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July 13, 2015

Private Eye Issue 1343
Filed under: Private Eye — Dr. Phil @ 3:35 pm

The Cost of Chaos

MD takes a very simple view on NHS reform. The perfect structure doesn’t exist in any organisation, least of all something as complex as the NHS, and it can be profoundly damaging to keep reorganising in the hope of finding it. The side effects of the unnecessary and ill-judged Health and Social Care Act have been so severe that even lawyers are blowing the whistle to the Eye. As one put it: ‘I get so angry when the government says it’s reduced NHS bureaucracy. It might have cut the number of managers, but the bureaucracy has mushroomed after Lansley’s act. For example, to run community services out of a GP practice used to be simple – a single lease arrangement and contract between the GPs and the Primary Care Trust. Now the PCT commissioning powers have transferred to the Clinical Commissioning Group. The PCT’s interest as tenant transfers to NHS Property Services Limited. NHS PS are now the direct landlord of the provider of the services and the commissioning contract is with the CCG. So now there are four parties to the arrangement to provide simple community services from the GP premises – the GPs, the CCG, NHSPS and the provider.
To review the rent, NHS England needs to give approval if the GPs are to get their rent reimbursed and there is a knock on effect for all the leases in the chain so all parties need to be involved in some way. This simple process now requires the engagement and approval of the GPs, the Landlord, the CCG, NHSPS, the new provider and NHS England, and four leases and one community services contract. With each added party, there are more loops to jump through, more people on the email trails, more people at the meetings, more approval processes, more professional fees, more time wasted and greater delay. Frankly, I’d rather stay at home and nail my testicles to the table.’

The stated aim of government is to move some services out of acute hospitals closer to home, and yet the same government has created absurd bureaucratic hurdles and provided no new money for investment. Providers of essential community services that are just about breaking even are now being asked to pay higher property costs but do not have the money to do so and the government has made it clear they won’t be getting any more. Last month, North Bristol NHS Trust decided not to retender for its excellent community paediatric care services, which covers all community child health, and child and adolescent mental health services for Bristol and south Gloucestershire. The trust’s official reason for ditching such a vital service is that it wants to focus on its hospital based care. But the hidden message is clear. The government has made it near impossible for such services to break even in future and – along with the bureaucratic torture of running them – it’s easier for the NHS providers to give up and leave it to the private sector to tender for.

Meanwhile, an independent investigation into the collapse of the specialist adult dermatology service at Nottingham University Hospitals Trust has described the handling of changes by commissioners and providers as an ‘unmitigated disaster’. The trust had to close its internationally renowned acute adult dermatology service earlier this year after five of its 11 consultants quit rather than transfer to private provider Circle (Eyes passim) Circle is now relying on six long term locums costing £300,000 a year each because it cannot fill vacant consultant posts. Some of the locums are not sufficiently qualified to be included on the General Medical Council’s specialist register for dermatology. The current service faces the imminent loss of a further consultant rendering the acute rota unworkable and the possibility that, if any of the remaining consultants leave, the demise of the tertiary paediatric service. The consultants gave fair warning well in advance they would leave if the service transferred to Circle because of fears about the quality of the service and job security.

The decimation of the excellent Countess of Chester integrated sexual health service has also been an unmitigated tendering disaster by an incompetent local government (Eyes passim). Tendering is not mandatory, and the three sexual health services in Cheshire would have been far better off collaborating rather than competing and fragmenting. Sexual health relies on a complex network of joined up services (e.g. sexual assault, disease screening and treatment, sexual dysfunction, contraception, pregnancy advice). The new slimmed down services can’t cope with the demand. Waiting lists are rising, calls are not answered and the IT system is useless. HIV and syphilis are now treated in separate clinics, miles apart. Although the tendering could not be stopped, the adverse publicity from this appalling decision may explain why Chester bucked the national trend by returning a Labour MP at the slimmest of margins (93 votes) and gained control of the previously Conservative-led council. The scrutiny meeting discussing the tender is online, but probably not for long

MD’s book, ‘Staying Alive – How to get the Best from the NHS’ is available here