Prime Minister David Cameron may become known as the man who destroyed the NHS.
NHS spending cuts put babies at risk
Private sector supports Clinical Commissioning Groups.
GPs concerned that they may lose maternity pay
- Conservative election poster 2010
A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.
The Prime Minister could end up with a reputation as the man who broke the NHS.
The NHS bill cleared a legislative hurdle in the Lords this week . But that doesn’t really solve any of the political problems facing the government’s reforms. Of those problems, one of the biggest is that the coalition doesn’t seem to have a clear grasp of why Andrew Lansley’s plans are causing so much difficulty.
The one thing everyone can agree on is that the plans have been appallingly presented. Lansley cooked them up in the Department of Health without much input or scrutiny from Downing Street. (So blindsided was the prime minister that the episode triggered a whole re-organisation of the Number 10 policy operation earlier this year.) According to one senior civil servant at the heart of the operation, when Cameron was first presented with Lansley’s plan he skimmed the introduction and then turned to his aides in shock and disbelief and said “have you read this stuff?!” He had, until then, had no idea of the scale of what was being planned.
There was a moment, towards the end of January, when a u-turn was still an option. But Cameron feared looking weak by abandoning such a huge public sector policy drive – and, reasonably enough, worried that dropping the reforms would implicitly confirm voters’ suspicions that the Tories had some hidden agenda on health. A u-turn would make it look as if they had been rumbled. The way senior figures in government tell the story, Cameron’s foot hovered between the brake and the accelerator, finally choosing the latter. That now looks like a huge mistake.
The essential miscalculation was the PM’s assumption that if he personally threw some weight behind the cause – deploying the powers of persuasion in which he has considerable confidence – the public mood might shift. Of course, the Conservatives did not count on a Lib Dem backlash, sanctioned from the top of the party as a device to “differentiate” the junior coalition partner (fearful of losing its identity) over an issue of famous toxicity to the Tories. Some of the Lib Dem turbulence around the NHS earlier this year was principled objection to the reforms but some is retaliation for the Tories’ personal attacks on Nick Clegg during the referendum campaign on the alternative vote. The compromise package that ended up before the Lords this week was therefore a mangled monster consisting of the original Lansley plan with heaps of ad hoc Lib Dem caveats, brakes, disruptions and supposed safeguards.
And there lies the government’s problem. The reform it is now trying to sell is the expression of Westminster political choreography and not a coherent response to the needs of the health service. Everyone in the NHS knows it and voters can sense it.
Special care baby charity Bliss warns about qualifications of some nurses and midwives in hospital neonatal units
More than half of England’s specialist baby care units do not meet the government’s minimum standards and are putting the most vulnerable babies at risk, a charity warned on Monday.
Bliss, a special care baby charity, said staff cuts in a third of England’s 172 neonatal units were “significantly affecting the care of premature and sick babies”.
Minimum standards set by the Department of Health require 70% of nurses and midwives in neonatal units to be qualified in specialist care, Bliss said, but more than half had failed to meet this target. Last year, the charity said 1,150 extra nurses would be needed to reach minimum standards, but a recent freedom of information request by the charity found 140 posts had been cut.
In addition, it said that while 450 nurses needed to receive extra training to meet the department’s standards, one in 10 units said they were struggling to release staff for training because of budget cuts.
Andy Cole, chief executive at Bliss, said: “The government’s assurances that frontline services would not be affected by changes in the NHS is not true for these most vulnerable patients. The government and the NHS must take responsibility now and ensure our tiniest and sickest babies receive the highest standard of care at this critical time in their lives.”
Bliss reported that about 20% of neonatal units were likely to make further cuts to their workforce in the next 12 months, through redundancies, vacancy freezes and down-banding posts.
Janet Davies, executive director of nursing at the Royal College of Nursing, said the findings were deeply shocking and called for a stronger strategy.
“At a time when extra nurses are needed to meet even the most basic standards of neonatal care, some [NHS] trusts are making reckless cuts to posts, which will undoubtedly have an impact on the care of premature and sick babies,” she said.
“Sadly, this is a reflection on what is happening throughout the NHS, where we know that 40,000 posts are earmarked to be lost. It is critical that hospitals have the right numbers of specialist nurses, who can provide one-to-one care to premature babies and support for families at an extremely stressful time in their lives. Equally, a properly funded strategy is now urgently needed to recruit and retain more of these specialist nurses.”
Clinical commissioning groups representing several thousand GPs across London have signed a multi-million pound deal with private consultants handpicked by NHS bosses to help support the rollout of GP commissioning.
The £7m landmark deal has seen 31 CCGs sign contracts for a programme of ‘intensive organisational support’ for commissioning from the likes of KPMG, Pricewaterhouse Coopers, Capita and McKinsey, which has formed a joint partnership with the RCGP’s Centre for Commissioning and consultancy Ashridge Alliancce to advise CCGs ahead of authorisation.
NHS London said all 38 of the capital’s pathfinders were expected to sign up to the ‘development framework’ within weeks, and that £3.7m had been allocated for ‘leadership training’ for managers and clinicians.
The list of approved commissioning partners, which also includes Ernst and Young, Capsticks Solictors, Binder Dijker Otte, and Entrusted Health Partnership, was drawn up by NHS London after a competitive tender designed to provide CCGs with assistance in organisational development, leadership training, strategy, finance and market analysis.
The consultants will offer CCGs coaching, leadership plans, resources and how-to guides, 360 degree feedback, self-assessment tools and organisational development plans to assess their readiness for authorisation.
The move significantly boosts the private sector’s stake in advising GP commissioners, after Pulse first revealed earlier this year that dozens of CCGs had enlisted the support of McKinsey and Pricewaterhouse Coopers with QIPP, budget holding and governance.
MWF president Dr Clarissa Fabre said funding for practices to cover the cost of locums for partners on maternity leave was under threat.
It was unclear whether clinical commissioning groups (CCGs) or the NHS Commissioning Board would be responsible for the payments once PCTs were abolished, she said.
‘At present, at least you know the PCT will pay a bit of the locum payments,’ Dr Fabre said. But she warned that in future CCG budgets could be so tight that they could no longer afford to pay them.
‘Locum payments are going to disappear,’ she said.
NHS Confederation acting deputy chief executive David Stout said he could not be sure who would be responsible for the payments once PCTs no longer existed.
But he suggested that because the NHS Commissioning Board (NCB) will hold GP contracts, it could take control of maternity payments as a part of this role.
Maternity locum payments are not mandatory under current rules, with some PCTs choosing not to pay.
Mr Stout said if the payments became the responsibility of the NCB, it would have a single national policy on maternity locum payments. ‘It’s unlikely that they’d do it inconsistently,’ he said.
GPC member Dr Helena McKeown said it was still unclear who would be responsible for the payments. She said a single policy would be welcome to eliminate the current postcode lottery.