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June 1, 2016

Private Eye Medicine Balls 1417
Filed under: Private Eye — Dr. Phil @ 11:02 am

It’s the Capacity, Stupid

It’s painfully clear to anyone works in or needs the NHS or social care services that we don’t have the capacity – equipment, technology, beds, staff – to cope with the demands placed on us. This is down both to lack of investment – the UK spends less of its GDP on health and social care than other Western European countries –, an ageing and expanding population, and massive waste, particularly on political reorganisations and reforms that are not evidence-led, cost a vast amount in time, money, effort and goodwill – and end up making little or no difference to the length or quality of people’s lives, and may even cause harm.

90% of consultations in the NHS occur in general practice, for a fraction of the funding. If general practice fails, the NHS fails. The belated bung now promised for GPs – £2.4 billion extra a year by 2020-21 – is not new money and may not stop the service collapsing. Sadly, much of it is likely to be wasted on non-evidence based political vanity projects such as opening surgeries for 12 hours on a Sunday when no one wants to be there, useless well person checks which only serve to make well people anxious, and ill thought out screening that doesn’t have a proper evidence base and hasn’t been approved by the National Screening Committee. Money will be thrown at faddish technological fancies that haven’t been properly evaluated, all GPs will be ‘accelerated towards a paper free environment’ and if there’s any money left over, it might be used to treat people who are genuinely ill. It might also be too late.

Research from the King’s Fund has found that the number of GP consultations has increased by 15% in 5 years, three times the rate of increase in the number of GPs. Consultations among the over-85’s were up 28% and many were too complex to be completed in ten minutes. The job is so stressful that five years after qualifying, only 1 in 10 new GP trainees plan to be working full time. Between 2009 and 2014, 46 per cent of GPs leaving the profession were under 50; between 2005 and 2014 the proportion of GPs aged between 55 and 64 leaving doubled. In addition to the stress of seeing more complex, demanding patients, GPs also have to cope with an absurd administrative burden. As well as individual appraisals and revalidations with the GMC, GP practices have to be inspected by the CQC which – driven by the fear of missing the next Harold Shipman – impose a hugely bureaucratic and stressful inspection procedure with little evidence base that it improves the quality of care.

Ruling the NHS by fear and bullying is a highly corrosive error that all governments make. Under Labour, access targets were brutally imposed and fear of failure was so great that figures were fiddled and patients were ignored, most notably in Mid Staffs hospital. Hospital inspections and targets are not in themselves a bad thing – inspections could focus on learning and development, targets could help provide quicker care for many patients but allow enough leeway to prioritise sicker patients at busier times. And yet both tend to be inflexibly enforced with no evidence or empathy

Nearly Four years ago, MD referred Dame Barbara Hakin – National Director of Commissioning Operations at NHS England – to the GMC for unilaterally raising the 4 hour casualty waiting time target from 98% to 100%, and insisting that it had to be met ‘whatever the demand’. In Hakin’s fantasy world, every single patient who turns up to an emergency department must be seen, treated, admitted or discharged within 4 hours no matter how busy it is. That the GMC is still considering whether this impossible imposition was unsafe suggests either a very limited understanding of patient safety or a chance for the second most senior doctor in the NHS to retire safely before reaching a decision. The fact that record numbers of hospitals are now missing a reduced 95% target shows what an unworkable demand it was. There will always be patients who can’t be seen within four hours when an emergency department lacks the capacity to deal with the demand, and there will always be patients who need to be kept longer than 4 hours because it is not safe to transfer or discharge them. Brutal imposition of such non-evidence based nonsense costs money, lives and careers in the NHS. Jeremy Hunt risks repeating the error by imposing an untested junior doctors’ contract without evidence he has enough doctors to cover extra shifts across seven days. Whatever way the vote goes on the junior doctors’ contract, many will continue to work dangerous hours and shifts come August, and there aren’t enough consultants to safely extend seven day services either. Does Hunt have the capacity to understand capacity? Or is he wilfully blind?

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