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November 4, 2014

Private Eye Issue 1377
Filed under: Private Eye — Dr. Phil @ 2:38 pm

Simon Says Sort Yourself Out

The five year plan for the NHS, as seen by NHS England CEO Simon Stevens, is mercifully free from the government’s five minute gimmicks (£55 and a pat on the back for GPs who diagnose dementia, a red flag and public humiliation for those who fail to diagnose cancer). But his big idea to reward workers for losing weight – an incentive that helped Stevens shed 3 stone in America – may not ‘gain traction’ over here. Steven’s predecessor David Nicholson became obese and developed type II diabetes whilst in the job, which he managed to disguise with Marks and Spencer elasticated waist trousers. Poor physical health usually starts with poor mental health, and the most urgent health need facing the NHS staff is to reduce the stress, overwork, bullying and fear.

Steven’s inherited chaotic structural reforms that unnamed senior Tories apparently told the Times are the government’s ‘worst mistake’. The idea of making clinical staff as responsible for spending taxpayers’ money wisely as they are for getting the diagnosis and treatment right has merit, but it could simply and cheaply have been done by putting clinical staff in control of the old PCTs. The hugely over-complicated structural reforms had no mandate and will be forever tainted with the suspicion that its part of some long term privatization plan. However, private companies such as Serco are dropping out of the NHS because there is no profit to be made, and large losses.

Stevens believes the £30 billion 5 year black hole can be filled with £22 billion of ‘doing stuff better’ and ‘people getting healthier’, with another £8 billion from the taxpayer. Steven’s is cleverly passing the buck for health onto citizens. Unless people take responsibility for staying as well as they can, the NHS cannot thrive. Steven’s other big idea is to offer patients a budget for buying their own health and social care. In theory, giving those with complex physical and learning disabilities, mental illnesses and multiple chronic diseases more power and control sound enticing, provided they’re willing, able and supported to do it, but it needs evidence from NICE that this is a sensible use of precious NHS resources (Eyes passim). The financial black hole in the NHS is eclipsed by the information black hole. For an organization that spends £110 billion a year, there is remarkably little evidence as to what treatments actually improved patients’ lives or helped them die with dignity. Until the NHS measures outcomes that matter to patients, it will continue to fly blind, driven by political gimmicks, medical fads and fear of failure.

The NHS can only improve by learning both from both its failures and its successes, without hanging people out to dry for challenging the system or standards of care. The fact that staff who raise safety concerns are still being punished and ostracised shows the enormity of the task facing Robert Francis and his Freedom to Speak Up Review. And the very public evisceration of consultant urologist Paul Miller (who MD trained with) shows how far the NHS has to go to investigate allegations fairly and humanely. The treatment of prostate cancer is complex and uncertain but whatever the result of the investigation, Miller’s reputation as an international prostate cancer expert has been brutally destroyed. His lawyers will now do battle with lawyers from Surrey and Sussex Healthcare Trust .

The worst bullying in the NHS is often doctor on doctor. The Alder Hey surgeons who raised concerns about techniques and standards in paediatric surgery (Eye last) have been so fiercely discarded by their former colleagues that they may struggle ever to work in the NHS again. The complaint MD and Andrew Bousfield made to Bar Standards Board about the conduct of Simon Gorton, Alder Hey’s barrister, has been dismissed but one of the whislteblowers has appealed against this. Now NHS England Clinical Director Bruce Keogh has asked to see evidence relating to the evidence. Whatever investigation follows, it needs to be done fairly and humanely, and focus on whether children are having the right operations backed up by evidence. Stevens is right – the money spent in the NHS on investigations and treatments of no or low benefit is staggering. The NHS needs value as well as values.

MD’s new book and ebook, What Doctors Really Think, is available here