself was controversial. John Hutton told the House of Commons “Standard Government procurement processes were followed in which advertisements were placed and companies were invited to send in expressions of interest. Following a robust negotiation process, Alliance Medical was selected as the company that offered value for money and capacity to deliver services.”
However, using the Freedom of Information Act it was later found that “the original idea for the MRI scan contract had come not from the government but Alliance itself. The only difference between the deal that Alliance finally secured and what it had at first proposed is that the company had also wanted to provide endoscopies, and ultrasound and PET/CT scans.” (Solomon Hughes, Red Pepper magazine).

Sources
Unicorn (http://www.againstcorruption.org/BriefingsItem.asp?id=12433)
Source Watch (http://www.sourcewatch.org/index.php?title=Alan_Milburn)

So Patricia Hewitt thinks that patients will vote with their feet and refuse to be treated at a poorly performing hospital (HJS, 26/110/06, p6) which she obvoiusly see as a good thing.

She is clearly not of this world.

Vaste rural swathes of the county do not have the luxury of competing local hospitals to shop around between. They are not like London, Manchester, Birmingham…or Leicester [1].

My little hospital is in the middle of nowhere.
It’s 30 miles to the nearest alternative hospitals. 30 miles of A-roads heaving with tractors. 30 miles of B-roads and dirt tracks for some people. Generally public transport is dire. Some villages do not even have a daily bus service to these alternative locations, they have a weekly one.
The trains are often unreliable. We are at the end of the line (literally), if a train is running late the train terminates early and it turned round to avoid any fines for late running throughout the day. The passengers are turfed out onto a bus to complete the journey [2].

In some cases our patients have already travelled 30 miles to get to us and would have to continue for another 30 to one of these alternative sites.

When you are ill, quite naturally, you feel insecure. You want visitors. You want your friends and relatives to talk to. You don’t want to be a two hour bus journey away, at the end of a phone costing 30p a minute, and which costs your nearest and dearest an arm and a leg to call.

The result of this nightmare scenario is ultimately that of a two tier network of hospitals.
The bright shiney income generating hospitals in cites and hospitals attended by the affluent and those fit, able and willing to travel.
And the other sort. The rural hospital for those too poor to travel. Those too ill to travel backwards and forwards possibly two or three times a week. Those who want to be near their relatives not face death miles from anyone they know or care for. Hospitals quietly spriralling into decline as their income is gradually sucked away.

At the moment all the talk is of community, local accountability, supporting the needs of the people. If a community needs a hospital then it needs a hospital. It should be a strategic decision. If it’s failing. Support it. Facilitate its development. What point is there in saying “you made your bed, now lie in it”? Is that supporting the community?

Patricia’s vision: Dying alone, among strangers.

Great!

[1] Besides aren’t nearby hospitals with duplication of services considered wasteful? See the Watford General/Hemel Hempstead battle.

[2] A few months ago there was a protest when passengers refused to get off – eventually the train did go to its supposed destination.

The excellent Dr Crippin has been invited to write on webcameron in the guest blog.

Given the chance, this is what I would like to say

“Dear David
Just like many did for JFK’s death I can remember where I was when Thatcher resigned. The whole bowling alley cheered, and I cheered with them.
I watched with disbelief as John Major crept in 1992 and, on a portable TV in casualty, with unconcealed joy as the results came through in1997.
By this time I had been working in the NHS for 10 years. I had seen healthcare devestated by the internal market. I saw GP fundholding dividing patients into those who could have and those who had to wait. My wife had seen examples in a specialist paediatric intensive care unit where sick children were made to wait until a senoir manager at the referring Trust was found to authorise the expenditure. I was convinced that given five more years then NHS would have been broken up like the railways. Divided up into Trusts and each sold off to the highest bidder.
I believed the Tories were evil. Socially divisive. I felt ashamed for voting Conservative in 1983. I thought I could never trust them again with the NHS.
Then Labour came along, and it was good … and then it wasn’t.
At first the money came in. We felt valued. We weren’t competing with our neighbours. Much needed staff were appointed. Money started to flow in to develop staff.
Targets had the effect of driving waiting lists down. but they turned us into a sausage machine. Quantity of care triumphed over quality.
And then, while enjoying its “best ever year”, the NHS it turned irretrievably to shit. After concentrating for so long on high profile targets, Trusts had relaxed on finances.
The truth of Agenda for Change hit. AfC was the biggest possible disaster you could imagine. Poorly, and still incompletely implemented, inconsistancy abounds. It was far more costly than we were told (to the tune more than two hundred million pounds), divisive and demoralising. It did not meet the prime objective of equal pay for equal work. Far from ecouraging flexibility of working it has acted as a barrier to role development.
Overnight the emphasis shifted. Breaking even within three months became the prime objective. Panic measures took over. Much needed staff were longer needed. Funding for education dried up. Morale plummetted.
And here we are.
We are sick of change. We are sick of targets. We are sick of playing catch-up. We are sick of the dumbing down of the professions.

You tell us “We will serve and support the National Health Service. We will never jeopardise the NHS by cutting its funding.” and that you “believe the creation of the NHS is one of the greatest achievements of the 20th century.” You say change is necessary but that it “must come from the bottom up; driven by the wishes and needs of NHS professionals”.

Have you really turned your back on the old guard as thoroughly as New Labour did with Old Labour? Are you just saying what we want to hear? Will the mask slip once if you come to power and we all return to the rampent xenophobia, slash and burn, privatise everything, greed is good, poverty is your own fault Tories we learnt to avoid in the 80s? Or is it genuinely a new form of Conservative party? The spectre of Tebbit still looms in the background and I still live in fear of ‘The Mummy returns’

I don’t trust you yet, but at least I am listening now.”

(Image c/o Conservatives.com) 

For years I have laboured under the impression that The Torys and the Tory press hate the NHS and NHS staff, and can’t wait to see that back of us.

Then there was David Cameron’s speech.

Cynical oportunism or the leopard changing it’s spots?

 Only time will tell.