Dr Lansley's Brave New World?

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 to ensure that the "new" NHS structures retains as much as is possible of the "old" NHS structures (that got us where we are today).

Now, the NHS hierarchy seem determined to create much bigger consortia than was originally envisaged. They are suggesting that in East London, the minimum size they see as sufficient to create the necessary economies of scale is about half a million patients. That is roughly the combined populations of the London Boroughs of Newham, Tower Hamlets, Hackney and The city of London. Amazingly enough (or not), that is precisely the description of the existing "cluster" formed by the amalgamation of the three PCTs last year. If you divide the poulation of England by half-a-million, that would mean about one hundred consortia for the instead of the 550 suggested by Dr A and his merry men. This is all a far cry from the original plans as they were explained to us.

Meanwhile, the PCT/Cluster seems determined to fashion things as it thinks they ought to be rather than what the commissioning groups think or want. Since it is these same PCT managers that got primary care where it is today, they’re mostly the people I would rather were NOT designing their replacement. However,  turkeys rarely vote for Christmas and here in East London, the turkeys still reign.

I now longer have either the energy or the enthusiasm to try and change things.

At a personal level, I am saddened by how little of the energy that is being expended is making any difference to patient care. Things are being rearranged, usually at some considerable cost, but rarely to make things better. We have been tricked into doing the government’s dirty work for them presiding over significant cuts in funding despite all the rubbish that ministers spout about “spending in real terms”. Primary care is 90% of the care and 10% of the funding. Giving us amateurs the budget for the other 90% whilst slashing it can only be poor value for taxpayers and poor value for patients. The answer to the problem of NHS managers that clearly can’t manage is to find managers that can, not give it to GPs who have no training or experience.

I am glad I will have retired by the time that our local general hospital announces firstly that it will have to close its A&E service (probably done in stages by first reducing opening hours), and then that it is closing most of the rest of the hospital too. For consortia, they should realise that the politicians will be quick to point out that this will be a commissioning decision so it will be their fault.

It's raining money

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 bureaucracy reached all the dark corners of the service and we had "realignment of services" (ward closures); "streamlining" (nursing staff were made redundant); and "financial re-focus"(budgets were suddenly reduced). Our own primary care trust was one of the few that had stayed within budget up until then. Suddenly, their budgets were "top sliced" and abracadbra - we were £30,000,000 in the red.

That's the good bit! Next, because the trust couldn't work out how to recover all this "overspend" a pack of management consultants was forced upon us (at our trust's expense) to tell us how to run more efficiently. (I don't know why but it reminds me of the old army joke: "all leave is cancelled until morale improves".

Life has moved on. Our trust has now had much of that top-sliced money suddenly returned. It is falling out of trust headquarters by the day. On my desk are three new incentive schemes that seem amazingly generous after the recent sparse past. I am trying to work out how to recruit (expensive) agency staff so I can grab this dosh before the meter stops (March 2009). My primary care management team was reduced to two people during the lean times. There are now at least ten of them floating around, some of whom are tasked specifically to help me spend money.

Meanwhile, back in the real world, we are hurtling towards a recession. This government is forecast to borrow £100,000,000,000 next year. somehow, I don't think that the next cuts are likely to be another unpleasant top slice. They are more likely to be financial castration.

I'm keeping everything crossed.