There have been “persistent requests” for this government to deliver on their pledge to add an extra 3,000 midwives, but they have not done so.

More importantly, those 3,000 extra midwives was an election pledge from Cameron a year ago. Like protecting Sure Start, like the cancer diagnosis targets, like the cancer nursing targets, like the pledge not to raise VAT…

This is a government of broken promises.

I am a grown up, I understand what coalition means, and I also understand that the junior partner in a coalition must more often have top break a pledge that the senior partner. But here we have absolute, signed in blood pledges from Cameron and he has broken the lot. How can anyone believe him at an election ever again?

“The rising birthrate and the increasing number of complicated births have combined with staff shortages to create a stressed working environment that will undermine the safety of mothers and babies. While the birthrate has increased by 19%, midwife numbers have increased by just 12%, at least 3,500 short of the number needed.

There have been “persistent requests” for this government to deliver on their pledge to add an extra 3,000 midwives, but they have not done so. ”

So, Stalinist planning of the workforce doesn’t work (especially when we’ve got the wrong Stalin in power). OK, so I assume then that you support the abolition of such Stalinist planning? You know, put power into the hands of he people actually running the service, the doctors?

As the Coalition is planning to do?

I presume you’re trying to defend the current NHS model. So why are you pointing out structural flaws within that model?

Tim and Falco

Why are you attacking the writer for backing a structure he hasn’t said anything about?

Why have you not said anything constructive about the pressures on the NHS at present?

Do you have no opinion on election promises being shelved?

Do you have no opinion on cuts to NHS finances (like that faced by NHS Direct?)

Do you have no opinion of sidelining mental health research?

Richard

The irony of cutting back on NHS Direct is that quite aside from the reasurance it provides people, it also filters many minor cases that thus don’t wind up costing the NHS more money through A&E visits or GP appointments.

Oddly, it is a cut that could end up costing money.

From recent personal experience – much of it previously related here – NHS administration is cimpletely shambolic.

I include in this being asked to sign a surgery consent form in mid October which had the wrong operation specified and which had to changed by a manuscript correction before I would sign. Another example was being offered an appointment to see a consultant to approve surgery in a letter from NHS Choose and Book when I had an appointment the previous day and which I had attended.

Yet another is a letter setting up an appoitment for a review of surgery in early December at a named ward which had long since changed its title to another name and to which – unsurprisingly – there were no signposts on the hospital site.

Does anyone in the NHS ever reflect on the impact that experiences such as the above have on the confidence of patients?

“The irony of cutting back on NHS Direct is that quite aside from the reasurance it provides people, it also filters many minor cases that thus don’t wind up costing the NHS more money through A&E visits or GP appointments. ”

No, not really. NHS Direct costs more to take a call than a GP visit costs the NHS….

BobB

Are you saying that cuts will make the NHS less shambollic?

Although that consent form proved it’s worth. Imagine if they didn’t need to seek consent, and did the wrong operation on you. That would have wasted valuable surgeon and nursing time, drugs, equipment, time in the operating theatre, and so on.

Thank heavens for efficiencies like consent forms…

@8: “Are you saying that cuts will make the NHS less shambollic? ”

No I’m not. At the very least the shambolic administration is likely to deteriorate with staff departures and orgnaisation upheavals spread over the next several years.

In addition, as I’ve already posted several times, the abolition of the Primary Care Trusts (PCTs) and the transfer of treatment commissioning work to GP-managed consortia will create substantive issues of transparency and accountability.

All that sounds very abstract but Parliamentary Questions could be – and were – put about the performance of particular PCTs and I can’t see that happening with GP-managed commissioning consortia.

The scandal of the differentially high rate of diabetes-related amputations in Devon and Cornwall emerged from PCT monitoring – I had a long PCT questionnaire to complete six weeks after my surgery in mid October. Will GP-managed treatment commissioning consortia incur the costs necessary to maintain the monitoring of patient outcomes?

The PCTs exercised patient liaison functions and mediated in cases of disputes – which can and do arise between patients and their GPs or between patients and hospitals. Who or what will take on those mediating functions if PCTs disappear?

Who will act as patient’s advocate in the event of disputes over the quality or costs of treatment commissioning when the commissioning work is done by GP-managed consortia?

All the stuff about the abolition of PCTs leading to more competition is for the birds. The commissioning work of my local PCT will be split between two GP-managed commissioning consortia which will each have effective monopolies in their respective areas.

Bob B – sounds like you might be on the verge of thinking that a continental style insurance based system might not be such a bad idea?

Bob

Interesting summary of your view there, and I think I back it pretty completely.

Tim

That’s remarkable. Is it true of is it one of those “facts” that drifts around politics when it is in fact not true?

True:

http://www.telegraph.co.uk/health/3253245/Every-call-to-NHS-Direct-costs-25.html

Thanks Tim

As I suspected, it’s not true and is just one of those “facts” that floats around politics.

“The cost of the service is calculated by dividing its total overheads, including staff and operating costs, by the number of calls that it answers.”

So it overlooks its internet service completely, and the budget for promoting use of the service, and instead just assumes the organisation’s whole cost is answering phones.

Also it overlooks that the BMA figures used for comparison include people who take about two minutes to renew a prescription, which of course can’t be done by NHS Direct thus making comparison rather weak.

Broad-bruch number crunching like this is always a bit weak.

@10: “Bob B – sounds like you might be on the verge of thinking that a continental style insurance based system might not be such a bad idea?”

From experience of online debates about healthcare going back to the 1990s (really), it’s unbelievably difficult to maintain a discussion better in kind than that between the average fans of rival football teams.

The unique aspect of Britain’s NHS is that it combines a social insurance system to cover most/many personal healthcare costs with a state-owned and controlled verging-on monopoly provider of healthcare services. As a consequence, with 1.3 million employees, the NHS is famously the largest single employer in western Europe. With the exception of China’s People’s Liberation Army and Indian Railways, it has few international rivals for sheer size.

By several independent, international assessments, the NHS is rated poorly compared with healthcare systems of many other west European countries.

From the perspective of a client of healthcare services, the NHS does not feel like a seriously joined-up organisation yet it was and is sold to us on the notion that its sheer size brings brand consistency, economies of scale and concerted buying power. Not so according to this recent news report:

“The NHS is wasting more than £1 billion of taxpayers’ money a year as managers spend vastly differing amounts on the same supplies, the head of a government-backed healthcare efficiency drive has claimed.”
http://www.google.com/hostednews/ukpress/article/ALeqM5hwJQp2dARKQVEWBJU7-SQ-puhsOQ?docId=N0429051294026063502A

The issue of post-code variations in the quality and quantity of healthcare treatment hasn’t gone away. Brand consistency of the NHS is simply not a credible feature – hance the recently exposed scandal of the differentially high rate of diabetes-related amputations in Devon and Cornwall.

As for relative pay of healthcare professionals, we have this from the Office of National Statistics:

The full-time occupations with the highest earnings in 2010 were ‘Health professionals’ (median pay of full-time employees of £1,067 a week); followed by ‘Corporate managers’ (£757); and ‘Science and technology professionals’ (£704). The lowest paid of all full-time employees were those in ‘Sales occupations’, at £287 a week.
http://www.statistics.gov.uk/cci/nugget.asp?id=285

According to a recent report of the National Audit Office on Management of NHS hospital productivity:

“Hospital productivity has fallen over the last ten years. There have been significant increases in  funding and hospitals have used this to deliver against national priorities, but they need to provide more leadership, management and clinical engagement to optimise the use of additional resources and deliver value for money.”
http://www.nao.org.uk/publications/1011/nhs_hospital_productivity.aspx

Bob

lower productivity was a choice between…

1 – a less producive NHS with enough nurses to treat everyone.
2 – a more productive NHS where many people didn’t get healthcare because there were not enough staff because the low pay meant people didn’t take the jobs or stay in them.

Basically – market forces demanded we paid nurses (and other staff) more if we wanted enough of them to treat our sick people.

Same was true in education.

Cutting class sizes cuts productivity and requires more staff (and thus higher wages to attract enough staff)

Yet we wanted smaller class sizes and thus wanted lower productivity.