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  Will the Welsh NHS be a political football in the General Election?

  jonathan 1:54 am on 27 January, 2010 | 0 Permalink | Reply
  Tags: Assembly (21), Health (10), NHS

  I had a meeting today with the Health Board Clinical Pharmacist who supports our general medical practice to use medicines safely and wisely. We discussed the targets that have been set for her which then become targets against which our prescribing behaviour and performance are measured and rewarded.

  I was interested to note references to ‘AOF targets and requirements’ sprinkled through her documentation.  The Annual Operating Framework for 2010/2011 was published just before Christmas. The Minister concludes her covering letter to the bosses of the NHS in Wales: ‘I am looking to you to make sure that your organisations are aware of their responsibilities and deliver the AOF requirements’. The AOF makes a surprisingly good read.

  The NHS in Wales has been moving along in a unique direction since devolution and this year’s strategies and targets build upon the strengths of policies, programmes and people that have been established in recent years. It makes me even happier to be a general practitioner serving the Welsh NHS.

  If you have not read Scott Greer’s analysis of the priorities within each devolved administration and their styles I warmly commend his paper ‘Devolution and divergence in UK health policies’ to you. 

  I have been mulling over how the NHS might become a political issue in the forthcoming General Election. Surely there will be no debates in the media or hustings in Wales since Welsh MPs have no say in Welsh NHS affairs? Why should precious time and energy be spent during the Welsh campaign on political issues that only matter in England?

  Last week the Nuffield Report about the differences in healthcare between the four Nations ten years after devolution was published.  The media paid the most attention to the headline figures in the Report about “efficiency”. It was reported that the Welsh NHS was less cost-efficient than the English Service. The Governments in Cardiff and Edinburgh made some cogent criticisms of the report’s methods and conclusion. The report was reviewed in the British Medical Journal by Peter Donnelly, now Professor of Public Health Medicine at St Andrew’s.  Peter will be remembered in Wales as a dynamic public health doctor who worked in Cardiff and Swansea. His concluding remarks are very interesting in the context of the General Election: ‘Ten years on, anxiety on behalf of the devolved administrations is unnecessary and perhaps even patronising. Their parliaments are accountable for the performance of their versions of the NHS. The UK parliament is accountable for the financial settlement with these devolved administrations.’

  What does this mean for the General Election contest in Wales? Should the manifestos of the Welsh parties only be tackling strategy and policy in relation to the ways in which Westminster will influence the Assembly? How much influence do MPs have upon decision making about the financial settlement?

   

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  Great Leap Forward?

  siobhan 10:32 am on 20 October, 2009 | 3 Permalink | Reply
  Tags: NHS, public sector (9)

  The latest reorganisation of NHS Wales went “live” at the beginning of October. Today’s Western Mail reports concerns that additional costs have been incurred by undertaking this “massive reorganisation” (the Minister’s words) part way through the financial year. These may not, however, be the only costs associated with reorganisation.

  I was not a fan of the previous structure which created a level of organisational complexity and bureaucracy that few understood. I said so at the time and received more than a little flak from the same party that is currently leading the latest reorganisation. However, I’m just as unconvinced by another “big bang” reorganisation which has the potential to yet again destabilise the health service. It would have been possible to take a more evolutionary approach to structural change.

  And that is what it is – structural change. It does not of itself improve services to patients. It just changes the organisational and management structure and we have little evidence of what the most effective structure for the NHS looks like. Unlike clinicians, who we ask to undertake evidence based practice, we are rather short of evidence based policy and this is not helped by the fact that we rarely evaluate the groundhog days of NHS reorganisation. We think the previous structure wasn’t effective but we don’t actually know why and how.

  There are costs to any reorganisation, for example simply in recruiting to new positions. This reorganisation has the potential to make savings in management costs but, as Felicity has written here and elsewhere, these do not seem to be being realised and it may be that it will actually end up costing more than the previous structure. However, because we don’t have the information on how much each respective structure has and will cost, again we just don’t know.

  Beyond this, radical reorganisations risk losing good practice, effective working relationships and organisational history. Managers, civil servants and politicians become preoccupied with restructuring (and for managers whether they will actually have a job) rather than improving services. It can take years for the new organisations to mature and “bed down”.

  So why do politicians reorganise the health service? Because they can. It is much easier than making difficult decisions about actually changing services. I hope and want to think it is out of a genuine belief it will improve things for patients and not for political advancement as is suggested today. Whether this is,as the Minister promises, the “doorstep of a new dawn” I’m not at all sure about. But I am sure that NHS reorganisations are like buses. If you miss one don’t worry – there will be another one along shortly.

   
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  Designed for Disposal

  felicity 8:24 am on 7 October, 2009 | 2 Permalink | Reply
  Tags: NHS, public sector (9)

  Assembly Finance Minister Andrew Davies says the years of plenty have come to an end for the foreseeable future. Agonising decisions are going to have to be made about where the axe will fall to protect frontline services, but there’s at least one that shouldn’t be that painful.

  Take the National Leadership and Innovation Agency for Healthcare (NLIAH).

  This quango spent nearly £100m of public money last year “to support and share best practice in the NHS”. Its acting chief executive was paid £93,604. He and his senior executives cost the taxpayer more than £500,000 – enough cash to pay for 25 nurses.

  For several months, doctors and other health professionals have been calling for a review of NLIAH because of concerns about its transparency and value for money. Very few have heard of it, those who have, roll their eyes. Yet it has somehow emerged unscathed from last week’s NHS reorganisation, whose main aim we’re told is to streamline management and cut costs.

  The Assembly Government which created NLIAH four years ago (when other quangos were being abolished) insists the agency plays an important role. Some £88m of its budget it says, is spent on “supporting workforce planning” and commissioning non-medical professional training in the NHS. But people I have spoken to with experience of its services say they have been “far from impressed”.

  Given that Edwina Hart also had to bring in two of her new Health Board chief executives from outside Wales, there is enough evidence to question whether it is fit for purpose. 

  There is no reason why its functions can’t now be absorbed by the new Boards under an already expensive tier of management.

  We’re in tough times.  There’s no room anymore for bodies that are reluctant to divulge how they spend millions of pounds of taxpayers’ money or whose outcomes and benefits remain unclear.

  Let NLIAH now justify is executive salaries while public sector workers face losing theirs, or go to the top of the list for disposal.

   
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  Measles in Merthyr: an outbreak waiting to happen?

  victoria 1:37 pm on 5 August, 2009 | 1 Permalink | Reply
  Tags: Heads of the Valleys (5), Health (10), Merthyr Tydfil (2), NHS

  Today’s Western Mail reports that 13 people from Merthyr’s Gellideg estate now have measles.  Before the commentators jump in linking this outbreak with the poverty of the area and parents not immunising their children, it is worth noting that take-up of MMR vaccinations in Merthyr as a whole is in fact slightly ABOVE all-Wales rates.  However, the take-up in Merthyr and in Wales as a whole is still well below the target of 95%. 

  At a discussionon vaccinations we held in June, Age Concern highlighted that take-up of flu vaccination would hugely increase if NHS staff thought about the patient’s needs when planning services. For example they found much greater flu vaccine take-up when administered in community settings – rather than expecting older people to go to their GP surgery vaccinations would be done e.g. at day centres or lunch clubs. There were logistical issues, but these could be overcome. 

  With some way to go before vaccinations against measles reaches the magic 95%, and with the prospect of mass swine flu vaccinations in the autumn / winter, perhaps it is time to think about a more radical ways of reaching people.

   
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  Is there a doctor in the house?

  felicity 7:21 pm on 31 July, 2009 | 2 Permalink | Reply
  Tags: doctors (2), NHS

  This weekend new rules come in limiting the number of hours junior doctors can work.  It never made sense for key health workers to be working round the clock, so the European Working Time Directive is surely a good thing.

  But if junior doctors are working fewer hours then we need more of them, and we are already precariously short.  

  Coupled with the new rules, Wales is struggling to attract trainees from across the Severn Bridge.  And on top of that the UK as a whole is now bound by stricter immigration laws on recruiting from outside Europe which is putting further strain on NHS Trusts, also desperately short of middle grade doctors

  The Assembly Government has set in train a significant expansion in places at medical schools in Wales and last month offered junior doctors free accommodation if they come to Wales to train.

  These are good long term strategies but they should have been in place long ago. NHS Trusts now need immediate solutions.

  During a recent session of First Minister’s questions Rhodri Morgan said “backfilling” from India was no longer an option and even went as far as to say it was “the lazy way out”.

  But desperate NHS managers in Swansea have confirmed they are looking for front line staff in India to plug gaps.

  Governments have had 11 years to prepare themselves for today. Too little action may now have left them with two unappealing options -  agree to the Conservatives call for an emergency delay on the directive or apply to Immigration and Customs for leniency.