tag:blogger.com,1999:blog-216404392012-02-16T14:50:04.804ZThe United Kingdom's National Health service was created in 1948 and provides medical care free to UK residents and many others too. It is one of the biggest employers on this planet and nearly all of them doing amazing and wonderful things every day despite the management.is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.comBlogger701100tag:blogger.com,1999:blog-21640439.post-34726745477097993302011-12-20T17:07:00.003Z2011-12-20T17:07:45.933Z

We are now well into the convulsions caused by Andrew Lansley's radical reorganisation of the NHS in England. Already, the NHS senior management establishment is undermining much of what he set out to achieve. We were told that it was expected that there would be about 550 consortia formed. Clearly this is far too anarchic for the bureaucrats and they have fought back with dogged determination

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-17709048527526894842011-11-04T17:29:00.000Z2011-12-01T17:11:25.995Z

In a little under five months, GP commissioning groups are supposed to take over the reins of most of the prodigious NHS budget £106 billion for 2011/12. If you have read previous entries, you know I like the real numbers: So that's one and and six, thousand, thousand thousand pounds. £106,000,000,000. Even the Greek economy doesn't need that much (this time round). Well, MrTaxpayer, how do you

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-48274970013439992612011-09-08T15:11:00.000+01:002011-12-01T17:17:00.047Z

Probably because it got off to such a poor start, the National Programme for IT ("NPfIT") got a rebranding and became "Connecting for Health". Several billions later, we are still light years away from any system that delivers good quality decision support so I prefer to call them NPunfIT since that is exactly what we've got: a system that is definitely not fit for purpose. I suspect that people

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-71074693599942416712011-07-23T17:03:00.019+01:002011-08-14T11:23:11.192+01:00

If you click on the title of this entry, it will take you to a BBC news article about Professor Tony Leeds - an obesity guru at Central Middlesex Hospital. His underlying concern is that "The impact of Britain's obesity epidemic continues to increase, and so does the cost, both human and financial. Obesity now costs the NHS around £4.2bn annually, and the wider economy a frightening £16bn."Though

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com2tag:blogger.com,1999:blog-21640439.post-62932940729611066792011-07-01T13:52:00.012+01:002011-07-01T16:13:52.573+01:00

In the 1970s, I spent a great couple of weeks in Bristol learning about "Operational Research". This was the original name of what is now called "Applied Statistics" - using statistics to solve a specific "here and now" problem. The course lecturer had formerly worked on the great technological white elephant that was Concorde.He explained that he watched the Concorde project abandon financial

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-41082421150954296212011-06-20T14:45:00.005+01:002011-06-20T15:31:30.977+01:00

The title of this posting was first applied to the allied soldiers rotting in the trenches in the first world war. It is a phrase that often haunts me when I collide with NHS management. I am weary of sitting with groups of managers and those GPs that get involved in management and hearing them defend the NHS as something that is far too good and noble to be tainted by the whiff of commercialism

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-11492917476469194382011-03-09T09:06:00.003Z2011-07-01T15:51:48.008+01:00

The TV programme was all about the experiences of an undercover reporter in hospital and the subject was the awful food. I have no idea why this reporter felt the need to hide under the covers; hospital food is almost invariably awful and everybody knows it to be so. Anyway, having puffed up his feathers into a fit of righteous indignation, he confronts some poor hapless politician to demand what

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-81802117558954888802011-02-26T10:30:00.004Z2011-02-26T10:57:40.746Z

The meeting had lasted 1½ hours and was drawing to a close. We had been discussing the improvements in performance of a screening service that our PCT had taken over and then completely buggered up. Right at the end, they produced their performance report and in it were two graphs (which I have combined into one shown on the right).You will see that routine referrals by the service to hospital

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-33604424773466799972010-10-30T10:53:00.002+01:002010-10-30T11:08:27.435+01:00

The current mantra of our healthcare policy makers is "moving care closer to the patient". The reason (excuse) for this catchy little phrase is money. It is now assumed that moving care out of hospitals and into community settings is cheaper and on paper this is entirely reasonable. That's the "what" and the "why". It's the "how" that always terrifies me.As a taxpayer, I wan't the NHS to be

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-20738034052905227962010-09-14T16:41:00.002+01:002010-09-14T17:05:45.824+01:00

Back in January this year a young baby, one of our patients, died whilst waiting in A&E. It was unexpected but actually no great surprise. The poor mite had been born with a number of severe heart defects which skilled surgeons were doing wonderful things to fix but only a few at a time.I have just received "Form B" from them upstairs.On the front page it says:"Each agency representative is to

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-36556015103321508892010-07-05T10:37:00.002+01:002010-07-05T10:46:35.083+01:00

You are currently spending lorryloads of money creating the ability for clinicians everywhere in the NHS to view your summary care record ("SCR"). Whenever this investment is challenged and for whatever reason, the shroud wavers emerge to say that it will save lives. They give examples of people who would suffer a severe anaphylactic shock if given drugs to which they will react badly. They are

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-74613048931100583352010-06-22T15:19:00.006+01:002010-06-22T16:02:29.188+01:00

The Government has made much of its decision to scrap a couple of NHS targets: the "48 hour target" within which time a patients is guaranteed to see a GP; and the "18 week rule" within which time a patient should have been treated in hospital following a referral from a GP. I really disliked these targets but perversely, I am sorry to see them go.Firstly, what didn't I like?Well, let's start

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-67559495536429190092010-06-03T15:45:00.004+01:002010-06-03T16:09:32.472+01:00

In the left corner:Our PCT, insisting that we provide ever more appointments that have to be bookable two weeks in advance; also insisting that we see patients immediately when they say it's "urgent" even when it's clear it isn't; and also providing minimum number of appointments each GP must provide each week. Their targets are ambitious but we do our best.In the right corner:The BMA Guidance on

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-77114505265198749982010-06-02T17:43:00.003+01:002011-02-26T10:27:25.538Z

Yesterday I went to the funeral of the last of my mother's seven siblings. Uncle Noel died peacefully at the splendid age of 93. He started as a miner at the age of 14 but continued his education and after the war became the Deputy Master of Worcester Workhouse. What a splendid title! Pure Dickens, porridge and all. For the rest of his working life, together with my aunt, they cared for old

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-38752187569225028152010-05-10T17:18:00.003+01:002010-05-10T17:45:55.260+01:00

"Phlebotomy" = extracting blood for testing and monitoring patients. Some GP surgeries do it but mostly it's done either in the local hospital or a large health centre.A few weeks ago we were informed that the afternoon opening hours our local phlebotomy clinics would be reduced."Why?" I asked (since afternoons were especially popular with people with jobs). The answer came back:"The activity

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-40644261529433489902010-03-25T11:35:00.004Z2010-03-25T11:58:22.919Z

I guess everybody now knows the "old Chinese proverb":Be careful what you wish for;it may be granted.A fair number of people must be hoping that the Tories do win the election that can be no more than six weeks away. Let's just suppose they do. Then what?Trouble, that's what!! Big trouble.The present lot have presided over and implemented the most right-wing policies ever experienced since the

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-53591780797739460252010-03-24T15:56:00.006Z2010-03-24T16:31:33.765Z

The sudden burst of posts might lead you to think that I have suddenly become more agitated of late but you'd be wrong. It's just that the year end in public accounting is when we all get inundated with requests for "stuff" - I won't bore you with the trivia that is much of my working day. The worst of the storm has passed, so I can attempt to benefit from the catharsis from shouting at the

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-12889081140511229262010-03-24T15:49:00.003Z2010-03-24T15:53:46.367Z

George Monbiot writes for The Grauniad. his article on polywotsits is a standard of writing to which I can only aspire with little confidence of achieving.Do read it here

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-82541592738266593302010-03-24T14:27:00.003Z2010-03-24T14:42:24.583Z

In our neck of the woods, "polysystems" are the flavour of the moment. They are the result of Lord Darzis's major review that in far too many words and way, way too much money, concluded that:London has too many hospitals;Lots more care should be delivered "locally" (which is healthspeak for "not in hospitals");GPs should work in polyclinics (but we'll call them something else because polyclinics

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-29146479350352640112010-03-22T12:20:00.004Z2010-03-22T15:17:40.240Z

Our local general hospital shares with our own primary care trust a DH target of "eighteen weeks from referral to treatment". Laudable? Oh yes.! Achievable? Mostly! But ...If you make an appointment but then, due to unforeseen circumstances have to change it, you can't! Your referral is cancelled and you have to go back to your GP and start all over again. There is a reason (although "reason" is

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-83277761338604879342010-03-15T14:14:00.002Z2010-03-15T14:25:40.551Z

On telly the other evening was an article about how farmers are able to deliver "fresh" apples to us all year round. The answer is that they store apples in reduced-oxygen cooled storage units. Similar things are done with the humble potato. The way in which Tesco et al monitor the growing, storage and packing of everyday food items is astonishing. Consider the following the next time you are

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-39845867429887777462010-03-11T17:08:00.005Z2010-03-13T09:48:45.881Z

Many, many years ago, I was a military chap. I look back on my ten years defending Queen and country with fond memories and an ever-increasing amount of nostalgia for an organisation that was just that - organised! Quite often I resort to military metaphors to try and get across what I see are some of the things our senior NHS dafties get up to.Time to bring on Connecting for Health.CfH is a big

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-58481234013408651462010-03-11T14:12:00.010Z2010-03-13T09:45:56.312Z

I have been in in my current job for over seven years. In that time, at my PCT I have seen the comings and goings of four chief executives, four directors of finance, seven directors/managers of primary care, two directors of commissioning, three finance managers, three directors of clinical governance and three directors of human resources. Not one of the heads of the major departments was in

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-80199273373372329962010-03-10T17:20:00.012Z2010-03-11T17:27:51.266Z

General Practice is managed by its local Primary Care Trust. Our PCT has a population of 330,000 patients and spends hundreds of millions of pounds of your money and mine. They are responsible not just for ensuring we are performing our duties properly, but also for introducing new services and the procedures to support them. They also commission new buildings; they modify and adapt the complex

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-18872903303268408732009-08-20T09:55:00.002+01:002009-08-20T09:59:55.367+01:00

Today's FT prints a concise summary of the rise and predicted fall of the National Care Record project. You can read it here.

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-23301443479587240112009-08-19T17:26:00.001+01:002009-08-19T17:45:08.027+01:00

Some things were ever so. As William Moyes, chairman of the foundation trusts regulator, confirmed this week, reform of the National Health Service has been slower than was hoped. The same can be said of the UK’s other wasteful state services. The Conservative party, which is likely to win the general election due by next summer, has rightly focused itself on public sector reform. But this, sadly

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-80765884468675541602009-08-17T16:54:00.004+01:002009-08-17T17:12:59.250+01:00

The forthcoming general election - a maximum of nine months away - will generate a great deal of heat about each party's plans to preserve and improve the NHS. I can't imagine that any of them will admit to any plans to reduce spending so that's alright then ... isn't it?Well, not exactly.Given the state of the UK economy and the amount of debt, both government and household, that we have

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-57793285369198772922009-07-06T21:02:00.006+01:002010-04-06T16:55:53.498+01:00

I first started working in an NHS GP practice over six years ago. One of the first challenges was to try and get a grip of unscheduled care of our patients; people phoning us or turning up 'at the desk' demanding immediate care usually in the form of "seeing the doctor... now". Being an 'outsider' and a novice, I reached for ... The Contract. This was, and supposedly still is the document that

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-56793132144066747742009-01-13T15:35:00.003Z2009-01-13T16:14:03.032Z

In 2002, our practice moved over to a different contract under which we supply 'doctoring' to our local population. I won't bore you with the detail but we signed what is, in the jargon, a Primary Medical Services ("PMS") contract. In essence, we are paid an annual sum of money out of which we have to run the practice, rent and maintain the premises, and pay the staff. Whatever is left is the

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-31198554629102412372008-12-18T22:45:00.004Z2008-12-18T23:06:35.212Z

On UK television this evening, we watched an episode of a documentary series about Whipps Cross Hospital ( a large general hospital in north-east London). One of the featured patients was a man suffering from the usual complications of heart failure, odema, breathing difficulties, impaired mobility, etc. He was a very sick person and he freely admitted that his current plight was a result of

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-30459368105354200872008-12-18T21:59:00.003Z2008-12-18T22:44:08.497Z

The NHS year runs from April to the following March. Over the past couple of years, we have been encouraged to take a greater interest in the cost of the medicines we prescribe for our patients. You might think that such interest would be a "given" but it is not so. The NHS relies on doctors to "do the right thing" when choosing which drug to prescribe. At the same time, these same doctors are

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-61094199885724444392008-11-11T13:20:00.004Z2008-11-11T13:44:32.212Z

You might remember the "shock/horror" headlines of a couple of years ago when many NHS organisations were finally forced to declare their hidden deficits. Our then illustrious leader, the glorious Patsy Hewitt, forced trusts to do all the unpleasant things they had tried to avoid such as getting rid of surplus staff, becoming more efficient, etc. However, the knee-jerk actions of the NHS

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-63710271374805726772008-10-27T15:51:00.003Z2008-10-27T16:15:45.848Z

Our Primary Care Trust has, as one of its objectives, "that the health of its residents is as good as other Londoners by 2020". As things stand at the moment, this is near nigh bloody impossible.For well over half of the patients who register with us, we are their first general practice in the United Kingdom. They come from all over the globe and mostly from areas where their "health" is nowhere

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-10724302470998942462008-09-17T16:24:00.002+01:002008-09-17T16:54:50.895+01:00

My own primary care trust has long been careless with the term "Health Inequalities". They always include within their strategic plans the lofty aim of: "eliminating health inequalities within the trust's area". They also have another lofty aim of making sure that our resident's health is at least as good if not better than the London average. To me, the first aim misses the point and the second

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-62322469029051129342008-09-15T16:57:00.003+01:002008-09-15T17:45:01.607+01:00

I am one of only two people to whom an elderly distant relative can turn for any contact in her ever-shrinking world. Elsie is ninety years old and currently in a general hospital "somewhere in England". That "somewhere" is two hundred miles cross-country from both me and also the other relative. Her latest crisis started some months ago when the accumulated effects of her self-imposed social

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-14809086754918708942008-06-07T12:36:00.003+01:002008-06-07T12:51:33.120+01:00

There are good doctors and there are some that are not so good. A few are dreadful. Such things are inevitable when there are so many of them and none of them every get younger. GPs are not except from this. In fact, given that most of them run their own businesses (i.e. their practice) the opportunity for variation is all the bigger.Enter the "primary care trust". The job of a PCT is to be the

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-69916126904165533732008-04-11T14:35:00.003+01:002008-04-11T15:53:16.792+01:00

I attended a presentation yesterday about "Practice-based Commissioning". If you don't understand the term, may I suggest you click the "Next Blog" link at the top of the page? It would take too long ...Anyway, one of the speakers was a passionate GP who explained what he and his colleagues were doing to ensure that the big, bad, Tesco/Boots/Sainsburys axis of evil didn't invade primary care. Why

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-9833059751719354752008-04-05T12:42:00.001+01:002010-03-24T14:43:56.323Z

I live in a small rural village. It's lovely. It has a post office but not for long. Following a "public consultation" our post office will close at the end of the month. A lot of our neighbours submitted their opinions to the Post Office. Every one of them said "please keep it open". The only person I know who wants it closed is the man who owns the shop and post office in the next village five

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-54441208609261943142008-03-26T17:02:00.001Z2008-03-26T17:04:49.907Z

Dear Alan, I write to congratulate you on your shrewd career move away from the post office, completed before your colleagues presided over the disintegration of the Post Office network. At the same time, I wanted to warn you about some worrying symptoms that might give you pause to consider whether Health Secretary is quite the place to be just now. Who am I talking about here? As

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com2tag:blogger.com,1999:blog-21640439.post-48024314171620262872008-01-31T14:57:00.000Z2008-01-31T15:24:08.314Z

Just before closing time, the mother of a 14 year-old girl phones us and is very anxious about her daughter's "funny breathing" and chest pains that she had had all day at school. She is asked to bring daughter to surgery where GP examines the lass. As a result of the examination, the GP decides that there is no cause for alarm and that with the medication prescribed, she should soon be well

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-42828478240488736812007-04-28T17:57:00.000+01:002007-04-28T18:08:23.363+01:00

In this Thursday's Financial Times there is an article about the dire financial state of seventeen NHS trusts. It reads:NHS trusts in financial mess Seventeen NHS trusts are in such deep financial difficulty they are unlikely to be able to get themselves out of it within a decade, the Department of Health has admitted. They are now undergoing "rigourous review" to identify what David

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-46840128046663416302007-04-05T20:33:00.000+01:002007-04-05T20:48:35.395+01:00

Over the past few months, GPs up and down the land have been encouraged by their PCTs to switch patients on some brands of statins (cholesterol reducing drugs) to the cheaper "Simvastatin™". The savings to the NHS are enormous and for most patients there is no real difference. I have no problem with doing this. As a taxpayer, I am saving me and you millions of pounds within a few years. Clearly

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-64044819760353149622007-02-28T18:20:00.000Z2007-02-28T18:32:50.664Z

Everybody and his or her dog reckons they know how GPs work. They don't need to ask us before providing new systems 'cos they already know what we do. They don't need to ask us if the new system will work. Of course it will work. Could anything be more simple? Well let's see.The "Choose & Book" system had a cleverly designed form that it printed for us to give to patients. It provided them with

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-35789113156281730602007-02-08T13:40:00.000Z2007-02-08T13:42:16.448Z

Dear Patsy,Thank you so much for all your recent communications to us lowly people who look towards you as their leader. My word you have been busy but through this maelstrom of media engagement your new organisation has triumphed. I haven't actually seen the Powerpoint presentation as yet; our PCT's IT department is busy taking down the Christmas decorations at their shiny new offices in Marie

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-59882848903702165742007-01-22T10:35:00.000Z2007-01-22T10:39:15.862Z

Patsy,The speed of your response is breathtaking. Thank you.Thank you for the names I requested as examples of very bestest practice. I'm ashamed to admit that I thought you might find it a little difficult to find a name but so many?? That's truly impressive stuff. I've already had a preliminary chat with most of them and will update you further once I 've had the chance to absorb the 28-carat

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-21493651382938579482007-01-22T10:30:00.001Z2007-01-22T10:31:58.516Z

Dear Patsy,I am writing to say how sorry we are to have been the cause of so much inconveniece to you and your team at the Depratment of Health. How could we have been so inconsiderate? How could we have so exceeded your performance expectations and quality targets. Please, please calm yourself. The solution is at hand.Our partners have cancelled all their sessions for this week in order to focus

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-2797730861550582072006-12-08T15:52:00.000Z2006-12-08T16:04:25.552Z

Dear Dianne Abbott,After much consideration, I have decided that it really is about time that you, as my MP, put my interests at the forefront of your thinking. Gone are the days when every four years or so, you could break off from your busy schedule of evening television programmes to remind us all just how great you have been at doing whatever it is that you do. I think it's about time that

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-80576067704726194592006-11-10T16:18:00.000Z2006-11-10T16:56:53.297Z

The real problem with a well-functioning democracy is that our representatives need you and me to re-elect them every now and again. This would be more than a tad difficult unless he or she can convince you that: (a) they're doing a good job; and, (b) their opponents would do it worse. Recent governments have perfected the art of making all news sound good or as we all know, "finding good days

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-4934849592042349262006-11-10T15:51:00.000Z2006-11-10T16:08:41.050Z

Imagine you are manager of your household's finances. Your spouse tells you that you will receive £xoo each month to keep you both in food, bog rolls, cleaning stuff as well as pay the gas and electricity bills and all the other domestic minutiae. The amount on offer is barely sufficient but, with careful management and a keen eye on the money-off bargains and the dented tins shelf at your local

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1158127550291149522006-09-13T06:39:00.000+01:002006-10-20T23:55:53.151+01:00

It seems to me that taxation is a kind of unwritten agreement between me and the politicians. I agree to give the money and in return they give me and mine with all the sorts of stuff that can only be provided by pooling my money with every other citizen's money. Our A&E services are available free to anyone who really needs them and this is a very good thing. I wouldn't want it any other way.

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1155056100168603852006-08-08T17:16:00.000+01:002006-10-20T23:55:52.881+01:00

You will pleased to note that the NHS decided to concentrate its efforts."Other key themes to emerge (sic) from the consultation process were: " ...investing in services for people whose health and well-being may be at greater risk, for example: minority ethnic groups, teenagers, and people on low income."Well let me see. The population of England and Wales in 2001 was recorded as 49,138,831

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1155048662466337692006-08-08T15:05:00.000+01:002006-10-20T23:55:52.816+01:00

Read the new government White Paper? With its zippy touchy feeley title, it can only be a political winner. This government "listens". It puts us first. It drives me bonkers.The whole "listening exercise" with its preposterous "citizens summit" and its "panels of stakeholders" seems to me to be a complete abrogation of strategic management by the Department of Health and the National Health

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1154105351795222382006-07-28T17:32:00.000+01:002006-10-20T23:55:52.757+01:00

It seems absurd that the same government that spouts so much guff about "joined up care", "integrated patient care pathways" and other equally noble sounding objectives, is the same lot that bombards from all points of the compass with new initiatives. One of this month's flavours tastes of "Long Term Conditions". Pareto still rules and the "80/20" rule is as valid for patients and costs as it is

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1148816616584841712006-05-28T12:20:00.000+01:002006-10-20T23:55:52.699+01:00

Rarely does a week pass without me being required to absorb and react to some new policy or other. The variety is bemusing and the volume is breathtaking. Being an awkward sort of sod, every now and again I ask:"Why?".If an answer appears (sometimes), and if it makes sense (rarely), the usual justification is "Standards for Better Health" which is a government White Paper. This justification is

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1146485068362137082006-05-01T12:51:00.000+01:002006-10-20T23:55:52.644+01:00

The dust has settled and they've swept away the debris from the annual conferences of Nurses and Unison (the health workers' union). The Secretary of State survived her "ordeal" of heckling, jeering and slow handclaps. Everyone can be pleased and none more so than Her Secretaryship. Frankly, anyone who has shimmered her way so far up the greasy pole would find being politely heckled by nurses

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1144775802533496252006-04-11T18:01:00.000+01:002006-10-20T23:55:52.584+01:00

I thought I would get ahead of the game. Everybody tells me that the Avian Flu pandemic is a matter of when and not if. Some time ago those that carve the stone tablets sent me a sample "Flu Pandemic Information Pack" containing a range of publications. Some were aimed at clinicians, some for patients, and there were nice big posters inviting patients to "ask for further information". Well,

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1144269493847757982006-04-05T21:09:00.000+01:002006-10-20T23:55:52.522+01:00

It is fashionable to complain that the NHS has spent much of the extra funding provided over the past few years on recruiting loads of managers. Like most "well know facts" there is some truth in it. I should know since I am one of 'em. Irrespective of the 'new vs old' chestnut, one feature of most NHS management that does get me down is how little leadership they provide. It is a difficult time

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1144266996036796072006-04-05T20:33:00.000+01:002006-10-20T23:55:52.467+01:00

Gaby Hinsliff is a journalist on The Observer (a UK Sunday newspaper). She was told to ring her hospital to arrange an appointment to see a consultant. Read how she got on here. Don't think that this is unusual because it isn't. Whenever I challenge our local hospitals over their appointment booking telephone facilities (from the latin facile which means "easily, without difficulty") they

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1141855292992962782006-03-08T21:31:00.000Z2006-10-20T23:55:52.410+01:00

In my current role, I am for the first time responsible for maintaining a fairly sizeable building and surrounding land that isn't my home. Looking after 'bogs and drains', fixing dripping taps and redecorating is time-consuming, fiddly and, not to put too fine a point on it, dull. Even worse, occasionally I have to deal with the Scarlet Pimpernel of English tradesmen - builders ("They seek him

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1141768213698410452006-03-07T21:37:00.000Z2006-10-20T23:55:52.355+01:00

For a year or more, the Department of Health has been touting Choose and Book as a good thing. In many ways they are correct. As a patient, I too would be impressed that, on being told that I am being referred to a consultant for a specialist opinion or for specialist treatment, I could "leave the surgery with an out-patient hospital appointment convenient to me". This post isn't about the merits

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1141507955163734862006-03-04T21:23:00.000Z2006-10-20T23:55:52.296+01:00

General practitioners (or GPs as we say in England) are some of the most advanced users of software to support them in their day-to-day clinics. Many practices use their computer-based medical record as the primary source of information about the patient sitting in front of them. An ingenious system of coding every sort of ailment, disease and unfortunate event that can befall man means that all

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-1141463304150486792006-03-04T08:58:00.000Z2006-10-20T23:55:52.238+01:00

Yesterday we reviewed with a number of your performance directors and choice leads, the best means of assuring readiness is genuine and reaffirmed the expectation that this is captured in a written form, practice by practice.or ...We met yesterday to decide how to make sure that you were all ready, and to agree what written evidence we will ask you to submit to prove it.

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1141248084957885132006-03-01T21:15:00.000Z2006-10-20T23:55:52.126+01:00

Extract from a report by a Strategic Health Authority into progress made in implementing "Choose and Book". Ready?"The key concern is that the added resources funding implementation teams expire this March, while local communities need to move from 2% electronic booking to the December target of 90%. Communities are at various stages of identifying funds to continue implementation, but credible

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1140901658911577202006-02-25T20:59:00.000Z2006-10-20T23:55:52.066+01:00

Next time you hear a politician on the BBC Radio 4 announce a new initiative, may I ask you to stop and ask yourself: "How will that be implemented?" You might be forgiven for thinking that the answer is not only straightforward but reasonably obvious. There are thousands and thousands of health service managers so the one thing we're not short of is people to actually "DO IT".If only it was that

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1140546920454761802006-02-21T18:15:00.000Z2006-10-20T23:55:52.005+01:00

The latest political wheeze is to campaign on the promise of giving local people much more direct control over the management of their local services; from bin men to hospitals; from where to put the local library to changing bus routes. It all sounds jolly democratic and something that could only be opposed by the "Daddy knows best" brigade.I hope that this shift in power will mean that we can

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1140460749043950932006-02-20T18:26:00.000Z2006-10-20T23:55:51.940+01:00

"The money will follow the patient" is one of the new fashion phrases amongst senior healthcare planners. In essence, it is supposed to mean that having given patients the choice of where they can obtain hospital care, the hospital will then be paid by the number of patients it "attracts". There is a national tariff (price list) which ensures that all hospitals are competing on a level playing

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1139409582036677012006-02-08T14:38:00.001Z2006-10-20T23:55:51.881+01:00

Public Inquiries into failures in the caring services seem to lead inevitably to new layers of procedures and paperwork. The aim is to prevent whatever went wrong from going wrong again. The recent biggies were Shipman and the death of Victoria Climbie. In both cases it was people who went wrong and the system didn't work in such a way as to prevent them. As a result, there are now more

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1tag:blogger.com,1999:blog-21640439.post-1139081166190378622006-02-04T19:19:00.000Z2006-10-20T23:55:51.666+01:00

Today's "strange but true" entry is presented courtesy of Newham General Hospital and is about their management of their out-patient appointment system.They plan their out-patient clinics weeks and weeks and months and months ahead. When you make an appointment, it might be for a clinic in sixteen weeks time. OK, you might not like the wait, but at least you're on the way. So, in the diary it

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1139080735136429002006-02-04T19:02:00.000Z2006-10-20T23:55:51.599+01:00

The government has decided that the best way to conceal the cracks in their healthcare strategy is to generate enormous amounts of paper. (Paper ... cracks ... OK??) For the past few weeks we have been the recipients of a blizzard of spin from Patricia (a.k.a. Mummy knows best) Hewitt, the politician who is supposed to be in charge of it all.This weeks classic was the announcement of the new "

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com0tag:blogger.com,1999:blog-21640439.post-1138488743344147662006-01-28T22:42:00.000Z2006-10-20T23:55:51.529+01:00

It's 2006 and our government has thrown enormous amounts of money to "solve" the NHS' problems. The trouble is that near the top of the problem list, is the fact that NHS management skills are generally not very good. Giving poor managers lots and lots (and I mean LOTS) of additional cash is like trying to fill up a leaky bucket by pouring in more water and hoping that you can fill it faster than

is it just me?http://www.blogger.com/profile/01831118247224287094noreply@blogger.com1