The Lancet on the failed NHS records IT project.
Corporate Watch investigates the Co-operation and Competition Panel (CCP) quango that supports privatisation and the abolition of public sector NHS provision.
Waiting times for Accident and Emergency treatment increase.
- Conservative election poster 2010
A few recent news articles about the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
This is an editorial from The Lancet.
If there were an award for the world’s most mismanaged national health project, England’s National Programme for IT in the NHS would be a strong contender, if not outright winner. Started in 2002, Tony Blair’s brainchild has, like the computer in 2001: A Space Odyssey, gone badly wrong.
The main aim of the project was to create a fully integrated centralised electronic care records system to improve services and patient care by 2007. The budget for the undertaking was a substantial £11·4 billion. Nine years on, the Department of Health has spent £6·4 billion on the project so far, failed to meet its initial deadline, and has had to abandon the central goal of the project because it is unable to deliver a universal system.
Given the ineptitude that has characterised this project, disaster was almost certain. According to a new report by the Public Accounts Committee (PAC), the Department has failed to get value for the vast sums of money that it has paid contractors. Of the two companies that are still involved in the project, one has yet to deliver the bulk of the systems that it was contracted to supply despite being paid £1·8 billion since 2002, and the other is being paid £9 million to implement systems at each NHS site that have cost other organisations outside the programme £2 million.
The Department seems to have been foolishly duped by commercial companies that promised the sun, cost the earth, and delivered not much more than hot air. Damningly, PAC’s report states: “The Department could have avoided some of the pitfalls and waste if they had consulted at the start of the process with health professionals.”
“NHS delays operations ‘as it waits for patients to die or go private’” thundered the front page of the Daily Telegraph after the release of the Co-operation and Competition Panel (CCP)’s report on choice and competition in elective care late last month. Most of the major papers and news broadcasters jumped on board, the majority repeating that Primary Care Trusts (PCTs), in an attempt to cut costs, are setting minimum waiting times for patients, who then either “die or go private.” A Daily Mail leader declared: “it’s hard to conceive of a more barbaric tactic than making patients wait so long for surgery that they either go private or die.”
But reading the report, it turns out they were getting all worked up for nothing. For a start, the report is looking into elective care. Elective care includes things like hip replacements, knee replacements, foot surgery, tinnitus, varicose veins and so on: “pre-arranged, non-emergency care that includes scheduled operations,” in the words of the Department of Health. Serious, painful conditions of course, but not ones that will kill you if you have to wait a couple more weeks for an operation. As a weary David Stout, director of the Primary Care Trust Network, told the Today programme: “the suggestion people are dying waiting for routine elective care doesn’t make sense.”
So what’s this “waiting for patient to die” claim? It comes from paragraph 131 of the report, in which the writers explain they were told: “increasing waiting times for patients did have the potential to save money overall” and then they quote someone who says: “Experience suggests that if patients wait longer then some will remove themselves from the list or will no longer require treatment when it is finally offered.”
This is footnoted, but not to explain who is being quoted.* Instead, the note says:
“We understand that patients will ‘remove themselves from the waiting list’ either by dying or by paying for their own treatment at private sector providers.”
And that’s what the fuss is about. One unsubstantiated footnote. We asked the CCP if they had based this on any evidence but they didn’t reply. So the Co-operation and Competition Panel – which, if the government’s reforms go through, will become a decision-making body within the NHS – is saying that if someone’s knee replacement is delayed by an extra two weeks they may choose to die rather than wait. As the Daily Mail put it: that is sickening.
We are told early on that it is based on “around 80 submissions from NHS providers, GPs, Primary Care Trusts, Strategic Health Authorities, independent and third sector providers, representative organisations and others,” but that those submissions made by the independent sector providers – i.e. private companies – will not be disclosed due to: “concerns that publication of these submissions would be likely to prejudice the commercial interests of the organisation which had made the submission.” This makes things difficult, because the report is based on the companies’ allegations that PCTs are unfairly denying them work by encouraging patients to use public healthcare providers. Quotes of no more than a couple of sentences are pulled out of the companies’ submissions, but we are never told which company made them or what context they were made in.
Reading through the submissions made by the PCTs which we are allowed to read, it seems they were kept in the dark too. Many seem confused because the CCP has told them they have been accused of something but they haven’t been told what. NHS Somerset, among others, says it is “difficult to comment directly on the points raised without sight of the specific allegations raised.” NHS North Yorkshire and York note: “without further detail or specific examples it is difficult to respond to this allegation.”
Recommendations for the whole NHS are conjured up from a combination of accusations from a few un-named companies, explanations from a few PCTs and the panel’s “understanding” of the issue, which, as we have seen, isn’t exactly foolproof. To show PCTs are encouraging GPs to restrict patients’ ability to choose which provider they go to for their treatment, for example, we are given two, single sentence quotes from un-named PCTs and three unsubstantiated allegations made by unnamed providers. There is no thorough analysis of all the evidence taken together and no suggestion of exactly how widespread this so-called anti-competitive behaviour is. Early on they say they saw “many” examples of PCTs “excessively constraining patients’ ability to choose” and then, later on: “a significant number of PCTs are restricting patient choice and competition in routine elective care,” but that’s about it.
If the Health and Social Care bill goes through the CCP’s remit will only widen. The Department of Health has already announced that the “any qualified provider” policy will be extended into community and mental health services and it will not stop there. David Cameron and his health secretary Andrew Lansley are always keen to say how their reforms will bring an end to the reign of pen-pushing bureaucrats in the NHS but they are quietly loading an unelected body run by bureaucrats (albeit pro-market bureaucrats) with the power to censure and overrule any doctors, managers or staff that try to keep healthcare public.
The number of patients waiting more than four hours for treatment in accident and emergency departments has almost doubled in the space of a year, the latest statistics reveal.
Figures show 161,422 patients were left waiting over four hours for “major A&E” treatment between April and June 2011 – 91% more than during the same period in 2010.
A broader measure including minor injuries units and walk-in centres was also up 90%, to 165,279.
The increases come despite a slight fall in the number of patients using A&E services, from 3.6 million to 3.58 million, scotching past Department of Health assertions that the longer waits were down to increased pressure on services.